AUSTRALIAN clinical pharmacists investigating the impact of drug-drug interaction (DDI) alerts on rates of DDIs and associated patient harms found that implementing them, without tailoring them to clinical context, is unlikely to reduce patient harms.
These alerts target the co-prescription of two potentially interacting medications and are a frequent feature of hospital electronic medical records (EMRs), explained the study authors.
However several studies have shown the signals are often overridden by prescribers, usually due to excessive alerts leading to 'alert fatigue', and there have been few controlled studies evaluating the effectiveness of DDI alerts.
The study included five hospitals in NSW and Queensland, and compared data before and after DDIs were introduced.
Only the highest level of severity (major-contraindicated) was operational, and included approximately 7,500 DDI alerts.
Pharmacists completed a detailed audit of patients' medical records to determine whether potential DDIs were clinically relevant, and considered whether the benefit of prescribing the combination outweighed any risks to patients.
Where medications were administered, they also looked for evidence of harm.
They found that introducing alerts have no effect on the prevalence of clinically relevant DDIs, and make no difference to patient-related harms.
While there was a decrease in the number of potential DDI alerts after implementation, the majority were not clinically relevant, "creating high levels of noise for end-users and fostering conditions ripe for alert fatigue", the authors wrote.
"Future research should focus on identifying safe, efficient and cost-effective ways of refining DDI alerts, including ways of effectively capturing drug interactions beyond drug pairs, so that expected clinical benefits are achieved, and negative consequences resulting from excessive alerting are minimised," they concluded.
Read the study HERE. KB
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