Clinical decision support drug interaction alerts need overhaul, report finds

alertsA new report recognizes the frustration physicians commonly have with drug-drug interaction (DDI) alerts in clinical decision support software and presents a number of ways they could be improved.

“Improving the usability of DDI decision support is essential because patient safety is compromised when clinicians perceive DDI alerts as unimportant because of poor presentation or lack of relevance,” authors Payne et al. write in the March edition of the Journal of the American Medical Informatics Association.

The authors collected input from 24 experts over the course of a year to gain consensus on recommendations for how to improve DDI alerts in clinical decision support tools. The working group came up with these seven components that should be integrated into alerting systems for DDI warnings:

  • Drugs involved
    • The interacting drug pairs should be clearly identified
  • Seriousness
    • Consistent terms indicating seriousness of an interaction should be used
  • Clinical consequences
    • The potential adverse clinical outcomes for the patient taking the interacting drugs should be clearly described
  • Mechanism of the interaction
    • How the interaction occurs, if known, should be described so the prescriber can gain a better understanding of the problem and identify possible alternatives
  • Contextual information/modifying factors
    • Patient-specific factors, such as age, predisposing diseases and pharmacogenetic phenotype, should be included if available
  • Recommended action
    • Guidance on how harm can be mitigated should be included. Possible solutions include:
      • Dose modification
      • Order cancellation
      • Ordering an alternative medication
      • Monitoring/surveillance actions
    • Evidence
      • At least some information related to the strength and source of evidence for a given DDI should be available

Though not discussed at length in the review article, another area of improvement for drug-interaction software is the integration of patient genetic information that could inform prescribers of potential drug-gene or drug-drug-gene interactions.

Research done involving the YouScript Personalized Prescribing Software has found that as many as 33 percent of all potential clinically significant drug interactions involved genetics. These potential interactions are entirely missed by electronic health records and drug interaction software currently used by physicians, pharmacists, nurses and physician assistants. Learn more here about gene-related drug interactions that current drug interaction software programs could be missing.

Want to find out how YouScript could be built in to your workflow? Check out our downloadable primer on the YouScript Pilot Program to see how the patented software could be put to work for you.