View source for Drug-drug interaction

A '''drug-drug interactions''' is an [[adverse drug event]].

== Introduction ==

many organizations quickly realize that "Tylenol interacts with everything".

So you get a lot of alerts that fire at the “mild,” “moderate,” and “severe” level.  So many organizations do a lot of tweaking of their clinical decision support early-on.  For example, they turn off the “mild,” alerts after consultation with their pharmacy and therapeutics or physician review board.  Then they turn off the “moderate” alerts after additional consultations. These decisions are particularly effective in hospitals with all-attending staff, where they routinely get comments from the physicians that like, “’Severe’ is all we need here.”

Missed drug-drug interactions can lead to [[Medication errors|medication errors]]

When implementing '''drug-drug interactions''', many organizations quickly realize that "Tylenol interacts with everything".  So you get a lot of alerts that fire at the “mild,” “moderate,” and “severe” level.  So many organizations do a lot of tweaking of their clinical decision support early-on.  For example, they turn off the “mild,” alerts after consultation with their pharmacy and therapeutics or physician review board.  Then they turn off the “moderate” alerts after additional consultations. These decisions are particularly effective in hospitals with all-attending staff, where they routinely get comments from the physicians that like, “’Severe’ is all we need here.”

It is recommended to start Low and go slow. The default position for all interruptive alerts is off, and to gradually turn them on as the hospital culture matures. Hospitals that have started with the default on, had to later turn them off but in the process they lost the providers community trust in the system and have already built the bad habit of overriding the alert without even reading it. Evaluating which Drug-Drug interaction to turn on is a daunting challenge for each hospital to undertake individually. There is minimal data on the risk benefit analysis to help guide the prioritization process. A hospital will need to evaluate not only the potential severity of harm to the patient but also the likelihood of that harm as well as the frequency of us of this particular medication combination. For example, hospitals would start with alerts that have a high likelihood of a severe harm in a medication combination that is rarely used, and leave an alert for a rare mild patient impact resulting from a commonly prescribed combination for last. 

Also if hospitals undertake these challenges on their own, there is always the liability issue resulting from their decisions. If there is a patient harm happened from a combination medication that the institution had elected to turn off, are they liable? This is why a national/organizational effort to sort these alerts and prioritize them for hospitals would be very helpful.

[[Category:CDS]]


[[Category:CDS]]