Evaluation of drug interaction software to identify alerts for transplant medications.
BACKGROUND
The ability of computerized physician order entry (CPOE) systems to identify clinically significant drug interactions is dependent upon the integrity of the drug information populating the software. A CPOE system with incomplete or inaccurate drug information will fail to identify clinically important drug interactions and, therefore, fail to reduce preventable adverse drug events (pADEs).


OBJECTIVE
To evaluate, from the prescribers' perspective, the ability of a common drug interaction database to identify clinically important drug interactions involving drugs used in transplantation.


METHODS
The clinical significance of drug interactions involving 5 transplant drugs was evaluated by an expert panel to determine whether alerts should be generated for physicians not involved in the transplant at the time of order entry. Drug interactions included in the analysis were generated from the expert panel, a common drug interaction database, and 2 standard drug interaction references. Responses on the clinical significance were used to calculate the sensitivity, specificity, and positive and negative predictive values for each severity setting of a common electronic drug interaction database.


RESULTS
Overall, the database failed to identify approximately 70% of interactions considered significant by the expert panel. Of the alerts that were generated, >85% were considered clinically significant. The database was most deficient in identifying interactions resulting from additive toxicity.


CONCLUSIONS
To expect a decrease in pADEs caused by drug interactions, the information used to populate CPOE systems must be validated. Establishing consistency and integrity of this information may be a future role for pharmacists.
Smith
Wendy D
WD
Shands Hospital, University of Florida, Gainesville, FL, USA.
Hatton
Randy C
RC
Fann
Amy L
AL
Baz
Maher A
MA
Kaplan
Bruce
B
D019992:Databases as Topic; D004347:Drug Interactions; D011307:Drug Prescriptions; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007256:Information Systems; D008508:Medication Errors / Q000517:prevention & control*; D012680:Sensitivity and Specificity; D012984:Software; D014180:Transplantation
D007166:Immunosuppressive Agents