Purpose: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all... Show morePurpose: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting. Materials & methods: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting. Results: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when con -sidering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs. Conclusions: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients. ? 2020 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/). Show less
Adverse drug events (ADEs) refer to any injury from the use of a drug. ADEs occur frequently in hospitalized patients and a substantial proportion are considered preventable. A method to prevent... Show moreAdverse drug events (ADEs) refer to any injury from the use of a drug. ADEs occur frequently in hospitalized patients and a substantial proportion are considered preventable. A method to prevent ADEs is computerized physician order entry (CPOE) combined with a clinical decision support system (CDSS). This thesis describes the development and validation of our CDSS with clinical rules, called Adverse Drug Event Alerting System (ADEAS). The development and validation of ADEAS was successful but time-consuming. Further, this thesis describes the investigations in which 1) the ability of ADEAS to identify patients at risk of ADEs are studied and 2) the ability in which these potential ADEs can be prevented by interventions by the hospital pharmacist are studied. The results of the clinical validity studies show that ADEAS is able to identify patients at risk of ADEs and that this method is a useful addition to the conventional medication surveillance. The clinical utility studies show that ADEAS can effectively be used in daily hospital pharmacy practice to identify patients at risk of potential ADEs and that ADEAS based interventions by the hospital pharmacist can reduce the number of preventable ADEs. For future use the rule effectiveness and positive predictive value of the clinical rules should be improved. Show less
