Polidori Piera, Di Giorgio Concetta, Provenzani Alessio
Clinical Pharmacy Department, ISMETT, Palermo, Italy.
Inform Prim Care. 2012;20(4):257-62. doi: 10.14236/jhi.v20i4.15.
Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs.
The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed. DDIs were assessed using a Micromedex® healthcare series database.
The system, adopted by the hospital, generates alerts for prescriptions with negative interactions and thanks to an 'acknowledgement function' it is possible to verify physician adherence to alerts. This function, although used previously, became mandatory from September 2010. Physician adherence to alerts and mean monthly incidence of potential DDIs in analysed units, before and after the mandatory 'acknowledgement function', were calculated.
The intensive care unit (ICU) registered the greatest incidence of potential DDIs (49.0%), followed by the abdominal surgery unit and dialysis (43.4 and 42.0%, respectively). The cardiothoracic surgery unit (41.6%), step-down unit (38.3%) and post-anaesthesia care unit (30.0%) were comparable. The operating theatre and endoscopy registered the fewest potential DDIs (28.2 and 22.7%, respectively). Adherence to alerts after the 'acknowledgement function' increased by 25.0% in the ICU, 54.0% in the cardiothoracic surgery unit, 52.5% in the abdominal surgery unit, 58.0% in the stepdown unit, 67.0% in dialysis, 51.0% in endoscopy and 48.0% in the post-anaesthesia care unit. In the operating theatre, adherence to alerts decreased from 34.0 to 30.0%. The incidence of potential DDIs after mandatory use of the 'acknowledgement function' decreased slightly in endoscopy (-2.9%), the abdominal surgery unit (-2.7%), dialysis (-1.9%) and the step-down unit (-1.4%).
Improving DDI alerts will improved patient safety by more appropriately alerting clinicians.
药物相互作用（DDIs）可能导致药物不良事件。信息技术（IT）系统可以成为医护人员识别药物相互作用的重要决策工具。
本研究旨在分析我院主要科室的药物处方，以衡量潜在药物相互作用的发生率和严重程度。还评估了临床决策支持系统（CDSSs）和计算机化医师医嘱录入（CPOE）在警报依从性方面的效用。使用Micromedex®医疗系列数据库评估药物相互作用。
医院采用的该系统会对具有负面相互作用的处方生成警报，并且借助“确认功能”可以核实医生对警报的依从性。此功能虽先前已使用，但自2010年9月起成为强制性要求。计算了在强制性“确认功能”实施前后，各分析科室医生对警报的依从性以及潜在药物相互作用的平均月发生率。
重症监护病房（ICU）潜在药物相互作用的发生率最高（49.0%），其次是腹部外科病房和透析科室（分别为43.4%和42.0%）。心胸外科病房（41.6%）、逐步降级病房（38.3%）和麻醉后护理病房（30.0%）的发生率相当。手术室和内镜科室潜在药物相互作用的发生率最低（分别为28.2%和22.7%）。在“确认功能”实施后，ICU对警报的依从性提高了25.0%，心胸外科病房提高了54.0%，腹部外科病房提高了52.5%，逐步降级病房提高了58.0%，透析科室提高了67.0%，内镜科室提高了5l.0%，麻醉后护理病房提高了48.0%。在手术室，对警报的依从性从34.0%降至30.0%。在强制性使用“确认功能”后，内镜科室（-2.9%）、腹部外科病房（-2.7%）、透析科室（-1.9%）和逐步降级病房（-1.4%）潜在药物相互作用的发生率略有下降。
改进药物相互作用警报将通过更适当地提醒临床医生来提高患者安全性。
