Clinical Usefulness of Electronic Drug-Drug Interaction Checking in the Care of Cardiovascular Surgery Inpatients

Abstract

Objectives: Drug-related problems (DRPs) are events or circumstances involving drug therapy that actually or potentially interfere with desired health outcomes. This study tested the applicability of clinical decision support software in identifying and managing DRPs among cardiovascular surgery inpatients. Methods: Two clinical pharmacologists attended ward rounds on a low-dependency cardiovascular surgery ward every 2 weeks over a 7-month period. Three hundred and three patients were assessed. On average, patients received 17 scheduled and ‘as required’ medicines. DRPs were identified ‘manually’ via assessment of electronic prescription charts and patient records and ‘electronically’ using clinical decision support software (Pharmavista®). The numbers of alerts for optimizing medication safety generated by the two methods were compared. Results: Manual checking identified 346 DRPs leading to 346 alerts in 201 patients (overall 1.1 alerts/patient). Relevant interactions accounted for 44% of DRPs detected by clinical pharmacologists. Clinical decision support software, which could only report interactions, however, generated 1,370 alerts (average 4.5 alerts/patient). Only 147 (11%) drug-drug interaction alerts were identical to those identified by manual checking; the remaining 89% were considered not clinically relevant. Conclusions: Compared to identification of DRPs by clinical pharmacologists, the clinical decision support software performed poorly due to over-alerting and inability to assess for problems not caused by drug-drug interactions.

Potential drug-drug interactions among hospitalized cardiac patients

“…1,7,18 Since our study was only a prescription analysis, we couldn't comment whether the observed pDDIs actually led to clinically appreciably consequences or not. In a study done by Taegtmeyer et al 19 the authors have shown that pharmacologist agreed with only 11% of DDI alerts as shown by electronic software and 89% were not thought to be clinically significant. Hence, the major limitation in our study is the lack of clinical or laboratory evidence of the actual incidence of DDIs.…”

The Community Pharmacist’s Role in Reducing Cardiovascular Risk Factors in Lebanon: A Longitudinal Study

“…Such agreements expand the role of the pharmacists' role in initiating, modifying, discontinuing, and monitoring drug therapy, ordering or administering laboratory tests, and performing limited physical exams such as checking vital signs and assessing edema [5]. In addition, clinical pharmacy services can provide valuable inputs in identifying drug-related problems and providing suggestions on how they might be avoided [6].…”

Drug prevalence and comparison interaction between numbers of patients admitted at two teaching hospitals; Quetta, Pakistan

“…[13]. The importance of the use of electronic software has been reported in the previous studies [16]. I used a software Mediscape for my study, Similarly, other software has been used in a study by Sepehri and his colleagues who used the software recognition advance and noted the presence of DDIs in 20% of patients [17].…”