title: Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations: need for specific alerts.
abstract: Computer-triggered reminders alerting physicians on every potentially harmful drug-drug-interaction (DDI) induce alert fatigue due to frequent messages of limited clinical relevance. On demand DDI-checks, however, are not commonly used by physicians. Optimal strategies for sustained quality assurance have to consider patients' risk factors and focus on the most significant DDIs only. An approach is proposed based on the analysis of concurrent prescription of potassium-sparing diuretics and potassium supplements (CPPP), which are the most frequent DDIs classified as contraindicated. Although the frequency of monitoring potassium serum levels declined during prolonged periods of CPPP, the likelihood of observing a hyperkalaemia increased. The median treatment period of CPPP was 3.3 days, whereas hyperkalaemia occurred after a median observation time of 4.5 days of CPPP. Thus, computer-triggered reminders for ordering potassium serum levels may be indicated if monitoring has been discontinued after 48h of CPPP.
authors.affiliation: Research Centre for Medical Informatics, University Hospital, Zurich, Switzerland. emmanuel.eschmann@usz.ch
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Eschmann
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Beeler
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kaplan
authors.forename: Markus
authors.initials: M
authors.lastname: Schneemann
authors.forename: Gregor
authors.initials: G
authors.lastname: Zünd
authors.forename: Jürg
authors.initials: J
authors.lastname: Blaser
mesh_terms: D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D004347:Drug Interactions; D004360:Drug Therapy, Computer-Assisted; D064420:Drug-Related Side Effects and Adverse Reactions / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000139:chemically induced* / Q000517:prevention & control; D011188:Potassium / Q000097:blood*; D017010:Reminder Systems; D013557:Switzerland / Q000453:epidemiology
chemical_list: D011188:Potassium