Table 2.
Rate of override alerts and appropriateness of override alerts by type.
| Reference | Type of alerts | Overridden (%) | Appropriateness (%) | Evaluation criteria | Evaluation rater | Interrater agreement, kappa (95% CI) |
| Wong et al [7] | Dose | 93.0 | 88.8 | Based on previously published data including guidelines | Clinical pharmacist and research assistant | 0.87 (0.85-0.90) |
| Wong et al [17] | DAIa | Inpatient: 46.0; outpatient: 68.8 | Inpatient: 83.9; outpatient: 100 | NRb | NR | NR |
| Cho et al [18] | DDIc | 71.7 | ~75.3 | Based on previously published data including guidelines | Physicians | 0.92 |
| Nanji et al [19] | DAI, DDI, and DDd | DAI: 81.9, DDI: 68.2, DD: 51.9 | DAI: 96.5, DDI: 62.0, DD: 98.0 | Based on previously published data including guidelines | Physician and pharmacist | 0.96 (0.95-0.97) |
| Wong et al [20] | DAI, DDI, dose, geriatric, renal | DAI: 83.6, DDI: 91.9, dose: 96.8, geriatric: 2.30, renal: 97.1 | DAI: 83.4, DDI: 82.0, dose: 43.9, geriatric: 14.3, renal: 87.5 | Based on previously published data including guidelines | Clinical pharmacist | 0.89 (0.85-0.93) |
| Rehr et al [8] | DAI, DDI, dose | DAI: ~80, DDI: ~87, dose: ~82 | DAI: 83.0, DDI: 0.00, dose: 85.0 | NR | NR | NR |
| Wong et al [21] | DAI, DDI, geriatric, renal | DAI: 46.3, DDI: 56.3, geriatric: 87.1, renal: 74.4 | DAI: 94.0, DDI: 84.0, geriatric: 57.0, renal: 27.0 | Based on previously published data including guidelines | Clinical pharmacist | 0.79 (0.73-0.86) |
| Slight et al [22] | DAI | Inpatient: 83.0; outpatient: 81.0 | Inpatient: 96.5; Outpatient: 94.0 | Based on previously published data including guidelines | Pharmacist | 0.86 |
| Topaz et al [23] | DAI | ~87.6 | NR | NR | NR | NR |
| Her et al [24] | FAe | ~61.2 | 82.8 | Based on previously published data including guidelines | Pharmacist | 0.97 (0.92-1.00) |
| Topaz et al [25] | DAI | 89.7 | NR | NR | NR | NR |
| Straichman et al [5] | Dose, RDAf, DTg, DDI, MDDIh | Dose, 92.1; RDA: 92.3, DT: 96.0, DDI: 95.6, MDDI: 96 | Overall: 84.5 | Based on previously published data including guidelines | Pharmacist | NR |
| Ahn et al [26] | DDI (EDi), DDI (GWj) | DDI (ED): 94.0, DDI (GW): 57.0 | DDI (ED): 59.6, DDI (GW): 40.4 | NR | NR | NR |
| Nanji et al [4] | DAI, DDI, DDf, DCIk, CCIl, ABSm, renal, FA | DAI: 77.4, DDI: 60.2, DD: 28.6, DCI: 24.4, CCI: 69.7, ABS: 79.0, renal: 78.0, FA: 85.0 | DAI: 92.0, DDI: 12.0, DD: 82.0, DCI: 88.0, CCI: 69.0, ABS: 39.0, renal: 12.0, FA: 57.0 | Based on previously published data including guidelines | Physician, pharmacist, and nurse | 0.89 |
| Cho et al [27] | Renal | 78.2 | 29.4 | Based on previously published data including guidelines | Physician | 0.93 |
| Jani et al [34] | DAI, DDI, DT, ED | DAI: 63.4, DDI: 73.0, DT: 95.0, ED: 90.6 | NR | NR | NR | NR |
| Bryant et al [28] | DDI and DAI | DDI: 95.0 and DAI: 91.0 | NR | NR | NR | NR |
| Slight et al [11] | DDI | 60.0 | 68.2 | Based on previously published data including guidelines | Pharmacist | 0.84 |
| Mille et al [29] | DDI | 68.7 | NR | NR | NR | NR |
| Van der Sijs et al [30] | DDI | 72.0 | NR | NR | NR | NR |
| Shah et al [31] | DCI, DDI, DLIn, DRDIo, and DPIp | DCI: 23.0, DDI: 58.0, DLI: 60.0, DRDI: 47.0, DPI: 90.0 | NR | NR | NR | NR |
| Hsieh et al [32] | DAI | 80.0 | NR | NR | NR | NR |
| Weingart et al [33] | DAI and DDI | DAI: 91.2; DDI: 94.6 | 63.5 | Based on previously published data including guidelines | Board-certified internee | 0.86 |
aDAI: drug-allergy interaction.
bNR: not reported.
cDDI: drug-drug interaction.
dDD: drug duplicate.
eFA: formulary alert.
fRDA: renal dose adjustment.
gDT: duplicate therapy.
hMDDI: major drug-drug interaction.
iED: emergency department.
jGW: general ward.
kDCI: drug-class interaction.
lCCI: class-class interaction.
mABS: age-based suggestion.
nDLI: drug-lab interaction.
oDRDI: drug-disease interaction.
pDPI: drug-pregnancy interaction.