Alert fatigue

Clinical decision support (CDS) is the descriptive term used for computer functionality that allows for the comparison of various pieces of patient information in order to generate patient-specific advice or alerts. The prevalent use of CDS in pharmacy and physician ordering systems makes it one of the most common computer-based error-prevention tools. Unfortunately, one of the unintended consequences of a growing number of alerts (in the interest of patient safety) is the potential for user desensitization. This desensitization has also been called “alert fatigue,” “cry-wolf syndrome,” and “pop-up fatigue.” Greengold’s1 tongue-in-cheek commentary “Chronic Alert Fatigue Syndrome: An In-Your-Face-Dilemma” humorously illustrates the level to which this problem has risen. Alert fatigue can be compared to the law of diminishing returns in economics, to the saturation point in chemistry, and to Shakespeare’s As You Like It, “Why then, can one desire too much of a good thing?” When does the value of alerting decrease in the face of increasing alerts? Unfortunately, there is not a clear answer. Published articles and active discussion on alert fatigue related to computerized prescriber-order-entry (CPOE) systems have recently emerged, although CDS has been used in pharmacy systems for much longer. Alert fatigue is the most common complaint about CPOE systems,2 and alerts are overridden 49–96% of the time.3 Generally speaking, a pharmacy computer system’s CDS is comparable to that of a CPOE system’s. The two often use the same data tables to determine when an alert should be issued. Thus, the potential alert fatigue with CPOE can reasonably be predicted by the alert fatigue seen with pharmacy computer systems.