Frequency and nature of drug-drug interactions in a Dutch university hospital.
OBJECTIVE
Drug-drug interactions (DDIs) may lead to often preventable adverse drug events and health damage. Especially within hospitals, this might be an important factor, as patients are severely ill and multiple medications may be prescribed simultaneously. The objective of this study was to measure the frequency and nature of DDI alerts in a Dutch university hospital.


METHODS
All patients hospitalized in the University Medical Centre Utrecht in 2006 who were prescribed at least one medication were included. The frequency of DDIs was calculated as: (i) the percentage of patients experiencing at least one DDI, and (ii) the percentage of prescriptions generating a DDI alert. Based on the national professional guideline, DDIs were classified into categories of potential clinical outcome, management advice, clinical relevance (A-F) and available evidence (0-4).


RESULTS
Of the 21 277 admissions included, 5909 (27.8%) encountered at least one DDI. Overall, the prescribing physician received a DDI alert in 9.6% of all prescriptions. The most frequently occurring potential clinical consequence of the DDIs was an increased risk of side-effects such as increased bleeding risk (22.0%), hypotension (14.9%), nephrotoxicity (12.6%) and electrolyte disturbances (10.5%). Almost half (48.6%) of the DDIs could be managed by monitoring laboratory values.


CONCLUSIONS
Computerized DDI alerts may be a useful tool to prevent adverse drug events within hospitals, but they may also result in 'alert fatigue'. The specificity of alerts could significantly improve by the use of more sophisticated clinical decision support systems taking into account, for example, laboratory values.
Zwart-van Rijkom
Jeannette E F
JE
Department of Clinical Pharmacy, D00218, University Medical Centre Utrecht, PO Box 85500, Utrecht 3508 GA, The Netherlands. jzwart2@umcutrecht.nl
Uijtendaal
Esther V
EV
ten Berg
Maarten J
MJ
van Solinge
Wouter W
WW
Egberts
Antoine C G
AC
D016907:Adverse Drug Reaction Reporting Systems; D004347:Drug Interactions; D011307:Drug Prescriptions; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D009426:Netherlands / Q000453:epidemiology; D010593:Pharmaceutical Services / Q000592:standards*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017010:Reminder Systems; D012308:Risk Management
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