Background Through targeted medication alerts, clinical decision support systems (CDSS) help users to identify medication errors such as disregarded drug–drug interactions (DDIs). Override rates of such alerts are high; however, they can be mitigated by alert tailoring or workflow-interrupting display of severe alerts that need active user acceptance or overriding. Yet, the extent to which the displayed alert interferes with the prescribers' workflow showed inconclusive impact on alert acceptance.

Objectives We aimed to assess whether and how often prescriptions were changed as a potential result of interruptive alerts on different (contraindicated) prescription constellations with particularly high risks for adverse drug events (ADEs).

Methods We retrospectively collected data of all interruptive alerts issued between March 2016 and August 2020 in the local CDSS (AiDKlinik) at Heidelberg University Hospital. The alert battery consisted of 31 distinct alerts for contraindicated DDI with simvastatin, potentially inappropriate medication for patients > 65 years (PIM, N = 14 drugs and 36 drug combinations), and contraindicated drugs in hyperkalemia (N = 5) that could be accepted or overridden giving a reason in free-text form.

Results In 935 prescribing sessions of 500 274 total sessions, at least one interruptive alert was fired. Of all interruptive alerts, about half of the sessions were evaluable whereof in total 57.5% (269 of 468 sessions) were accepted while 42.5% were overridden. The acceptance rate of interruptive alerts differed significantly depending on the alert type (p <0.0001), reaching 85.7% for DDI alerts (N = 185), 65.3% for contraindicated drugs in hyperkalemia (N = 98), and 25.1% for PIM alerts (N = 185).

Conclusion A total of 57.5% of the interruptive medication alerts with particularly high risks for ADE in our setting were accepted while the acceptance rate differed according to the alert type with contraindicated simvastatin DDI alerts being accepted most frequently.

背景 通过有针对性的用药警报，临床决策支持系统 (CDSS) 可帮助用户识别用药错误，例如被忽视的药物相互作用 (DDI)。此类警报的覆盖率很高；但是，它们可以通过警报定制或工作流中断显示需要用户主动接受或覆盖的严重警报来缓解。然而，显示的警报干扰开处方者工作流程的程度显示出对警报接受的不确定影响。

目标 我们旨在评估是否以及更改频率是由于对具有特别高的不良药物事件 (ADE) 风险的不同（禁忌）处方群发出中断警报的潜在结果。

方法 我们回顾性收集了 2016 年 3 月至 2020 年 8 月期间在海德堡大学医院当地 CDSS（AiD Klinik）中发布的所有中断警报的数据。警报组包括 31 种不同的警报，分别是对辛伐他汀的 DDI 禁忌症、> 65 岁患者可能不适当的药物治疗（PIM，N  = 14 种药物和 36 种药物组合），以及 可以接受或接受的高钾血症禁忌症药物 ( N = 5)覆盖以自由文本形式给出原因。

结果 在总共 500 274 个处方的 935 个处方中，至少触发了一个中断警报。在所有中断警报中，大约一半的会话是可评估的，其中总共 57.5%（468 个会话中的 269 个）被接受，而 42.5% 被覆盖。中断警报的接受率因警报类型而异 ( p <0.0001)，DDI 警报达到 85.7% ( N  = 185)，高钾血症禁忌药物达到65.3% ( N  = 98)，PIM 警报达到 25.1% ( N  = 185)。

结论 在我们的环境中，共有 57.5% 的 ADE 风险特别高的中断性药物警报被接受，而接受率因警报类型而异，其中禁忌的辛伐他汀 DDI 警报最常被接受。