Evidence map›Paper›PMID 40350265›Full record

ArticleBMJ quality & safety2025

Effectiveness of computerised alerts to reduce drug-drug interactions (DDIs) and DDI-related harm in hospitalised patients: a quasi-experimental controlled pre-post study.

Melissa Therese Baysari, Sarah Nicole Hilmer, Richard O Day, Bethany Annemarie Van Dort, Wu Yi Zheng, Renee Quirk, Danielle Deidun, Maria Moran, Kristian Stanceski, Nanda Aryal and 9 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ quality & safety, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

19 authors.

Melissa Therese BaysariFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia melissa.baysari@sydney.edu.au.ORCID http://orcid.org/0000-0003-1645-9126
Sarah Nicole HilmerClinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia.ORCID http://orcid.org/0000-0002-5970-1501
Richard O DayClinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
Bethany Annemarie Van DortFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-0052-6400
Wu Yi ZhengFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Renee QuirkFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Danielle DeidunFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Maria MoranFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Kristian StanceskiFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Nanda AryalCentre for Health Systems and Safety Reseach, Australian Institute of Health Innovation, faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Ahmed Abo SalemFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Lauren FarrowRobina Hospital, Robina, Queensland, Australia.
Jannah BakerCentre for Health Systems and Safety Reseach, Australian Institute of Health Innovation, faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Andrew HargreaveseHealth NSW, Chatswood, New South Wales, Australia.
James GrantOffice of the Chief Information Officer, Queensland Health, Fortitude Valley, Queensland, Australia.
Paula DohertyJohn Hunter Hospital, New Lambton Heights, New South Wales, Australia.
Karma Zarif Sourial MekhailBankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia.
Johanna I WestbrookCentre for Health Systems and Safety Reseach, Australian Institute of Health Innovation, faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0003-1083-8192
Ling LiCentre for Health Systems and Safety Reseach, Australian Institute of Health Innovation, faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.ORCID http://orcid.org/0000-0002-1642-142X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDrug-drug interaction (DDI) alerts target the co-prescription of two potentially interacting medications and are a frequent feature of electronic medical records (EMRs). There have been few controlled studies evaluating the effectiveness of DDI alerts. This study aimed to determine the impact of DDI alerts on rates of DDIs and on associated patient harms.

methodsQuasi-experimental controlled pre-post study in five Australian hospitals. Three hospitals acted as control hospitals (EMR with no DDI alerts) and two as intervention (EMR with DDI alerts). Only DDI alerts at the highest severity level (defined as 'major contraindicated') were switched on at intervention hospitals. These alerts were not tailored to clinical context (ie, patient, drug). A total of 2078 patients were randomly selected from all patients (adult and paediatric) admitted to hospitals 6 months before and 6 months after EMR implementation. A retrospective chart review was performed by study pharmacists. The primary outcome was the proportion of admissions with a clinically relevant DDI. Secondary outcomes included the proportions of admissions with a potential DDI and with DDI-related harm.

resultsPotential DDIs were identified in the majority of admissions (n=1574, 74.7%) and clinically relevant DDIs identified in half (n=1026, 48.7%). DDI alerts were associated with a reduction in the proportion of admissions with potential DDIs (adjusted OR (AOR)=0.38 (0.19, 0.78)) but no change in clinically relevant DDIs (AOR=1.12 (0.68, 1.84)) or in DDI-related harm (AOR=2.42 (0.47,12.31)). 199 DDIs (76 at control and 123 at intervention hospitals) for 35 patient admissions were associated with patient harm, and 2 patients experienced severe DDI-related harm pre-EMR implementation. DISCUSSION: Implementation of DDI alerts, without tailoring alerts to clinical context, is unlikely to reduce patient harms from DDIs. Organisations should reconsider implementation of DDI alerts in EMRs where significant tailoring of alerts is not possible. Future research should focus on identifying safe, efficient and cost-effective ways of refining DDI alerts, so expected clinical benefits are achieved, and negative consequences of excessive alerting are minimised.

Indexed as

Medical Order Entry SystemsMedication ErrorsAdultAgedAustraliaChildControlled Before-After StudiesDrug InteractionsDrug-Related Side Effects and Adverse ReactionsElectronic Health RecordsFemaleHospitalizationHumansMaleMiddle AgedRetrospective StudiesDecision support, computerizedHealth services researchMedication safety

Identifiers

PMID40350265
PMCPMC12703349

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.