背景:药物相互作用(DDI)可能会损害重症监护病房(ICU)的患者。然而,旨在帮助医生预防DDI的临床决策支持系统(CDS)受到低产量警报的困扰,引起警觉疲劳和危及患者安全。这项多中心研究的目的是评估针对ICU设置定制潜在DDI警报对施用高风险药物组合的频率的影响。
方法:我们在荷兰的9个ICU中实施了一项集群随机阶梯式楔形试验。五个ICU已经使用了潜在的DDI警报。包括年龄在18岁或更大的患者入住ICU并给予至少两种药物。我们的干预是适应性CDSS,仅为被认为是高风险的潜在DDI提供警报。干预是在ICU级别和目标医生进行的。我们假设仅显示相关警报将提高CDSS的有效性,并导致施用的高风险药物组合数量减少。在ICU中实施干预的顺序由独立研究人员随机分配。主要结果是每个患者每1000次药物施用中施用的高风险药物组合的数量,并在所有纳入的患者中进行评估。该试验于2018年11月26日在荷兰试验登记册(标识符NL6762)中注册,现已关闭。
结果:总计,对2018年9月1日至2019年9月1日期间入住ICU的10423例患者进行了评估,纳入了9887例患者。在干预组(n=5534)中,每位患者每1000次药物施用的高风险药物组合的平均数量为26·2(SD53·4),对照组为35·6(65·0)(n=4353)。为ICU量身定制潜在的DDI警报导致每位患者每1000个药物给药的高风险药物组合的给药数量减少了12%(95%CI5-18%;p=0·0008),在调整聚类和预后因素后。
结论:这项整群随机阶梯式楔形试验表明,为ICU设置定制潜在的DDI警报显着减少了施用高风险药物组合的数量。我们的高风险药物组合清单可用于其他ICU,我们基于临床相关性定制警报的策略可以应用于其他临床环境。
背景:ZonMw。
BACKGROUND: Drug-drug interactions (DDIs) can harm patients admitted to the intensive care unit (ICU). Yet, clinical decision support systems (CDSSs) aimed at helping physicians prevent DDIs are plagued by low-yield alerts, causing alert fatigue and compromising patient safety. The aim of this multicentre
study was to evaluate the effect of tailoring potential DDI alerts to the ICU setting on the frequency of administered high-risk drug combinations.
METHODS: We implemented a cluster randomised stepped-wedge
trial in nine ICUs in the Netherlands. Five ICUs already used potential DDI alerts. Patients aged 18 years or older admitted to the ICU with at least two drugs administered were included. Our intervention was an adapted CDSS, only providing alerts for potential DDIs considered as high risk. The intervention was delivered at the ICU level and targeted physicians. We hypothesised that showing only relevant alerts would improve CDSS effectiveness and lead to a decreased number of administered high-risk drug combinations. The order in which the intervention was implemented in the ICUs was randomised by an independent researcher. The primary outcome was the number of administered high-risk drug combinations per 1000 drug administrations per patient and was assessed in all included patients. This
trial was registered in the Netherlands
Trial Register (identifier NL6762) on Nov 26, 2018, and is now closed.
RESULTS: In total, 10 423 patients admitted to the ICU between Sept 1, 2018, and Sept 1, 2019, were assessed and 9887 patients were included. The mean number of administered high-risk drug combinations per 1000 drug administrations per patient was 26·2 (SD 53·4) in the intervention group (n=5534), compared with 35·6 (65·0) in the control group (n=4353). Tailoring potential DDI alerts to the ICU led to a 12% decrease (95% CI 5-18%; p=0·0008) in the number of administered high-risk drug combinations per 1000 drug administrations per patient, after adjusting for clustering and prognostic factors.
CONCLUSIONS: This cluster randomised stepped-wedge
trial showed that tailoring potential DDI alerts to the ICU setting significantly reduced the number of administered high-risk drug combinations. Our list of high-risk drug combinations can be used in other ICUs, and our strategy of tailoring alerts based on clinical relevance could be applied to other clinical settings.
BACKGROUND: ZonMw.