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MediQ detected a large number of drug interactions with variable clinical relevance in neurological inpatients. ZHIAS supports the selection of those interactions that require active management, and the effects of its implementation into CDSS on medication safety should be evaluated in future prospective studies.

Evaluation of medication safety in the discharge medication of 509 surgical inpatients using electronic prescription support software and an extended operational interaction classification Frölich, T B Abstract: Purpose We aimed to study drug interactions and dose adjustments for renal impairment in the discharge medication of surgical inpatients, and to evaluate strengths and limitations of Clinical Decision Support software (CDSS) for this task. Methods Cross-sectional study in 509 surgical patients of a primary care hospital. We developed a customized interface for the CDSS MediQ, which we used for automated retrospective identification of drug interactions in the patients' discharge medication. Clinical relevance of interactions was evaluated based on the Zurich Interaction System (ZHIAS) that incorporates the Operational Classification of Drug Interactions (ORCA). Prescriptions were further analyzed for recommended dose adjustments in patients with a GFR <60 ml/min. Results In 509 patients with 2,729 prescriptions MediQ generated 2,558 interaction alerts and 1,849 comments. Among those there were 10 "high danger" and 551 "average danger" alerts that we reclassified according to ORCA criteria. This resulted in 10 contraindicated combinations, 77 provisionally contraindicated combinations, 310 with a conditional and 164 with a minimal risk of adverse outcomes. The ZHIAS classification also provides categorical information on expected adverse outcomes and management recommendations, which are presented in detail. We identified 56 prescriptions without recommended dose adjustment for impaired renal function. Conclusions CDSS identified a large number of drug interactions in surgical discharge medication, but according to ZHIAS criteria only a minor fraction appears to involve a substantial risk. CDSS should aim at reducing over-alerting and improve usability in order to become more efficacious regarding the prevention of adverse drug events in clinical practice.