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MEDICATION SAFETY

Evaluation of Drug Interaction Software to Identify Alerts for Transplant Medications

at time of writing, Drug Information Specialty Resident, Shands Hospital, University of Florida, Gainesville, FL; now, Clinical Pharmacy Specialist in Drug Information, The Methodist Hospital, Houston, TX

Randy C Hatton, PharmD FCCP BCPS

Co-Director, Drug Information and Pharmacy Resource Center, Shands Hospital; Clinical Professor, College of Pharmacy, University of Florida

Amy L Fann, PharmD BCPS

Clinical Specialist in Solid Organ Transplantation, Shands Hospital, University of Florida; Clinical Assistant Professor, College of Pharmacy, University of Florida

Maher A Baz, MD

Associate Professor of Medicine, College of Medicine, University of Florida; Medical Director of Lung Transplantation, Department of Medicine Pulmonary Disease, Shands Teaching Hospital, University of Florida

Bruce Kaplan, MD

Professor of Medicine and Pharmacology, Central Florida Kidney Center Eminent Scholar; Medical Director of Renal and Pancreas Transplant, Division of Nephrology, Department of Medicine, College of Medicine, University of Florida

Reprints: Dr. Hatton, College of Pharmacy, University of Florida, 1600 Southwest Archer Rd., PO Box 100316, Gainesville, FL 32610-0316, fax 352/338-9860, hatton{at}shands.ufl.edu

BACKGROUND: The ability of computerized physician order entry (CPOE) systems to identify clinically significant drug interactions is dependent upon the integrity of the drug information populating the software. A CPOE system with incomplete or inaccurate drug information will fail to identify clinically important drug interactions and, therefore, fail to reduce preventable adverse drug events (pADEs).

OBJECTIVE: To evaluate, from the prescribers' perspective, the ability of a common drug interaction database to identify clinically important drug interactions involving drugs used in transplantation.

METHODS: The clinical significance of drug interactions involving 5 transplant drugs was evaluated by an expert panel to determine whether alerts should be generated for physicians not involved in the transplant at the time of order entry. Drug interactions included in the analysis were generated from the expert panel, a common drug interaction database, and 2 standard drug interaction references. Responses on the clinical significance were used to calculate the sensitivity, specificity, and positive and negative predictive values for each severity setting of a common electronic drug interaction database.

RESULTS: Overall, the database failed to identify approximately 70% of interactions considered significant by the expert panel. Of the alerts that were generated, >85% were considered clinically significant. The database was most deficient in identifying interactions resulting from additive toxicity.

CONCLUSIONS: To expect a decrease in pADEs caused by drug interactions, the information used to populate CPOE systems must be validated. Establishing consistency and integrity of this information may be a future role for pharmacists.

Key Words: computerized physician order entry, drug interaction software, drug interactions, transplantation

Published Online, December 14, 2004. www.theannals.com, DOI 10.1345/aph.1E331