Evaluation of Contraindicated Drug-Drug Interaction Alerts in a Hospital Setting
Evaluation of Contraindicated Drug-Drug Interaction Alerts in a Hospital Setting
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DOI：
10.1345/aph.1p533
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发表时间：
2011-03-01
影响因子：
2.9
通讯作者：
Lewis, James R.
中科院分区：
文献类型：
--
作者：
Hatton, Randy C.;Rosenberg, Amy F.;Lewis, James R.
背景：与禁忌药物相互作用警报（CDDIAs）相关的风险应始终大于获益。错误分类的CDDIAs应消除。目的：审查CDDIAs，并确定他们是否禁忌根据食品和药物管理局批准的产品标签，如果有情况下，禁忌的相互作用是可接受的。方法：一个横断面观察和质量改进研究进行了两个1年的时间。2007年5月至2008年5月的20例最常见的CDDIA和2008年4月至2009年4月的所有CDDIA均在一家大型教学医院收集。Horizon Meds Manager使用First Data Bank作为决策支持的知识库。如果在至少一种相互作用药物标签的禁忌症部分列出相互作用，则认为其确实禁忌。警报按药物和药理学类别分组，以评价支持这些相互作用相关性的证据。一个专家小组确定警报何时被错误分类。一个医疗咨询委员会确定是否禁忌的药物组合是acceptable.RESULTS：十二（60%）的最常见的20个禁忌的相互作用对2007年至2008年被不适当地分类。半数警报并非真正禁忌。8种真正禁忌的药物-药物对是酮咯酸和其他非甾体类药物或口服固体钾产品和抗胆碱能药物。这些相互作用中有一半后来被认为在特定情况下是可以接受的。在第二年也发现了类似的结果，尽管消除了第一年被错误分类的一些警报，但只有55.1%的CDDIAs是真正禁忌的。近四分之三的合法CDDIAs被认为是可接受的，在特定的countries.CONCLUSIONS：最禁忌的药物相互作用警报从商业知识库不适当的分类，可以降级。某些禁忌的药物组合在特定情况下是允许的。警告表明某些药物永远不应一起使用，但它们一起使用有时是可以接受的，这会导致警告疲劳。
BACKGROUND: Risks associated with contraindicated drug-drug interaction alerts (CDDIAs) should always outweigh benefits. Misclassified CDDIAs should be eliminated.OBJECTIVE: To review CDDIAs and determine if they are contraindicated according to Food and Drug Administration approved product labeling and if there are circumstances in which contraindicated interactions are acceptable.METHODS: A cross-sectional observational and quality improvement study was conducted over two 1-year periods. The 20 most common CDDIAs from May 2007 to May 2008 and all CDDIAs from April 2008 to April 2009 were collected at a large teaching hospital. Horizon Meds Manager used First Data Bank as the knowledge base for decision support. Interactions were deemed truly contraindicated if listed in the contraindications section of the labeling of at least one of the interact ng drugs. Alerts were grouped by drug and pharmacologic class to evaluate the evidence supporting the relevance of these interactions. An expert panel determined when an alert was misclassified. A medical advisory committee determined whether a contraindicated drug-drug combination was acceptable.RESULTS: Twelve (60%) of the most common 20 contraindicated interaction pairs from 2007 to 2008 were inappropriately classified. Half of the alerts were not truly contraindicated. The 8 truly contraindicated drug-drug pairs were ketorolac and other nonsteroidal antiinflammatory drugs or oral solid potassium products and anticholinergics. Half of these interactions were subsequently deemed acceptable under specific circumstances. Similar results were found in the second year, with only 55.1% of all CDDIAs being truly contraindicated despite eliminating some of the alerts that were misclassified in the first year. Nearly three fourths of legitimate CDDIAs were deemed acceptable under specific circumstances.CONCLUSIONS: Most contraindicated drug-drug interaction alerts from a commercial knowledge base were inappropriately categorized and could be downgraded. Some contraindicated drug combinations are permissible under specific circumstances. Alerts suggesting that certain drugs should never be used together, but their use together is sometimes acceptable, contribute to alert fatigue.