Medication Safety and Informatics Professionals:

Regarding Alert Fatigue, we are looking at modulating the severity to DDI alerts at verification. We have are undergoing an intensive and robust approval process (which can be seen in the attached flowchart). But have come to fears of litigation which really is what got us to this point in the first place (as HER vendors will have everything as a higher level to avoid litigation).

So I would like to reach out as I can only say that we have found that we cannot safely take our EHR's recommendation to have everyone ONLY see the highest level, but have to do something.

Questions:
1. Which level of DDIs are displayed for providers and for Pharmacy. At CoxHealth, providers and Nursing see only the highest-level (Major-Contraindicated), while Pharmacy sees the top two (Major and Major-Contraindicated), leading to 84% of DDI alerts only firing to Pharmacy.
2. If you are on the same DDI severity level, what have you done in order to catch the relevant and actionable items within levels that are a bit lower? Do you have rules within your real-time clinical surveillance tool (such as Sentri7, VigiLanz, Cerner’s tool)?
3. If you are on different levels (such as we are), what have you done to help cut down on the noise within Pharmacy.
4. What are your metrics for Alert Fatigue? While most appropriate for locales where #3 is applicable, there are a lot of studies. I’ve mostly seen metrics that show a decrease in the number of alerts (of course they go down), but what about the quality of the program in the first place. I have thought about overrides per 1000 alerts, with the goal of those going down. What do other places use?

Thank you,