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Vital computer drug alerts swamped by false alarms

GPs are accidentally overriding crucial drug alerts on their computer screens because their systems generate too many false alarms.

A study for the National Patient Safety Agency tested information systems used by more than 90 per cent of GPs that alert them to potentially dangerous drug combinations or contraindications.

But researchers presenting their findings at an RCGP/NPSA conference earlier this month found there were too many 'spurious' warnings while some crucial alerts were omitted.

'Sometimes patients end up on dangerous combinations of drugs because GPs have overridden alerts,' said study leader Professor Tony Avery, a GP in Nottingham and professor of primary care at the city's university.

'The flip-side is that virtually all systems produce spurious alerts ­ and if you get used to messages not being relevant you get a cry wolf situation.'

He said unnecessary alerts arose because manufacturers played safe. 'If something is mentioned in the literature the manufacturers are covering themselves, but GPs might be over-alerted.'

For example, he said a system may unnecessarily warn of increased pregnancy risk for a woman combining HRT and an antibiotic because both contain oestrogen.

Some systems allowed alerts to be overridden with a single keystroke, while alerts on other systems were hidden behind an icon.

GPs interviewed for the study said they wanted crucial alerts ­ of risks of serious morbidity and death ­ to be more difficult to override.

A serious concern was the lack of warnings about methotrexate, which is prescribed weekly. 'GPs are used to prescribing daily, and if a system is not set up to prevent these errors someone will end up prescribing it daily,' said Professor Avery.

Drop-down menus of drugs also made it possible to accidentally prescribe penicillamine, a toxic antirheumatic, instead of penicillin, he added.

Drop-down menus should list the most commonly prescribed drug first, he said.

GPC prescribing subcommittee chair Dr Peter Fellows said GPs often used their clinical judgment to override warnings. 'Alerts are put there by the drug companies which have a vested interest in protecting themselves against lawsuits,' he said.

'They tend to be very detailed in terms of possible interactions that are not always clinically significant.'

The researchers also recommend the introduction of an NHS drug dictionary, giving each medicine a unique code.

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