Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts.
INTRODUCTION
Drug-drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients' medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems.


METHODS AND ANALYSIS
A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three as intervention sites with DDI alerts. The medical records of 280 patients admitted in the 6 months prior to and 6 months following implementation of the EMM system at each site (total 3360 patients) will be retrospectively reviewed by study pharmacists to identify potential DDIs, clinically relevant DDIs and associated patient harm. To identify barriers and facilitators to optimal use of alerts, 10-15 doctors working at each intervention hospital will take part in observations and interviews. Non-identifiable DDI alert data will be extracted from EMM systems 6-12 months after system implementation in order to quantify alert burden on prescribers. Finally, data collected from chart review and EMM systems will be linked with clinically relevant DDIs to inform the development of algorithms to trigger only clinically relevant DDI alerts in EMM systems.


ETHICS AND DISSEMINATION
This research was approved by the Hunter New England Human Research Ethics Committee (18/02/21/4.07). Study results will be published in peer-reviewed journals and presented at local and international conferences and workshops.
['Baysari|Melissa T|MT|0000-0003-1645-9126', 'Zheng|Wu Yi|WY|', 'Li|Ling|L|', 'Westbrook|Johanna|J|', 'Day|Richard O|RO|0000-0002-6045-6937', 'Hilmer|Sarah|S|', 'Van Dort|Bethany Annemarie|BA|0000-0003-0052-6400', 'Hargreaves|Andrew|A|', 'Kennedy|Peter|P|', 'Monaghan|Corey|C|', 'Doherty|Paula|P|', 'Draheim|Michael|M|', 'Nair|Lucy|L|', 'Samson|Ruby|R|']
D003625:Data Collection D020000:Decision Support Systems, Clinical D004347:Drug Interactions D057286:Electronic Health Records D005500:Follow-Up Studies D006801:Humans D050316:Medical Order Entry Systems D008510:Medication Systems, Hospital D009517:New South Wales D011793:Queensland D017010:Reminder Systems D012189:Retrospective Studies
decision support drug-drug interaction alert alert fatigue