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Failure of Pharmacists to Heed Computerized Drug Warnings May Lead to Medical Malpractice Lawsuits

After visiting our physicians, we trust our local pharmacist to accurately fill our prescriptions. In order to do so, most pharmacists rely on computerized warning systems which alert then if there are potentially dangerous effects or conflicts with the drugs that they are prescribing to a particular patient. However, a recently conducted study revealed that the vast majority of computerized drug warning alerts generated in hospitals are overridden, suggesting that these systems need refinement. Not only do the systems need refinement, but medical providers should be more alert, otherwise more and more patients will be put at risk, which will likely lead to those providers being held liable in medical malpractice lawsuits.

According to, among 40,391 medication orders issued during a one-year period, only 4% were accepted, reported Amy Knight, MD, of Johns Hopkins Bayview Medical Center in Baltimore. Computerized provider order entry (CPOE) systems have been developed to generate warnings when there is the possibility of allergy, adverse events, interactions, and duplications, with the intent of increasing inpatient safety.

“However, the problem with these computerized warning systems is that providers develop ‘alert fatigue’ and end up overriding many potentially important warnings,” Knight said at the annual meeting of the Society of Hospital Medicine.

These study results dovetail with research published this week, which found that medication alerts generated by an electronic medical record system were frequently frustrating to prescribers. For this retrospective study, Knight’s group sought to clarify the factors associated with accepting or overriding a warning, with the goal of providing data for developers of these systems to improve their efficacy and utility.

As reported by, the data were from a 410-bed academic medical center, and the system used by the center since 2003 is Meditech, with drug interactions from First DataBank. In this system, Knight explained, when an order is placed, all possible warnings appear on the same screen, in the identical font, with nothing to differentiate the potential severity of the adverse outcome.
For the analysis, they identified 6,646 patients for whom a medication order had generated a warning, by 655 providers. These patients’ mean age was 57, 44% were men, and the mean length of hospital stay was 4 days. A total of 45% were on medical wards, 28% on surgical wards, 29% in psychiatric departments, and small numbers in other departments such as obstetrics and gynecology.

For the patients whose medication orders generated at least a single warning, the range of medications per patient was from 1 to 84, with a median of 4. The range per provider was from 1 to 1,057, with a median of 15. The reasons for the warnings were duplications in 47%, potential interactions in 47%, allergies in 6%, and only 0.1% for potential adverse reactions.

One-quarter of the warnings were for parenteral medications, and 13% were on the Institute for Safe Medication Practices list of high-alert medications. “The least common warnings were those that were most frequently accepted, with the average accepted warnings for drug interactions and allergy being 37% and 10%, respectively,” Knight said.

Warnings for parenteral medications were accepted twice as often as were those for oral medications, at 8% versus 4% (P=0.002), she reported. “Developers of these computerized provider systems need to revise their programs to more clearly differentiate between types of warnings and, in particular, to distinguish the warnings that are most likely to have severe consequences,” she concluded.

As an attorney who represents of those who have been injured as a result of medical malpractice or medical negligence, I not only hope that these computerized systems are reconfigured to increase patient safety, but I also hope that medical providers exercise more caution in prescribing and administering medication.