For ambulatory care clinicians who use electronic prescribing, medication safety alerts are familiar, but not always welcome.
Most alerts warn about the potential adverse effects of combining medications. Clinicians are often ambivalent about these warnings. Some alerts are useful, while others are a nuisance. Busy prescribers who encounter numerous alerts daily can become habituated, a phenomenon known as “alert fatigue,” and are at higher risk of ignoring important warnings.
In order to assist clinicians who prescribe electronically, the Dana-Farber Center for Patient Safety, with support from the Physicians’ Foundation for Health Systems Excellence, studied the value of drug interaction alerts.
We examined the behavior of more than 2,000 clinicians in three states who used the PocketScript electronic prescribing system. We calculated the rate with which clinicians accepted (and rejected) high-severity drug interaction alerts among all classes of medications.
This information offers important insight into which types of alerts clinicians found most and least useful. Acceptance rates varied between 2.2% and 43.1%, depending on the interacting classes of medications.
We list here the high-severity medication interactions that had the highest and lowest acceptance rates. The list may also help clinicians who lack access to electronic prescribing, since the list of accepted alerts identifies common medication combinations that should often be avoided.
See a complete list of the 100 highest and lowest acceptance rates
High severity interactions with highest accept rates
non-cardioselective beta blockers*macrolides
macrolides*calcium channel blocking agents
ophthalmic glaucoma agents*adrenergic bronchodilators
macrolides*coumarins and indandiones
potassium-sparing diuretics*minerals and electrolytes
sulfonamides*coumarins and indandiones
impotence agents*antianginal agents
potassium-sparing diuretics*angiotensin converting enzyme inhibitors
antihypertensive combinations*antihypertensive combinations
analgesic combinations*SSNRI antidepressants
smoking cessation agents*quinolones
calcium channel blocking agents*antiarrhythmic agents
upper respiratory combinations*quinolones
smoking cessation agents*anorexiants
upper respiratory combinations*TOPIRAMATE
Printable list of top 20 potentially dangerous drug combinations
For more information, contact Thomas_Isaac@dfci.harvard.edu
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