Effect van beslissingsondersteuning op het verminderen van interacterende medicatie-combinaties op de intensive care

BACKGROUND Patients in the intensive care unit (ICU) are at a higher risk of medication-related harm due to potential drug-drug interactions (DDIs). This increased risk is related to the high number of drugs administered. Clinical decision support systems (CDSSs) have the potential to reduce potential DDIs (pDDIs) and improve medication safety. OBJECTIVE To evaluate the effect of a CDSS on the incidence of serious pDDIs in the ICU of an academic hospital. DESIGN and METHODS This study was conducted at the ICU department of the Amsterdam UMC (location AMCI in the Netherlands. Interrupted time series analysis was used to evaluate the effect of a CDSS. This CDSS generated pDDI alerts during prescribing. Data on medication administrations, pDDIs and pDDI alerts were gathered a year before and a year after implementation of the CDSS from April 2011 till April 2013. The primary outcome was the rate of serious pDDIs per 100 medication administrations. Secondary outcomes were the proportions of overridden pDDI alerts and monitoring actions related to pDDI alerts. RESULTS In total 2711 patients having 58.455 drugs administered were included. The rate of serious pDDIs did not significantly change after CDSS implementation (P = 0.098). The mean proportion of overridden pDDI alerts was high: 97% (total: 11.592 alerts). The mean proportion of pDDI alerts followed by a monitoring action varied between alert types (5.8-M,9%). CONCLUSION The implementation of a CDSS did not result in a decrease of serious pDDIs at the ICU. Lack of agreement on which pDDIs are clinically relevant for the ICU may explain our findings, since almost all alerts were overridden. Future research should focus on identifying which pDDIs are important in the ICU setting.