Enabling drug-drug interaction alerts in an electronic medication management system: impact on prescriber alert burden

The volume of clinical decision support (CDS) alerts encountered by prescribers (i.e. alert burden) within electronic medication management (EMM) systems is likely to influence whether CDS alerts are read and acted upon. This study aimed to determine the impact of introducing drug-drug interaction (DDI) alerts on the total alert burden experienced by prescribers. This was a simulated cohort study. Clinical data for a given study date were extracted from a ‘live’ EMM system in use at a tertiary teaching hospital. No DDI alerts were enabled in the hospital at the time (Alert Condition 1). The same medication orders were then replicated via manual entry into a simulated version of the EMM system where DDI alerts were enabled (Alert Condition 2). CDS alert data from Alert Condition 1 and 2 were extracted and compared. With DDI alerts in place, prescriber alert burden increased from 38% to 72% of a prescriber’s medication orders triggering at least one alert. Alerts were encountered by almost all doctors (91%), and each doctor received approximately four times more alerts (15 alerts vs 3.8 alerts per doctor) than in the absence of DDI alerts. DDI alerts, if enabled, would significantly increase the alert burden on prescribers and are likely to lead to alert fatigue. To reduce their impact on prescriber alert burden and improve alert effectiveness, DDI alerts should be refined prior to their implementation.