Introduction: We developed an enhancement to a chemotherapy order-entry system that alerted prescribers to potential drug interactions between patients' usual outpatient medications and those prescribed for onsite cancer treatment. This report summarizes the interactions and analyzes the impact of alerts on clinician behavior.
Methods: We studied electronic orders created from November 2010 to December 2011 by oncology clinicians at two comprehensive cancer centers who shared a chemotherapy order-entry system and an ambulatory electronic medical record. The enhancement generated an alert if a new chemotherapy system order for an antineoplastic agent or supportive care medication interacted with an existing medication in the ambulatory record, and tracked prescribers' responses.
Results: New chemotherapy system orders triggered 29,592 drug interaction alerts. New orders for antineoplastic agents accounted for 495 (32.6%) of 1518 high- and medium-severity alerts. Interactions with antibiotics accounted for the majority of these alerts. New chemotherapy system orders for antiemetics triggered 352 (23.2%) alerts and more than two-thirds were attributed to interactions with analgesic opioids. High- and medium-severity alerts changed prescriber behavior in 224 (14.8%) occurrences, including potentially fatal interactions between meperidine and monoamine oxidase inhibitors. Clinicians who overrode alerts indicated that they would monitor the patient (54.6%), the patient already tolerated the combination (24.5%), and they would adjust the dose (15.1%).
Conclusion: Cancer patients are at risk of serious interactions between medications ordered for cancer care and those provided for general medical care. Organizations and order-entry applications should develop countermeasures to identify and prevent potentially serious drug interactions.
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http://dx.doi.org/10.1177/1078155213487395 | DOI Listing |
Eur J Clin Pharmacol
February 2025
Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Purpose: To explore how hospital interns and residents specialising in family medicine act on drug interaction alerts in a specific patient case, and on interaction alerts in general.
Methods: A 4-page questionnaire, including a fictional patient case (73-year-old woman; 10 drugs in the medication list triggering 11 drug interaction alerts) and questions regarding the use of interaction alerts in general, was distributed to interns and residents during educational sessions (November‒December 2023). The respondents were instructed to consider what actions they would take "a normal day at work" due to the risk of interactions between the patients' drugs.
J Pharm Technol
October 2024
Department of Pharmacy, Henry Ford Hospital, Detroit, MI.
Purpose: To evaluate judicious antibiotic prescribing of benzathine penicillin G (BPG) after implementation of an electronic health record-based medication shortage alert during a critical drug shortage.
Methods: This was an institutional review board-approved retrospective cohort study of patients aged ≥3 months who received BPG between May 9, 2023, and February 28, 2024. The study included inpatient and outpatient visits after implementing a BPG medication shortage alert; patients with severe penicillin allergy, neurosyphilis, or congenital syphilis were excluded.
JMIR Form Res
November 2024
Michigan Program on Value Enhancement, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
Background: While direct oral anticoagulants (DOACs) have improved oral anticoagulation management, inappropriate prescribing remains prevalent and leads to adverse drug events. Antithrombotic stewardship programs seek to enhance DOAC prescribing but require scalable and sustainable strategies.
Objective: We present a pilot, prescriber-level randomized controlled trial to assess the effectiveness of electronic health record (EHR)-based medication alerts in a large health system.
BMJ Health Care Inform
November 2024
Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
Objectives: Technology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors (TREs) occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of TREs using prescribing error data from two adult hospitals.
View Article and Find Full Text PDFJt Comm J Qual Patient Saf
December 2024
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