Grading the severity of drug-drug interactions in the intensive care unit: a comparison between clinician assessment and proprietary database severity rankings.
BACKGROUND
Computerized provider order entry with decision support software offers an opportunity to identify and prevent medication-related errors, including drug-drug interactions (DDIs), through alerting mechanisms. However, the number of alerts generated can overwhelm and lead to "alert fatigue." A DDI alert system based on severity rankings has been shown to reduce alert fatigue; however, the best method to populate this type of database is unclear.


OBJECTIVE
To compare the severity ranking of proprietary databases to clinician assessment for DDIs occurring in critically ill patients.


METHODS
This observational, prospective study was conducted over 8 weeks in the cardiac and cardiothoracic intensive care unit. Medication profiles of patients were screened for the presence of DDIs and a severity evaluation was conducted using rankings of proprietary databases and clinician opinion using a DDI severity assessment tool. The primary outcome measure was the number of DDIs considered severe by both evaluation methods.


RESULTS
A total of 1150 DDIs were identified after 400 patient medication profiles were evaluated. Of these, 458 were unique drug pairs. Overall, 7.4% (34/458) were considered a severe interaction based upon proprietary database ratings. The assessment by clinicians ranked 6.6% (30/458) of the unique DDIs as severe. Only 3 interactions, atazanavir-simvastatin, atazanavir-tenofovir, and aspirin-warfarin, were considered severe by both evaluation methods.


CONCLUSIONS
Since proprietary databases and clinician assessment of severe DDIs do not agree, developing a knowledge base for a DDI alert system likely requires proprietary database information in conjunction with clinical opinion.
Smithburger
Pamela L
PL
University of Pittsburgh Medical Center, PA, USA. smithburgerpl@upmc.edu
Kane-Gill
Sandra L
SL
Benedict
Neal J
NJ
Falcione
Bonnie A
BA
Seybert
Amy L
AL
D003325:Coronary Care Units / Q000379:methods; D016638:Critical Illness; D016208:Databases, Factual; D020000:Decision Support Systems, Clinical; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted / Q000379:methods; D006801:Humans; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D011446:Prospective Studies; D017010:Reminder Systems; D012720:Severity of Illness Index