Box 1.

Motivational construct explanations and a priori knowledge relevant to the behavior of overriding alerts.

Control	The motivation to gain and maintain control is a core and ubiquitous human motivation9,10. Threats to a loss of control result in work-arounds, frustration, and active strategies to regain control. Supporting autonomy and control improves workers’ performance and their emotional status. Behaviors that are motivated by threats to control include ignoring information, demeaning the messenger, and manipulating tools to identify causal factors of an outcome11. We expect that hardstop medication alerts interrupt order verification tasks and may cause frustration.
Self-efficacy	Self-efficacy refers to the belief about one’s ability to cope with work demands using the provided resources12. It is one of the most prominent factors in explaining choice, persistence, and resistance to negative feedback13. We expect that as pharmacists are exposed to medication alerts, they learn how and when to address triggering factors. Over time, pharmacists gain competence and may develop a mental model of the alert context, which gives them skills in managing attention and delegating effort when verifying medication orders.
Diffusion of responsibility	Diffusion of responsibility is defined as the tendency for people to take less responsibility when other individuals also contribute efforts to the same goal14. The result is a tendency to contribute less than equal effort or fail to fully commit to an assignment. Since similar if not the same medication alerts are seen during three different phases of the pharmacotherapy pipeline (i.e., order entry, order verification, and medication administration), we expect that pharmacists have mental models of who is receiving medication alerts, which may contribute to diffusion of responsibility.
Intrinsic motivation	Intrinsic motivation is the affective experience of enjoyment, involvement and concentration in an activity. We focused on the “flow” experience, which is described as being lost in an activity described as fun, enjoyable, and inherently interesting15. Intrinsic motivation at work is often described as a match between the task demands and the individual’s skill set and high “flow” states are those requiring substantial skills16. We expect that pharmacists may get a sense of satisfaction when overriding alerts because they have anticipated the work required which allows quick dismissal of the alert to resume work tasks.