National Rules for Drug-Drug Interactions: Are They Appropriate for Tertiary Hospitals?
The application of appropriate rules for drug-drug interactions (DDIs) could substantially reduce the number of adverse drug events. However, current implementations of such rules in tertiary hospitals are problematic as physicians are receiving too many alerts, causing high override rates and alert fatigue. We investigated the potential impact of Korean national DDI rules in a drug utilization review program in terms of their severity coverage and the clinical efficiency of how physicians respond to them. Using lists of high-priority DDIs developed with the support of the U.S. government, we evaluated 706 contraindicated DDI pairs released in May 2015. We evaluated clinical log data from one tertiary hospital and prescription data from two other tertiary hospitals. The measured parameters were national DDI rule coverage for high-priority DDIs, alert override rate, and number of prescription pairs. The coverage rates of national DDI rules were 80% and 3.0% at the class and drug levels, respectively. The analysis of the system log data showed an overall override rate of 79.6%. Only 0.3% of all of the alerts (n = 66) were high-priority DDI rules. These showed a lower override rate of 51.5%, which was much lower than for the overall DDI rules. We also found 342 and 80 unmatched high-priority DDI pairs which were absent in national rules in inpatient orders from the other two hospitals. The national DDI rules are not complete in terms of their coverage of severe DDIs. They also lack clinical efficiency in tertiary settings, suggesting improved systematic approaches are needed.
Nursing Department, Inha University, Incheon, Korea.|The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
Insook
http://orcid.org/0000-0002-5152-9567
I
Cho
The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.|Department of Biomedical Informatics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. rufiji@gmail.com.
Jae Ho
http://orcid.org/0000-0003-2619-1231
JH
Lee
Seoul National University Hospital, Seoul, Korea.
Jinwook
http://orcid.org/0000-0002-9424-9944
J
Choi
Seoul National University Bundang Hospital, Seongnam, Korea.
Hee
http://orcid.org/0000-0002-7964-1630
H
Hwang
The Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.|Partners Healthcare Systems, Wellesley, MA, USA.
David W
http://orcid.org/0000-0001-6268-1540
DW
Bates
D004347:Drug Interactions; D011307:Drug Prescriptions; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D006801:Humans; D008508:Medication Errors / Q000331:legislation & jurisprudence*; D056910:Republic of Korea; D062606:Tertiary Care Centers
Alert Fatigue; Drug-Drug Interactions; Medication Safety; Overrides; Prescription Alerts