Research Center for Medical Informatics, Directorate of Research and Teaching, University Hospital Zurich, Sonneggstrasse 6, D5, 8091 Zurich, Switzerland.
Drug Saf. 2013 Jun;36(6):427-34. doi: 10.1007/s40264-013-0022-1.
Offering a drug-drug interaction (DDI) checker on-demand instead of computer-triggered alerts is a strategy to avoid alert fatigue.
The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients.
The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital. The hospital-wide use of the on-demand DDI checker was measured for prescribers and consulting pharmacologists. The number of DDIs identified on-demand was compared to the number that would have resulted by computer-triggering and this was compared to patient-specific recommendations by a consulting pharmacist.
The on-demand use was analyzed during treatment of 64,259 inpatients with 1,316,884 prescriptions. The DDI checker was popular with nine consulting pharmacologists (648 checks/consultant). A total of 644 prescribing physicians used it infrequently (eight checks/prescriber). Among prescribers, internists used the tool most frequently and obtained higher numbers of DDIs per check (1.7) compared to surgeons (0.4). A total of 16,553 DDIs were identified on-demand, i.e., <10 % of the number the computer would have triggered (169,192). A pharmacist visiting 922 patients on a medical ward recommended 128 adjustments to prevent DDIs (0.14 recommendations/patient), and 76 % of them were applied by prescribers. In contrast, computer-triggering the DDI checker would have resulted in 45 times more alerts on this ward (6.3 alerts/patient).
The on-demand DDI checker was popular with the consultants only. However, prescribers accepted 76 % of patient-specific recommendations by a pharmacist. The prescribers' limited on-demand use indicates the necessity for developing improved safety concepts, tailored to suit these consumers. Thus, different approaches have to satisfy different target groups.
按需提供药物-药物相互作用（DDI）检查器而不是计算机触发的警报是避免警报疲劳的一种策略。
目的是确定在住院患者的临床信息系统中实施这种按需工具的使用情况。
该研究在苏黎世大学医院进行，该医院是一家拥有 850 张床位的教学医院。对处方医生和咨询药理学家进行了全院范围内按需使用 DDI 检查器的测量。比较了按需识别的 DDI 数量与计算机触发的数量，并将其与咨询药剂师的患者特异性建议进行了比较。
在治疗 64259 名住院患者的 1316884 份处方时，对按需使用情况进行了分析。DDI 检查器受到 9 位咨询药理学家的欢迎（每位咨询者 648 次检查）。共有 644 名开处方的医生很少使用它（每位医生 8 次检查）。在开处方的医生中，内科医生最常使用该工具，每次检查发现的 DDI 数量也最多（1.7 比外科医生的 0.4）。共发现了 16553 次按需 DDI，即不到计算机触发数量的 10％（169192）。在医疗病房访问 922 名患者的药剂师建议了 128 次调整以预防 DDI（0.14 次/患者），其中 76％的建议得到了医生的应用。相比之下，在这个病房中，计算机触发 DDI 检查器会导致 45 倍的警报（6.3 次/患者）。
按需 DDI 检查器仅受到顾问的欢迎。但是，开处方者接受了药剂师对 76％患者特异性建议的应用。开处方者对按需使用的有限使用表明有必要开发适合这些消费者的改进安全概念。因此，不同的方法必须满足不同的目标群体。
