Drug-Drug Interaction Alerts and Provider Response: A Retrospective Evaluation of Drug Overrides in the UC Davis Medical Center EpicCare CPOE/EMR System

Drug-Drug Interactions (DDIs) and their identification, presentation and resolution within an Electronic Medical Record (EMR) system creates significant challenges for protecting patients. The issue of alert fatigue can result in ignoring or overriding DDI alerts. This research characterized DDIs, user response, and clinically relevant DDIs were further evaluated for patient harm. The initial count of medication warnings generated in the EMR system during a three (3) month period was 99,638 with 10,299 unique DDI alerts. Over a third (34%) of the DDI alerts were overridden. Next, based on preponderance, risk or severity, a subset of five (5) drug interaction pairs were investigated for patient harm. These DDI pairs included: heparin with low molecular weight (LMW) heparin, ketorolac with non-steroidal anti-inflammatory drugs, ritonavir with fluticasone, simvastatin with gemfibrozil and nitrates with phosphodiesterase inhibitors. Surrogate markers for patient harm did not show negative outcomes with these contraindicated DDI pairs.