Use of an On-demand Drug–Drug Interaction Checker by Prescribers and Consultants: A Retrospective Analysis in a Swiss Teaching Hospital

Abstract

Offering a drug-drug interaction (DDI) checker on-demand instead of computer-triggered alerts is a strategy to avoid alert fatigue. The purpose was to determine the use of such an on-demand tool, implemented in the clinical information system for inpatients. The study was conducted at the University Hospital Zurich, an 850-bed teaching hospital. The hospital-wide use of the on-demand DDI checker was measured for prescribers and consulting pharmacologists. The number of DDIs identified on-demand was compared to the number that would have resulted by computer-triggering and this was compared to patient-specific recommendations by a consulting pharmacist. The on-demand use was analyzed during treatment of 64,259 inpatients with 1,316,884 prescriptions. The DDI checker was popular with nine consulting pharmacologists (648 checks/consultant). A total of 644 prescribing physicians used it infrequently (eight checks/prescriber). Among prescribers, internists used the tool most frequently and obtained higher numbers of DDIs per check (1.7) compared to surgeons (0.4). A total of 16,553 DDIs were identified on-demand, i.e., <10% of the number the computer would have triggered (169,192). A pharmacist visiting 922 patients on a medical ward recommended 128 adjustments to prevent DDIs (0.14 recommendations/patient), and 76% of them were applied by prescribers. In contrast, computer-triggering the DDI checker would have resulted in 45 times more alerts on this ward (6.3 alerts/patient). The on-demand DDI checker was popular with the consultants only. However, prescribers accepted 76% of patient-specific recommendations by a pharmacist. The prescribers' limited on-demand use indicates the necessity for developing improved safety concepts, tailored to suit these consumers. Thus, different approaches have to satisfy different target groups.