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Abstract

Background

Drug-drug interactions (DDIs) leading to adverse drug events (ADEs) are of special interest because they represent preventable medication errors. Preventable ADE can result in errors involving the manifestation of adverse patient outcomes. Given the high complexity of critically ill cardiac patients, it is important to learn how Clinical Drug Decision Support System (CDDSS) affects outcomes in this population and the number of alerts that are likely to be safely suppressed.

Purpose

Identify adverse DDIs that are clinically detected and review the appropriateness of the doctor's actions to the potential DDIs (PDDIs) alert. Study Design: This is a prospective observational study conducted at a critical cardiac care unit (CCU) in a selected tertiary cardiac center for a duration of six months.

Methods

Physicians treating critically ill cardiac patients were presented with PDDIs data which were acquired from two commercially available CDDSS. The relationship between the decision to prescribe and factors hypothesized to affect physicians' decisions was examined.

Results

Evaluation of 709 patient medication profiles were conducted, resulting in 521 assessed patient profiles having had one or more PDDIs with 87% of them being influenced by polypharmacy. Ninety-one patients (17.5%) were associated with one or more adverse DDIs. Of the total 3284 potential DDIs alerts, 95.5% of the alerts were overridden. Preventable ADE as an outcome of inappropriate override has resulted in 83.1%. (236/284) of adverse DDIs. Whereas appropriate overrides as an outcome of clinically irrelevant ADE were 16.9% (48/284).

Conclusion

Poor preventive actions taken by the doctors caused drug-related harm to the patients despite having CDDSS in place. This suggests that CDDSS is an important application to minimize the harm associated with adverse DDIs by alerting physicians of potentially unsafe situations.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): International Medical UniversityNational Heart Institute

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Reproduced from: European Heart Journal, Volume 43, Issue Supplement_2, October 2022, ehac544.2797, https://doi.org/10.1093/eurheartj/ehac544.2797 by permission of Oxford University Press on behalf of the European Society of Cardiology. The opinions expressed in the Journal item reproduced as this reprint are those of the authors and contributors, and do not necessarily reflect those of the European Society of Cardiology, the editors, the editorial board, Oxford University Press or the organization to which the authors are affiliated. The mention of trade names, commercial products or organizations, and the inclusion of advertisements in this reprint do not imply endorsement by the Journal, the editors, the editorial board, Oxford University Press or the organization to which the authors are affiliated. The editors and publishers have taken all reasonable precautions to verify drug names and doses, the results of experimental work and clinical findings published in the Journal. The ultimate responsibility for the use and dosage of drugs mentioned in this reprint and in interpretation of published material lies with the medical practitioner, and the editors and publisher cannot accept liability for damages arising from any error or omissions in the Journal or in this reprint. Please inform the editors of any errors. © The Author(s) 2022.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected]
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