Evaluation of the Performance of Drug-Drug Interaction Screening Software in Community and Hospital Pharmacies

Abstract

harmacists play an important role in protecting the public from the dangers posed by potential drug-drug interactions (DDIs), which have been identified as an important subset of medication errors.1 They are uniquely trained to recognize medication-related problems and have the opportunity to review the medication profiles of patients in the inpatient and outpatient setting before dispensing occurs.One of the tools that pharmacists rely on to review medication profiles for DDIs is computerized screening for DDIs. Computerized screening for DDIs and other potential drug-related problems is embedded within most pharmacy computer systems that are used in community and hospital pharmacies and also is included in the prospective, online drug utilization review provided by pharmacy benefit managers. While manual review of medication regimens can be performed by pharmacists, recognition of DDIs without the use of an aid (e.g., drug interaction reference, computer program) only identifies approximately 70% of DDIs in a 2-drug regimen and the proportion decreases substantially as the number of medications increases.2 Thus, computerized DDI screening has the potential to significantly improve the recognition of potentially harmful DDIs beyond what can be achieved with manual review alone. 3Research on the performance of computerized DDI screening software and the references they are based on have found problems in the ability to provide consistent information and screen for clinically significant DDIs. [4][5][6][7][8] For example, in 2001, Hazlet et al. ABSTRACTBACKGROUND: Computerized drug-drug interaction (DDI) screening is widely used to identify potentially harmful drug combinations in the inpatient and outpatient setting.OBJECTIVE: To evaluate the performance of drug-drug interaction (DDI) screening software in identifying select clinically significant DDIs in pharmacy computer systems in community and hospital pharmacies.

Pharmacy Students' Ability to Identify Potential Drug-Drug Interactions

“…Several studies have demonstrated the inconsistency and overall limited reliability of DDI screening software to warn dispensing pharmacists of potential serious drug interactions. [9][10][11] A study of 9 software programs installed in chain and healthcare management organization (HMO) pharmacies in Washington found that DDI screening software failed to recognize clinically significant DDIs approximately a third of the time. 9 A repeat of the study several years later in Tucson, Arizona, investigated the reliability of screening software in 8 community pharmacies and 5 hospital pharmacies, and found that the software in use in the community pharmacies had a median sensitivity of 0.88 (range, 0.81-0.94) and a median specificity of 0.91 (range, 0.67-1.00), while hospital screening software performed slightly worse, with a median sensitivity of 0.38 (range, 0.15-0.94) and median specificity of 0.95 (range, 0.81-0.95).…”

“…9 A repeat of the study several years later in Tucson, Arizona, investigated the reliability of screening software in 8 community pharmacies and 5 hospital pharmacies, and found that the software in use in the community pharmacies had a median sensitivity of 0.88 (range, 0.81-0.94) and a median specificity of 0.91 (range, 0.67-1.00), while hospital screening software performed slightly worse, with a median sensitivity of 0.38 (range, 0.15-0.94) and median specificity of 0.95 (range, 0.81-0.95). 10 Another limitation of DDI screening software is the problem of high signal to noise ratio with respect to DDI warnings. Glassman et al reported that 55% of clinicians perceived excessive nonrelevant alerts as a barrier to using automated drug alerts.…”

“…6,7 Also, software programs and drug compendia do not always recognize all potential DDIs. [8][9][10][11] Abarca and colleagues investigated the inclusion of major DDIs in 4 commonly used drug compendia (Drug Interaction Facts, Drug Interactions: Analysis and Management, Evaluations of Drug Interactions, and the Micromedex DRUG-REAX program). 8 Of the 406 major DDIs investigated, 72% were listed in only 1 compendium.…”

“…8 Studies have demonstrated similar ''holes'' in DDI screening software. [9][10][11] Given these system inadequacies, it is critical to train pharmacists to identify potential DDIs and determine their clinical significance without reliance on other resources. To date, few published studies examine the relationship between pharmacists' level of knowledge of DDIs and how much time pharmacy students spend learning about DDIs.…”

Pharmacy Students’ Retention of Knowledge of Drug-Drug Interactions

“…Unfortunately, pharmacists' knowledge of DDIs and the reliability of their computer systems to detect DDIs are limited. [17][18][19][20][21] Few assessments of healthcare providers' DDI knowledge, their retention of information over time after being educated on DDI topics, and the amount of time they spend learning about DDIs have been reported in the literature. Understanding what pharmacists are taught regarding DDIs and how much information is retained could be useful in identifying strategies for increasing pharmacists' knowledge about DDIs.…”