title: Time-dependent drug-drug interaction alerts in care provider order entry: software may inhibit medication error reductions.
abstract: Time-dependent drug-drug interactions (TDDIs) are drug combinations that result in a decreased drug effect due to coadministration of a second drug. Such interactions can be prevented by separately administering the drugs. This study attempted to reduce drug administration errors due to overridden TDDIs in a care provider order entry (CPOE) system. In four periods divided over two studies, logged TDDIs were investigated by reviewing the time intervals prescribed in the CPOE and recorded on the patient chart. The first study showed significant drug administration error reduction from 56.4 to 36.2% (p<0.05), whereas the second study was not successful (46.7 and 45.2%; p>0.05). Despite interventions, drug administration errors still occurred in more than one third of cases and prescribing errors in 79-87%. Probably the low alert specificity, the unclear alert information content, and the inability of the software to support safe and efficient TDDI alert handling all diminished correct prescribing, and consequently, insufficiently reduced drug administration errors.
authors.affiliation: Department of Hospital Pharmacy, Institute of Health Plicy and Management, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands. i.vandersijs@erasmusmc.nl
authors.forename: Heleen
authors.initials: H
authors.lastname: van der Sijs
authors.forename: Laureen
authors.initials: L
authors.lastname: Lammers
authors.forename: Annemieke
authors.initials: A
authors.lastname: van den Tweel
authors.forename: Jos
authors.initials: J
authors.lastname: Aarts
authors.forename: Marc
authors.initials: M
authors.lastname: Berg
authors.forename: Arnold
authors.initials: A
authors.lastname: Vulto
authors.forename: Teun
authors.initials: T
authors.lastname: van Gelder
mesh_terms: D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D004360:Drug Therapy, Computer-Assisted; D006801:Humans; D007318:Inservice Training; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D008510:Medication Systems, Hospital; D009426:Netherlands; D019982:Organizational Case Studies; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D013997:Time Factors