Negligible impact of highly patient-specific decision support for potassium-increasing drug-drug interactions - a cluster-randomised controlled trial.

Background And Objective: Clinical decision support (CDS) might improve management of potassium-increasing drug-drug interactions (DDI). We studied CDS with five features intended to increase effectiveness: (i) focus on serious DDIs, (ii) fewer notifications, (iii) presentation of current laboratory results, (iv) timing (when adverse event becomes likelier), (v) removal of notification when appropriate.

Methods: We conducted a 1-year, hospital-wide, cluster-randomised controlled trial in the inpatient setting at a large tertiary-care academic medical centre.

Chronic Pain: How Challenging Are DDIs in the Analgesic Treatment of Inpatients with Multiple Chronic Conditions?

Background: Chronic pain is common in multimorbid patients. However, little is known about the implications of chronic pain and analgesic treatment on multimorbid patients. This study aimed to assess chronic pain therapy with regard to the interaction potential in a sample of inpatients with multiple chronic conditions.

Developing strategies for predicting hyperkalemia in potassium-increasing drug-drug interactions.

Objective: To compare different strategies predicting hyperkalemia (serum potassium level ≥5.5 mEq/l) in hospitalized patients for whom medications triggering potassium-increasing drug-drug interactions (DDIs) were ordered.

Materials And Methods: We investigated 5 strategies that combined prediction triggered at onset of DDI versus continuous monitoring and taking into account an increasing number of patient parameters.

Too frequent low-dose methotrexate prescriptions: multicentre quality control and quality assurance with pre- and post-analysis.

Introduction: Methotrexate is used to treat many medical conditions with medication schedules that differ widely in dosage and frequency. The high potential of erroneous too frequent low-dose methotrexate prescriptions leading to severe adverse reactions is well known; however, documentation is mainly limited to case reports. We reviewed all methotrexate prescriptions in a secondary and a tertiary care hospital to analyse the incidence of too frequent low-dose methotrexate prescriptions, and assessed the quality assurance concepts implemented.

Earlier switching from intravenous to oral antibiotics owing to electronic reminders.

Unlabelled: Paper-based interventions have been shown to stimulate switching from intravenous (i.v.) to oral (p.

Impact of Specific Alerts in Potassium-Increasing Drug-Drug Interactions.

Alerts in potassium(K+)-increasing drug-drug interactions (DDIs) are often ignored due to their low specificity. Although different approaches have been implemented to address DDIs, subsequent clinical studies revealed poor adherence to such alerts. We therefore suggest a novel alert concept currently being evaluated in a randomized clinical trial in a large teaching hospital.

Patient- and physician-related risk factors for hyperkalaemia in potassium-increasing drug-drug interactions.

Purpose: Hyperkalaemia due to potassium-increasing drug-drug interactions (DDIs) is a clinically important adverse drug event. The purpose of this study was to identify patient- and physician-related risk factors for the development of hyperkalaemia.

Methods: The risk for adult patients hospitalised in the University Hospital Zurich between 1 December 2009 and 31 December 2011 of developing hyperkalaemia was correlated with patient characteristics, number, type and duration of potassium-increasing DDIs and frequency of serum potassium monitoring.

Evaluation of alerts for potassium-increasing drug-drug-interactions.

Electronic alerts for preventing hyperkalaemia during potassium-increasing drug-drug-interactions (DDIs) are often overridden due to their low specificity. Treatments of 76,467 inpatients were retrospectively analysed to establish more specific alerts. Alerting concepts for identifying DDIs that induced hyperkalaemia (serum potassium ≥5.

Use of an on-demand drug-drug interaction checker by prescribers and consultants: a retrospective analysis in a Swiss teaching hospital.

Background: Offering a drug-drug interaction (DDI) checker on-demand instead of computer-triggered alerts is a strategy to avoid alert fatigue.

Objective: The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients.

Methods: The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital.

Clinical decision support for monitoring drug-drug-interactions and potassium-increasing drug combinations: need for specific alerts.

Computer-triggered reminders alerting physicians on every potentially harmful drug-drug-interaction (DDI) induce alert fatigue due to frequent messages of limited clinical relevance. On demand DDI-checks, however, are not commonly used by physicians. Optimal strategies for sustained quality assurance have to consider patients' risk factors and focus on the most significant DDIs only.