Drug-Drug Interactions and Actual Harm to Hospitalized Patients: A Multicentre Study Examining the Prevalence Pre- and Post-Electronic Medication System Implementation.
Ling Li, Jannah Baker, Renee Quirk, Danielle Deidun, Maria Moran, Ahmed Abo Salem, Nanda Aryal, Bethany A Van Dort, Wu Yi Zheng, Andrew Hargreaves, Paula Doherty, Sarah N Hilmer, Richard O Day, Johanna I Westbrook, Melissa T Baysari
Author Information
Ling Li: Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia. ling.li@mq.edu.au. ORCID
Jannah Baker: Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia. ORCID
Renee Quirk: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia.
Danielle Deidun: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia.
Maria Moran: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia.
Ahmed Abo Salem: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia.
Nanda Aryal: Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia. ORCID
Bethany A Van Dort: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia. ORCID
Wu Yi Zheng: Black Dog Institute, Sydney, NSW, Australia.
Andrew Hargreaves: eHealth NSW, Sydney, NSW, Australia.
Paula Doherty: John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia.
Sarah N Hilmer: Faculty of Medicine and Health, Kolling Institute, Northern Sydney Local Health District, The University of Sydney, Sydney, NSW, Australia. ORCID
Richard O Day: Clinical Pharmacology and Toxicology, Therapeutics Centre, St Vincent's Hospital, Sydney, Australia. ORCID
Johanna I Westbrook: Faculty of Medicine, Health and Human Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia. ORCID
Melissa T Baysari: Biomedical Informatics and Digital Health, University of Sydney, Sydney, NSW, Australia. ORCID
INTRODUCTION: Drug-drug interactions (DDIs) have potential to cause patient harm, including lowering therapeutic efficacy. This study aimed to (i) determine the prevalence of potential DDIs (pDDIs); clinically relevant DDIs (cDDIs), that is, DDIs that could lead to patient harm, taking into account a patient's individual clinical profile, drug effects and severity of potential harmful outcome; and subsequent actual harm among hospitalized patients and (ii) examine the impact of transitioning from paper-based medication charts to electronic medication management (eMM) on DDIs and patient harms. METHODS: This was a secondary analysis of the control arm of a controlled pre-post study. Patients were randomly selected from three Australian hospitals. Retrospective chart review was conducted before and after the implementation of an eMM system, without accompanying clinical decision support alerts for DDIs. Harm was assessed by an expert panel. RESULTS: Of 1186 patient admissions, 70.1% (n = 831) experienced a pDDI, 42.6% (n = 505) a cDDI and 0.9% (n = 11) an actual harm in hospital. Of 15,860 pDDIs identified, 27.0% (n = 4285) were classified as cDDIs. The median number of pDDIs and cDDIs per 10 drugs were 6 [interquartile range (IQR) 2-13] and 0 (IQR 0-2), respectively. In cases where a cDDI was identified, both drugs were 44% less likely to be co-administered following eMM (adjusted odds ratio 0.56, 95% confidence interval 0.46-0.73). CONCLUSION: Although most patients experienced a pDDI during their hospital stay, less than one-third of pDDIs were clinically relevant. The low prevalence of harm identified raises questions about the value of incorporating DDI decision support into systems given the potential negative impacts of DDI alerts.
References
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[PMID: 23092060]
