Alert override reasons: a failure to communicate

In 2007, the Leapfrog CPOE standard required that all clinical alert overrides be accompanied by an override reason. We wanted to know how many of the free text comments left by clinicians were actually override reasons, and how many were other types of communication. We reviewed 3583 free text comments left voluntarily by clinicians while responding to an alert in a CPOE system. Of the comments received, 58% were override reasons, 28% were acknowledgment of the alert, 9% were content free and over 5% were misdirected communication, written with intent to reach someone who does not receive the alert comments. This is particularly concerning because much of the misdirected communication contained clinical instructions. Those clinical instructions were stored with the alert rather than with any clinical orders, and thus were not viewed by anyone receiving the orders. Our results show that free text alert comments may cause communication failures.