Prevention of adverse drug reactions in intensive care patients by personal intervention based on an electronic clinical decision support system

Intensive Care Med. 2010 Apr;36(4):665-72. doi: 10.1007/s00134-010-1778-8. Epub 2010 Feb 9.


Objective: We investigated the effect of written drug information for senior clinicians on the incidence of drug-drug interactions (DDIs) and DDI-related adverse events in intensive care patients.

Design and methods: A prospective controlled intervention cohort study was conducted in a medical intensive and intermediate care unit in a university hospital. From 1,062 consecutive intensive care patients, those 265 (control: 136, intervention: 129) with > or =8 concurrently prescribed drugs were included in the study (to include high-risk patients with polypharmacy). The DDI information for senior clinicians during an intervention period of 3 months was based on a computerised clinical decision support system (CDSS) containing information on risk and management of 9,453 drug combinations.

Results: The number of patients with at least one DDI at the end of the respective study phase decreased by 18% (relative risk reduction) from 90 (66%) patients in controls to 70 (54%) in the intervention group (p = 0.02). The relative risk of a patient suffering from at least one DDI-related adverse event decreased by 43% from 60 (44%) patients in controls to 32 (25%) in the intervention group (p < 0.01). Among these events, the incidence of QT(C) prolongation was reduced by 64% from 15 (11%) patients in the control group to 5 (4%) in the intervention group (p = 0.04), and the incidence of hypokalemia by 80% from 14 (10%) to 2 (2%, p < 0.01).

Conclusion: Written drug information based on a CDSS considerably decreased DDIs and DDI-related adverse events in routine practice.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Drug Reaction Reporting Systems
  • Case-Control Studies
  • Chi-Square Distribution
  • Critical Care / methods*
  • Decision Support Systems, Clinical*
  • Drug Interactions
  • Drug-Related Side Effects and Adverse Reactions / prevention & control*
  • Female
  • Hospitals, University
  • Humans
  • Male
  • Middle Aged
  • Polypharmacy
  • Prospective Studies
  • Statistics, Nonparametric