Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study

SIMPLIFY Study Group; Tinka Bakker; Ameen Abu-Hanna; Dave A Dongelmans; Wytze J Vermeijden; Rob J Bosman; Dylan W de Lange; Joanna E Klopotowska; Nicolette F de Keizer; S Hendriks; J Ten Cate; P F Schutte; D van Balen; M Duyvendak; A Karakus; M Sigtermans; E M Kuck; N G M Hunfeld; H van der Sijs; P W de Feiter; E-J Wils; P E Spronk; H J M van Kan; M S van der Steen; I M Purmer; B E Bosma; H Kieft; R J van Marum; E de Jonge; A Beishuizen; K Movig; F Mulder; E J F Franssen; W M van den Bergh; W Bult; M Hoeksema; E Wesselink

doi:10.1016/j.jcrc.2020.11.020

Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study

SIMPLIFY Study Group, Tinka Bakker^*, Ameen Abu-Hanna, Dave A Dongelmans, Wytze J Vermeijden, Rob J Bosman, Dylan W de Lange, Joanna E Klopotowska, Nicolette F de Keizer, S Hendriks, J Ten Cate, P F Schutte, D van Balen, M Duyvendak, A Karakus, M Sigtermans, E M Kuck, N G M Hunfeld, H van der Sijs, P W de FeiterE-J Wils, P E Spronk, H J M van Kan, M S van der Steen, I M Purmer, B E Bosma, H Kieft, R J van Marum, E de Jonge, A Beishuizen, K Movig, F Mulder, E J F Franssen, W M van den Bergh, W Bult, M Hoeksema, E Wesselink

^*Corresponding author for this work

Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting.

MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting.

RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs.

CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.

Original language	English
Pages (from-to)	124-130
Number of pages	7
Journal	Journal of Critical Care
Volume	62
DOIs	https://doi.org/10.1016/j.jcrc.2020.11.020
Publication status	Published - Apr-2021

Keywords

Intensive care
Drug-drug interactions
Patient safety
Pharmacoepidemiology
Clinical decision support
Medication safety

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SIMPLIFY Study Group, Bakker, T., Abu-Hanna, A., Dongelmans, D. A., Vermeijden, W. J., Bosman, R. J., de Lange, D. W., Klopotowska, J. E., de Keizer, N. F., Hendriks, S., Ten Cate, J., Schutte, P. F., van Balen, D., Duyvendak, M., Karakus, A., Sigtermans, M., Kuck, E. M., Hunfeld, N. G. M., van der Sijs, H., ... Wesselink, E. (2021). Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study. Journal of Critical Care, 62, 124-130. https://doi.org/10.1016/j.jcrc.2020.11.020

@article{7e04ea0b1a89481a9fab17cb1f19fcac,

title = "Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study",

abstract = "PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting.MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting.RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs.CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.",

keywords = "Intensive care, Drug-drug interactions, Patient safety, Pharmacoepidemiology, Clinical decision support, Medication safety",

author = "{SIMPLIFY Study Group} and Tinka Bakker and Ameen Abu-Hanna and Dongelmans, {Dave A} and Vermeijden, {Wytze J} and Bosman, {Rob J} and {de Lange}, {Dylan W} and Klopotowska, {Joanna E} and {de Keizer}, {Nicolette F} and S Hendriks and {Ten Cate}, J and Schutte, {P F} and {van Balen}, D and M Duyvendak and A Karakus and M Sigtermans and Kuck, {E M} and Hunfeld, {N G M} and {van der Sijs}, H and {de Feiter}, {P W} and E-J Wils and Spronk, {P E} and {van Kan}, {H J M} and {van der Steen}, {M S} and Purmer, {I M} and Bosma, {B E} and H Kieft and {van Marum}, {R J} and {de Jonge}, E and A Beishuizen and K Movig and F Mulder and Franssen, {E J F} and {van den Bergh}, {W M} and W Bult and M Hoeksema and E Wesselink",

year = "2021",

month = apr,

doi = "10.1016/j.jcrc.2020.11.020",

language = "English",

volume = "62",

pages = "124--130",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W B SAUNDERS CO-ELSEVIER INC",

}

SIMPLIFY Study Group, Bakker, T, Abu-Hanna, A, Dongelmans, DA, Vermeijden, WJ, Bosman, RJ, de Lange, DW, Klopotowska, JE, de Keizer, NF, Hendriks, S, Ten Cate, J, Schutte, PF, van Balen, D, Duyvendak, M, Karakus, A, Sigtermans, M, Kuck, EM, Hunfeld, NGM, van der Sijs, H, de Feiter, PW, Wils, E-J, Spronk, PE, van Kan, HJM, van der Steen, MS, Purmer, IM, Bosma, BE, Kieft, H, van Marum, RJ, de Jonge, E, Beishuizen, A, Movig, K, Mulder, F, Franssen, EJF, van den Bergh, WM , Bult, W, Hoeksema, M & Wesselink, E 2021, 'Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study', Journal of Critical Care, vol. 62, pp. 124-130. https://doi.org/10.1016/j.jcrc.2020.11.020

TY - JOUR

T1 - Clinically relevant potential drug-drug interactions in intensive care patients

T2 - A large retrospective observational multicenter study

AU - SIMPLIFY Study Group

AU - Bakker, Tinka

AU - Abu-Hanna, Ameen

AU - Dongelmans, Dave A

AU - Vermeijden, Wytze J

AU - Bosman, Rob J

AU - de Lange, Dylan W

AU - Klopotowska, Joanna E

AU - de Keizer, Nicolette F

AU - Hendriks, S

AU - Ten Cate, J

AU - Schutte, P F

AU - van Balen, D

AU - Duyvendak, M

AU - Karakus, A

AU - Sigtermans, M

AU - Kuck, E M

AU - Hunfeld, N G M

AU - van der Sijs, H

AU - de Feiter, P W

AU - Wils, E-J

AU - Spronk, P E

AU - van Kan, H J M

AU - van der Steen, M S

AU - Purmer, I M

AU - Bosma, B E

AU - Kieft, H

AU - van Marum, R J

AU - de Jonge, E

AU - Beishuizen, A

AU - Movig, K

AU - Mulder, F

AU - Franssen, E J F

AU - van den Bergh, W M

AU - Bult, W

AU - Hoeksema, M

AU - Wesselink, E

PY - 2021/4

Y1 - 2021/4

N2 - PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting.MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting.RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs.CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.

AB - PURPOSE: Potential drug-drug interactions (pDDIs) may harm patients admitted to the Intensive Care Unit (ICU). Due to the patient's critical condition and continuous monitoring on the ICU, not all pDDIs are clinically relevant. Clinical decision support systems (CDSSs) warning for irrelevant pDDIs could result in alert fatigue and overlooking important signals. Therefore, our aim was to describe the frequency of clinically relevant pDDIs (crpDDIs) to enable tailoring of CDSSs to the ICU setting.MATERIALS & METHODS: In this multicenter retrospective observational study, we used medication administration data to identify pDDIs in ICU admissions from 13 ICUs. Clinical relevance was based on a Delphi study in which intensivists and hospital pharmacists assessed the clinical relevance of pDDIs for the ICU setting.RESULTS: The mean number of pDDIs per 1000 medication administrations was 70.1, dropping to 31.0 when considering only crpDDIs. Of 103,871 ICU patients, 38% was exposed to a crpDDI. The most frequently occurring crpDDIs involve QT-prolonging agents, digoxin, or NSAIDs.CONCLUSIONS: Considering clinical relevance of pDDIs in the ICU setting is important, as only half of the detected pDDIs were crpDDIs. Therefore, tailoring CDSSs to the ICU may reduce alert fatigue and improve medication safety in ICU patients.

KW - Intensive care

KW - Drug-drug interactions

KW - Patient safety

KW - Pharmacoepidemiology

KW - Clinical decision support

KW - Medication safety

U2 - 10.1016/j.jcrc.2020.11.020

DO - 10.1016/j.jcrc.2020.11.020

M3 - Article

C2 - 33352505

SN - 0883-9441

VL - 62

SP - 124

EP - 130

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

Clinically relevant potential drug-drug interactions in intensive care patients: A large retrospective observational multicenter study

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Keywords

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