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Intensive Care Medicine

, Volume 36, Issue 4, pp 665–672 | Cite as

Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system

  • Thilo Bertsche
  • Johannes Pfaff
  • Petra Schiller
  • Jens Kaltschmidt
  • Markus G. Pruszydlo
  • Wolfgang Stremmel
  • Ingeborg Walter-Sack
  • Walter E. HaefeliEmail author
  • Jens Encke
Original

Abstract

Objective

We investigated the effect of written drug information for senior clinicians on the incidence of drug–drug interactions (DDIs) and DDI-related adverse events in intensive care patients.

Design and methods

A prospective controlled intervention cohort study was conducted in a medical intensive and intermediate care unit in a university hospital. From 1,062 consecutive intensive care patients, those 265 (control: 136, intervention: 129) with ≥8 concurrently prescribed drugs were included in the study (to include high-risk patients with polypharmacy). The DDI information for senior clinicians during an intervention period of 3 months was based on a computerised clinical decision support system (CDSS) containing information on risk and management of 9,453 drug combinations.

Results

The number of patients with at least one DDI at the end of the respective study phase decreased by 18% (relative risk reduction) from 90 (66%) patients in controls to 70 (54%) in the intervention group (p = 0.02). The relative risk of a patient suffering from at least one DDI-related adverse event decreased by 43% from 60 (44%) patients in controls to 32 (25%) in the intervention group (p < 0.01). Among these events, the incidence of QTC prolongation was reduced by 64% from 15 (11%) patients in the control group to 5 (4%) in the intervention group (p = 0.04), and the incidence of hypokalemia by 80% from 14 (10%) to 2 (2%, p < 0.01).

Conclusion

Written drug information based on a CDSS considerably decreased DDIs and DDI-related adverse events in routine practice.

Keywords

Drug interactions Intensive care Drug information services Medication errors Prescriptions drug Computer-assisted drug therapy 

Notes

Acknowledgements

We thank the clinicians and nurses on the ICU for their support, Gordon Chastain for critically reviewing the manuscript for language and style, and Anja Markmann for her helpful support in the patient chart analysis.

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Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Thilo Bertsche
    • 1
    • 2
  • Johannes Pfaff
    • 2
    • 3
  • Petra Schiller
    • 4
  • Jens Kaltschmidt
    • 1
  • Markus G. Pruszydlo
    • 1
  • Wolfgang Stremmel
    • 3
  • Ingeborg Walter-Sack
    • 1
  • Walter E. Haefeli
    • 1
    Email author
  • Jens Encke
    • 3
  1. 1.Department of Internal Medicine VI (Clinical Pharmacology and Pharmacoepidemiology)University of HeidelbergHeidelbergGermany
  2. 2.Cooperation Unit Clinical PharmacyUniversity HeidelbergHeidelbergGermany
  3. 3.Department of Internal Medicine IV (Gastroenterology, Infectious Diseases, Intensive Care Medicine)University HeidelbergHeidelbergGermany
  4. 4.Department of Medical Biometry, Institute of Medical Biometry and InformaticsUniversity HeidelbergHeidelbergGermany

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