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Alert fatigue is an unintended consequence of electronic health record and clinical decision support systems implementation. Alert fatigue is a form of cognitive overload desensitizing clinicians to future alerts. Further investigation of alert fatigue in nursing is warranted.
Key Words: nursing, alert fatigue, electronic health record, clinical decision support systems
Alert fatigue is recognized as one of the unintended consequences of electronic health record EHRs and clinical decision support systems (CDSSs) implementation (Gephardt, Carrington, & Finley, 2015). Alert fatigue, a form of cognitive overload that desensitizes the clinician to future alerts, is commonly associated with CDSSs (Ancker et al., 2017; Coleman et al., 2013; Kane-Gill et al., 2017; Sidebottom, Collins, Winden, Knutson, & Britt, 2012). CDSSs encompass a variety of decision support tools that link patient data to an electronic knowledge base to alert, remind or direct health care provider decisionmaking at the point of care (Beeler, Bates, & Hug, 2014; Khong, Holroyd, & Wang, 2015). Commercial EHR products commonly incorporate CDSSs, but stand-alone and custombuilt CDSSs do exist (Jones, Rudin, Perry, & Shekelle, 2014).
CDSSs are intended to improve patient care outcomes, safety, and quality by promoting timely evidence-based practice decisions, reducing risks of error or omission, and enhancing provider efficiency (Castillo & Kelemen, 2013; Kane-Gill et al., 2017; Lopez et al., 2017). Spurred by government financial incentives for the Medicare and Medicaid Meaningful Use programs, (Jones et al., 2014; Wright et al., 2011) there has been an exponential increase in EHRs and CDSS implementation during recent decades. This rapid deployment initially overshadowed concerns related to the unintended consequences of these technologies. However, recognition of the adverse events that may result from EHR and CDSS implementation is growing. The ECRI Institute's report, "Executive Brief: 2017 Top 10 Patient Safety Concerns," ranked information management in EHRs and the implementation and use of clinical decision support (CDS) in first and third place, respectively (ECRI Institute, 2017).
EHRs and CDSSs have changed how nurses organize and use patient information to deliver patient care (Higgins et al., 2017; Kaye, 2017; Kossman, Bonney, & Kim, 2013), yet there is a notable scarcity of literature specific to nursing alert fatigue. The lack of attention focused on this issue likely is due to a number of factors. The downstream effects...