Tinka Bakker1, Ameen Abu-Hanna2, Dave A Dongelmans3, Wytze J Vermeijden4, Rob J Bosman5, Dylan W de Lange6, Joanna E Klopotowska7, Nicolette F de Keizer8, S Hendriks9, J Ten Cate10, P F Schutte10, D van Balen11, M Duyvendak12, A Karakus13, M Sigtermans13, E M Kuck14, N G M Hunfeld15, H van der Sijs16, P W de Feiter17, E-J Wils17, P E Spronk18, H J M van Kan19, M S van der Steen20, I M Purmer21, B E Bosma22, H Kieft23, R J van Marum24, E de Jonge25, A Beishuizen26, K Movig27, F Mulder28, E J F Franssen29, W M van den Bergh30, W Bult31, M Hoeksema32, E Wesselink33. 1. Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Electronic address: t.bakker1@amsterdamumc.nl. 2. Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Electronic address: a.abu-hanna@amsterdamumc.nl. 3. Amsterdam UMC (location AMC), Department of Intensive Care Medicine, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Electronic address: d.a.dongelmans@amsterdamumc.nl. 4. Department of Intensive Care, Medisch Spectrum Twente, Koningsplein 1, 7512, KZ, Enschede, the Netherlands. Electronic address: j.vermeijden@mst.nl. 5. Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091, AC, Amsterdam, the Netherlands. Electronic address: r.j.bosman@olvg.nl. 6. Department of Intensive Care and Dutch Poison Information Center, University Medical Center Utrecht, University Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: d.w.delange@umcutrecht.nl. 7. Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Electronic address: j.e.klopotowska@amsterdamumc.nl. 8. Amsterdam UMC (location AMC), Department of Medical Informatics, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands. Electronic address: n.f.keizer@amsterdamumc.nl. 9. Department of Intensive Care, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands. 10. Department of Intensive Care, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 11. Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, the Netherlands. 12. Department of Hospital Pharmacy, Antonius Hospital, Sneek, The Netherlands. 13. Department of Intensive Care Diakonessenhuis Utrecht, Utrecht, The Netherlands. 14. Department of Hospital Pharmacy, Diakonessenhuis Utrecht, Utrecht, The Netherlands. 15. Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands; Department of Hospital Pharmacy, ErasmusMC, Rotterdam, The Netherlands. 16. Department of Hospital Pharmacy, Erasmus MC, University Medical Center, Rotterdam, The Netherlands. 17. Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands. 18. Department of Intensive Care Medicine, Gelre Hospitals, Apeldoorn, The Netherlands. 19. Department of Clinical Pharmacy, Gelre Hospitals, Apeldoorn, The Netherlands. 20. Department of Intensive Care, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. 21. Department of Intensive Care, Haga Hospital, The Hague, The Netherlands. 22. Department of Hospital Pharmacy, Haga Hospital, The Hague, The Netherlands. 23. Department of Intensive Care, Isala Hospital, Zwolle, The Netherlands. 24. Department of Clinical Pharmacology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands; Amsterdam UMC (location VUmc), Department of Elderly Care Medicine, Amsterdam, The Netherlands. 25. Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands. 26. Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands. 27. Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands. 28. Department of Pharmacology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands. 29. OLVG Hospital, Department of Clinical Pharmacy, Amsterdam, The Netherlands. 30. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 31. Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 32. Zaans Medisch Centrum, Department of Anesthesiology, Intensive Care and Painmanagement, Zaandam, The Netherlands. 33. Department of Clinical Pharmacy, Zaans Medisch Centrum, Zaandam, The Netherlands.
Abstract
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 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 considering 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.
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 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 considering 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.
Authors: Arthur T M Wasylewicz; Britt W M van de Burgt; Thomas Manten; Marieke Kerskes; Wilma N Compagner; Erik H M Korsten; Toine C G Egberts; Rene J E Grouls Journal: Clin Pharmacol Ther Date: 2022-06-27 Impact factor: 6.903
Authors: Tinka Bakker; Dave A Dongelmans; Ehsan Nabovati; Saeid Eslami; Nicolette F de Keizer; Ameen Abu-Hanna; Joanna E Klopotowska Journal: J Clin Pharmacol Date: 2022-02-21 Impact factor: 2.860