The Pharmaceutical Journal
Vol 269 No 7223 p666
9 November 2002

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GPs override drug interaction alerts without checking

Almost one-quarter of general practitioners surveyed admitted that they frequently override computerised drug interaction alerts without investigating them further.

Researchers in Nottingham surveyed 220 local GPs who had drug interaction alerts on their computer systems and found that 22 per cent said they frequently overruled the alerts without properly checking them (Journal of Clinical Pharmacy and Therapeutics 2002;27:377).

Further analysis of the data showed that GPs who used the EMIS (Egton Medical Information Systems) computer system were three times less likely to override these alerts than those using other computer systems in their surgeries. The reasons GPs gave for overriding alerts included the perception that they were often irrelevant. However, 90 per cent of respondents agreed it should be harder for them to override alerts for potentially lethal drug combinations.

The researchers, from Nottingham University department of general practice, suggest that alerts on EMIS are less likely to be overridden because they are not graded in terms of severity. They say: "This may encourage GPs to try to check all of them properly to ensure they are not missing anything important. In contrast, users of systems that grade the potential severity of alerts may become used to automatically overriding the alerts with the lowest level of hazard."

Noel Dixon, pharmacist at Dixon & Hall, County Durham, told The Journal that pharmacists also had to contend with irrelevant drug interaction alerts being flagged up by their computers. He added that some computer systems were preferable to others because they did not flag up repeat cases of a potential interaction. Mr Dixon said the main issue was pharmacists' understanding of drug interactions: "Drug interactions have to be interpreted in the context of their use and in the light of a pharmacist's knowledge. Even if the computer throws up a major interaction, the patient may be stable." He added that in his experience even newly qualified pharmacists did not have a good understanding of drug alerts.