Recognition and management of potential drug–drug interactions in patients on internal medicine wards
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Our aim was to study and possibly improve the clinical management of potential drug–drug interactions (pDDIs) in hospitalized patients by specific interventions.
During the initial period, inpatients on three medical wards were screened for major and moderate pDDIs using the interaction screening program Pharmavista. During the second period, patients at discharge were screened similarly. After assessment of the detected pDDIs for clinical relevance, written recommendations and/or information about the pDDIs were sent to the treating physicians. Feedback from the physicians and implementation of the recommendations were analyzed.
During the initial period, 502 inpatients were exposed to 567 pDDIs, of which 419 (74%) were judged to be clinically relevant. Three hundred and forty-nine substantiated recommendations and 70 simple information leaflets were handed out to the physicians. Eighty percent (278 of 349) of the recommendations were accepted and implemented. During the second period, 792 patients at hospital discharge were exposed to 392 pDDIs, of which 258 (66%) were judged to be clinically relevant. Two hundred and forty-seven substantiated recommendations and 11 simple information leaflets were sent to the physicians. Seventy-three percent (180 of 247) of the recommendations were accepted. At hospital discharge, 47 of 71 interventions recommending checkable medication changes were implemented. One year after hospital discharge, 11 of 13 checked medication changes were still in place.
Clinically relevant pDDIs are common in patients on medical wards, and their management can be influenced by providing substantiated recommendations to physicians. Most changes in medication following such recommendations are still in place 1 year after discharge.
KeywordsDrug–drug interactions Drug–drug interaction screening program Intervention Medication error Adverse drug reaction
- 6.Fattinger K, Roos M, Vergeres P, Holenstein C, Kind B, Masche U, Stocker DN, Braunschweig S, Kullak-Ublick GA, Galeazzi RL, Follath F, Gasser T, Meier PJ (2000) Epidemiology of drug exposure and adverse drug reactions in two swiss departments of internal medicine. Br J Clin Pharmacol 49(2):158–167PubMedCrossRefGoogle Scholar
- 18.e-mediat. Pharmavista - information for healthcare professionals. Version February 2005 ed: e-mediat AG, Schönbühl, Switzerland 2005Google Scholar
- 19.Vonbach P, Dubied A, Krahenbuhl S, Beer JH (2005) Evaluation of drug interaction screening programs. Forum Med Suisse 8S(Suppl 23):P15Google Scholar
- 20.Stockley IH (2002) Stockley’s drug interactions, 6th edn. The Pharmaceutical Press, London, ChicagoGoogle Scholar
- 21.Hanlon JT, Weinberger M, Samsa GP, Schmader KE, Uttech KM, Lewis IK, Cowper PA, Landsman PB, Cohen HJ, Feussner JR (1996) A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 100(4):428–437PubMedCrossRefGoogle Scholar
- 34.Payne TH, Nichol WP, Hoey P, Savarino J (2002) Characteristics and override rates of order checks in a practitioner order entry system. Proc AMIA Symp 602–606Google Scholar
- 38.Hansten PD, Horn JR, Hazlet TK (2001) ORCA: OpeRational ClassificAtion of drug interactions. J Am Pharm Assoc 41(2):161–165Google Scholar