National Rules for Drug-Drug Interactions: Are They Appropriate for Tertiary Hospitals?

Title
National Rules for Drug-Drug Interactions: Are They Appropriate for Tertiary Hospitals?
Authors
조인숙
Keywords
Medication Safety, Drug–Drug Interactions, Prescription Alerts, Overrides, Alert Fatigue
Issue Date
2016-12
Publisher
JOURNAL OF KOREAN MEDICAL SCIENCE
Series/Report no.
JOURNAL OF KOREAN MEDICAL SCIENCE ; Vol31 no.12 Startpage 1887 Endpage 1896
Abstract
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.
URI
https://doi.org/10.3346/jkms.2016.31.12.1887
http://dspace.inha.ac.kr/handle/10505/55911
ISSN
1011-8934
Appears in Collections:
Medical School/College of Medicine (의학전문대학원/의과대학) > Nursing (간호학) > Local Access Journal Papers, Reports(간호학 논문, 보고서)

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