Kannan Bhaskar, Nagella Amrutha Bindu, Sathia Prabhu A, Sasidharan Gopalakrishnan M, Ramesh A S, Madhugiri Venkatesh
Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Department of Anesthesiology and Critical Care, Mahatma Gandhi Medical College and Research Institute, Pondicherry, India.
Cureus. 2016 Nov 22;8(11):e886. doi: 10.7759/cureus.886.
Drug-drug interactions (DDIs) are very common adverse events in health care delivery settings. The use of electronic pharmacopeias can potentially reduce the incidence of DDIs, but they are often thought to be cumbersome to use. This study is aimed at studying the incidence of potential DDIs in a surgical department, where a limited number of drugs are used in stereotyped combinations. We also compared two popular drug compendia in detecting potential DDIs.
The prescriptions of selected patients were entered into Epocrates® and Medscape® for Android smartphones. Potential DDIs were generated and their categories were noted. The warnings generated by Epocrates® were compared with those generated by Medscape® and an agreement index was calculated.
Three hundred and thirty-one patients were included for analysis who had received a total of 2,878 drug orders. The incidence of potential DDIs was very high - 89% of all prescriptions. Phenytoin was the drug most commonly implicated, followed by furosemide. Of the DDIs detected, 0.14% were potentially serious and the drug combinations were contraindicated. There was a significant discrepancy between the categories of potential DDIs detected by Epocrates® and Medscape®. No clinically significant DDI was detected in any patient in this cohort.
Despite routinely using only a limited number of drugs in stereotyped combinations, prescriptions in surgical departments may not be immune from a significant incidence of DDIs. The use of free apps could reduce the incidence of DDIs, enhance patient safety, and also aid in educating trainees.
药物相互作用（DDIs）是医疗服务环境中非常常见的不良事件。使用电子药典有可能降低药物相互作用的发生率，但人们通常认为其使用起来很麻烦。本研究旨在调查外科科室中潜在药物相互作用的发生率，该科室使用的药物种类有限且组合固定。我们还比较了两种常用药物手册在检测潜在药物相互作用方面的表现。
将选定患者的处方录入适用于安卓智能手机的Epocrates®和Medscape®应用程序中。生成潜在的药物相互作用并记录其类别。将Epocrates®生成的警告与Medscape®生成的警告进行比较，并计算一致性指数。
纳入331例患者进行分析，这些患者共接受了2878次用药医嘱。潜在药物相互作用的发生率非常高——占所有处方的89%。苯妥英是最常涉及的药物，其次是呋塞米。在检测到的药物相互作用中，0.14%可能具有严重后果，且这些药物组合是禁忌的。Epocrates®和Medscape®检测到的潜在药物相互作用类别之间存在显著差异。该队列中的任何患者均未检测到具有临床意义的药物相互作用。
尽管外科科室通常仅常规使用有限数量的药物且组合固定，但该科室的处方仍可能存在较高的药物相互作用发生率。使用免费应用程序可以降低药物相互作用的发生率，提高患者安全性，也有助于培训学员。
