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Customize Your Drug Interaction Clinical Decision Support Software

Clinical decision support (CDS) for drug interaction (DI) screening is well known for its excessive alerts (false positives) and its lack of alerts for newly identified drug interactions (false negatives). Many of the systems used to classify potential drug interactions are based on outdated or irrelevant criteria. The result is a CDS program that is barely tolerated by pharmacists and one that is sure to defeat any attempt to introduce computerized physician order entry in your institution. Some users have responded by turning off whole sections of the DI database to lessen the number of interaction alerts. This is usually done without an awareness of the potential consequences. In one famous example, a pharmacy was successfully litigated against when a patient was injured by an interaction that had been blocked from the system. Other approaches have included assembling a team to modify the DI CDS, but the reality is that few will actually possess the knowledge necessary to do a credible job. For example, how will you ensure consistency in re-classification when multiple reviewers with varying degrees of knowledge are involved? How will you handle interactions involving drugs that are reported to prolong QT intervals, selective and nonselective beta blocker interactions, or drug pairs with boxed warnings in the labeling? Those who have attempted in-house customization report that one should expect to spend 0.5 to 1.0 FTE or more on this project. To overcome these obstacles, it may be more prudent and economical to trust software customization to experts in the field of drug interactions.

Hansten and Horn now offer two distinct options for customization of your drug interaction CDS software. The first involves a detailed assessment of your CDS drug information database to eliminate unnecessary alerts. We will work with you to develop a set of alerts that meet the specific needs of your institution. We can also provide education and training to your staff on how to best use the drug interaction screening software and other resources that are available. When completed, your DI alerts will be markedly reduced and limited to those that present risk to patients.

Alternatively, if this approach goes beyond what your organization requires, we can provide a list of interactions classified as MAJOR in most DI CDS databases and identify the interactions we believe can be demoted to a less significant rating. You can incorporate as many or as few of the suggested modifications into your DI database as is appropriate for your institution. While you will not benefit from a complete database review, this approach may provide a more accessible and affordable alternative while enabling in-house control of the effort and the opportunity to develop more expertise in the DI CDS databases.

Drs. Philip Hansten and John Horn are recognized international authorities in the field of drug-drug interactions, and have a combined experience of more than 75 years working with drug interactions. They co-author Hansten and Horn's Drug Interactions Analysis and Management, a standard drug interaction reference for more than 30 years. Their pocket-sized reference, The Top 100 Drug Interactions: A Guide to Patient Management is in its 20th edition. Hansten and Horn's drug interaction books have been translated into 6 languages and have sold more than one million copies worldwide since 1971. They have authored over 300 articles on various aspects of drug interactions.

Contact Hansten and Horn at info@hanstenandhorn.com for more information on how we can help you customize your drug interaction CDS software.