Rationalizing pharmacotherapy via performance feedback and computerized decision support in a national network of Intensive Care Units
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Context: In the Intensive Care environment where potentially interacting drugs are frequently co-prescribed there is no consensus on relevance of drug-drug interactions (DDIs). In addition, we lack evidence on the effectiveness of computerized decision support systems (CDSSs) on reducing potentially harmful co-prescriptions.
Goal: to improve pharmacological care in Dutch ICUs by establishing DDI relevance in the ICU and consequently assessing in an RCT the impact of performance feedback and computerized decision support on reduction of potentially harmful coprescriptions (main outcome). We also measure in one ICU the late effects of DDIs and the satisfaction of patients with an educational website.
Relevance identification of DDIs:
We will conduct analysis of medications of the 11 participating ICUs in order to identify potentially harmful comedications. This list is then scrutinized by a multidisciplinary team of intensivists and hospital pharmacists. Finally, actual patient harm will be assessed by chart reviews.
We will group DDI types into two subsets A and B. Then we will randomize ICUs on which DDI subset they receive performance feedback and decision support. In the first phase the ICUs will receive via a website feedback in the form of their comedication performance in the last months. In the second phase the prescribes in the ICU will receive carefully designed real time alerts on their prescribing behavior. We will measure the effect of the interventions on the reduction in the number of patients with at least one relevant comedication and number of comedications per patient-day. We will also assess the effect of DDIs on length of stay in the ICU.
In one ICU, which provides follow-up care we will ask patients additional questions about late effects of DDIs and provide them with an educational website about medicatio (interaction) and later measure their satisfaction with the educational website.