Drug–Drug Interactions and Actual Harm to Hospitalized Patients: A Multicentre Study Examining the Prevalence Pre- and Post-Electronic Medication System Implementation

Ling Li (), Jannah Baker, Renee Quirk, Danielle Deidun, Maria Moran, Ahmed Abo Salem, Nanda Aryal, Bethany A. Dort, Wu Yi Zheng, Andrew Hargreaves, Paula Doherty, Sarah N. Hilmer, Richard O. Day, Johanna I. Westbrook and Melissa T. Baysari
Additional contact information
Ling Li: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University
Jannah Baker: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University
Renee Quirk: University of Sydney
Danielle Deidun: University of Sydney
Maria Moran: University of Sydney
Ahmed Abo Salem: University of Sydney
Nanda Aryal: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University
Bethany A. Dort: University of Sydney
Wu Yi Zheng: Black Dog Institute
Andrew Hargreaves: eHealth NSW
Paula Doherty: John Hunter Hospital, Hunter New England Local Health District
Sarah N. Hilmer: Kolling Institute, Northern Sydney Local Health District, The University of Sydney
Richard O. Day: St Vincent’s Hospital
Johanna I. Westbrook: Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University
Melissa T. Baysari: University of Sydney

Drug Safety, 2024, vol. 47, issue 6, No 6, 557-569

Abstract: Abstract Introduction Drug–drug interactions (DDIs) have potential to cause patient harm, including lowering therapeutic efficacy. This study aimed to (i) determine the prevalence of potential DDIs (pDDIs); clinically relevant DDIs (cDDIs), that is, DDIs that could lead to patient harm, taking into account a patient’s individual clinical profile, drug effects and severity of potential harmful outcome; and subsequent actual harm among hospitalized patients and (ii) examine the impact of transitioning from paper-based medication charts to electronic medication management (eMM) on DDIs and patient harms. Methods This was a secondary analysis of the control arm of a controlled pre-post study. Patients were randomly selected from three Australian hospitals. Retrospective chart review was conducted before and after the implementation of an eMM system, without accompanying clinical decision support alerts for DDIs. Harm was assessed by an expert panel. Results Of 1186 patient admissions, 70.1% (n = 831) experienced a pDDI, 42.6% (n = 505) a cDDI and 0.9% (n = 11) an actual harm in hospital. Of 15,860 pDDIs identified, 27.0% (n = 4285) were classified as cDDIs. The median number of pDDIs and cDDIs per 10 drugs were 6 [interquartile range (IQR) 2–13] and 0 (IQR 0–2), respectively. In cases where a cDDI was identified, both drugs were 44% less likely to be co-administered following eMM (adjusted odds ratio 0.56, 95% confidence interval 0.46–0.73). Conclusion Although most patients experienced a pDDI during their hospital stay, less than one-third of pDDIs were clinically relevant. The low prevalence of harm identified raises questions about the value of incorporating DDI decision support into systems given the potential negative impacts of DDI alerts.

Date: 2024
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DOI: 10.1007/s40264-024-01412-w

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