International Journal of Clinical Pharmacy

, Volume 34, Issue 4, pp 547–552 | Cite as

Evaluation of drug–drug interaction screening software combined with pharmacist intervention

  • Cristiano S. MouraEmail author
  • Nília M. Prado
  • Najara O. Belo
  • Francisco A. Acurcio
Research Article


Background Drug-drug interactions (DDI) in hospitalized patients are highly prevalent and an important source of adverse drug reactions. DI computerized screening system can prevent the occurrence of some of these events. Objective To evaluate the impact of drug–drug interaction (DDI) screening software combined with active intervention in preventing drug interactions. Setting The study was conducted at General Hospital of Vitória da Conquista (HGVC), Brazil. Method A quasi-experimental study was used to evaluate the impact of IM-Pharma, a locally developed drug–drug interaction screening system, coupled with pharmacist intervention on adverse drug events in the hospital setting. Main outcome measure The proportion of patients co-prescribed two interacting drugs were measured in two phases, prior the implementation of IM-Pharma and during the intervention period. DDI rates per 100 patient days were calculated before and after implementation. Risk ratios were estimated by Poisson regression models. Results A total of 6,834 instances of drug–drug interactions were identified; there was an average of 3.3 DDIs per patient in phase one and 2.5 in phase two, a reduction of 24 % (P = 0.03). There was a 71 % reduction in high-severity drug–drug interaction (P < 0.01). The risk for all DDIs decreased 50 % after the implementation of IM-Pharma (P < 0.01), and for those with high-severity, the reduction was 81 % (P < 0.01). Conclusion The performance of IM-Pharma combined with pharmacist intervention was positive with an expressive reduction in the risk of DDIs.


Brazil Drug–drug interactions Pharmacist intervention Prescriptions Screening software 



The authors thank undergraduate students Ludmila Tavares, Jessica Bomfim, Luana Costa and Priscila Porto for their participation in collecting data and Andre Barboni and his team from State University of Feira de Santana who collaborated in the development of the DDI screening software.


This work was supported by the Bahia State Research Foundation (FAPESB).

Conflicts of interest

The authors have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Ernst FR, Grizzle AJ. Drug-related morbidity and mortality: updating the cost-of-illness model. J Am Pharm Assoc (Wash). 2001;41(2):192–9.Google Scholar
  2. 2.
    Rottenkolber D, Schmiedl S, Rottenkolber M, Farker K, Salje K, Mueller S, et al. Adverse drug reactions in Germany: direct costs of internal medicine hospitalizations. Pharmacoepidemiol Drug Saf. 2011;20(6):626–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Classen DC, Pestotnik SL, Evans RS, Burke JP. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991;266(20):2847–51.PubMedCrossRefGoogle Scholar
  4. 4.
    Glintborg B, Andersen SE, Dalhoff K. Drug–drug interactions among recently hospitalised patients–frequent but mostly clinically insignificant. Eur J Clin Pharmacol. 2005;61(9):675–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Moura CS, Acurcio FA, Belo NO. Drug–drug interactions associated with length of stay and cost of hospitalization. J Pharm Pharm Sci. 2009;12(3):266–72.PubMedGoogle Scholar
  6. 6.
    Radosevic N, Gantumur M, Vlahovic-Palcevski V. Potentially inappropriate prescribing to hospitalised patients. Pharmacoepidemiol Drug Saf. 2008;17(7):733–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Riechelmann RP, Zimmermann C, Chin SN, Wang L, O’Carroll A, Zarinehbaf S, et al. Potential drug interactions in cancer patients receiving supportive care exclusively. J Pain Symptom Manage. 2008;35(5):535–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Abarca J, Colon LR, Wang VS, Malone DC, Murphy JE, Armstrong EP. Evaluation of the performance of drug–drug interaction screening software in community and hospital pharmacies. J Manag Care Pharm. 2006;12(5):383–9.PubMedGoogle Scholar
  9. 9.
    Chan A, Yap KY, Koh D, Low XH, Cheung YT. Electronic database to detect drug–drug interactions between antidepressants and oral anticancer drugs from a cancer center in Singapore: implications to clinicians. Pharmacoepidemiol Drug Saf. 2011;20(9):939–47.PubMedGoogle Scholar
  10. 10.
    Halkin H, Katzir I, Kurman I, Jan J, Malkin BB. Preventing drug interactions by online prescription screening in community pharmacies and medical practices. Clin Pharmacol Ther. 2001;69(4):260–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Hazlet TK, Lee TA, Hansten PD, Horn JR. Performance of community pharmacy drug interaction software. J Am Pharm Assoc (Wash). 2001;41(2):200–4.Google Scholar
  12. 12.
    Taylor LK, Tamblyn R. Reasons for physician non-adherence to electronic drug alerts. Stud Health Technol Inform. 2004;107(Pt 2):1101–5.PubMedGoogle Scholar
  13. 13.
    Chen YF, Avery AJ, Neil KE, Johnson C, Dewey ME, Stockley IH. Incidence and possible causes of prescribing potentially hazardous/contraindicated drug combinations in general practice. Drug Saf. 2005;28(1):67–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Humphries TL, Carroll N, Chester EA, Magid D, Rocho B. Evaluation of an electronic critical drug interaction program coupled with active pharmacist intervention. Ann Pharmacother. 2007;41(12):1979–85.PubMedCrossRefGoogle Scholar
  15. 15.
    Murray MD, Ritchey ME, Wu J, Tu W. Effect of a pharmacist on adverse drug events and medication errors in outpatients with cardiovascular disease. Arch Intern Med. 2009;169(8):757–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Moura CS, Ribeiro AQ, Starling SM. Avaliação de interações medicamentosas potenciais em prescrições médicas do Hospital das clínicas da Universidade Federal de Minas Gerais. Lat Am J Pharm. 2007;26(4):596–601.Google Scholar
  17. 17.
    Tatro D. Drug Interaction Facts 2008: Facts and Comparisons. St. Louis: Wolters Kluwer Health Inc; 2008. ISBN: 15 7 439274 3.Google Scholar
  18. 18.
    Tobi H, Faber A, van den Berg PB, Drane JW. de Jong-van den Berg LT. Studying co-medication patterns: the impact of definitions. Pharmacoepidemiol Drug Saf. 2007;16(4):405–11.PubMedCrossRefGoogle Scholar
  19. 19.
    Bates DW, Cullen DJ, Laird N, Petersen LA, Small SD, Servi D, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995;274(1):29–34.PubMedCrossRefGoogle Scholar
  20. 20.
    Morales Conejo M, Moreno Cuerda VJ, Abellan Martinez J, Rubio R. Serious adverse events derived from the drug interactions of antiretroviral therapy. Rev Clin Esp. 2008;208(11):557–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Papadopoulos J, Smithburger PL. Common drug interactions leading to adverse drug events in the intensive care unit: management and pharmacokinetic considerations. Crit Care Med. 2010;38(6 Suppl):S126–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS. Physicians’ decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003;163(21):2625–31.PubMedCrossRefGoogle Scholar
  23. 23.
    Paterno MD, Maviglia SM, Gorman PN, Seger DL, Yoshida E, Seger AC, et al. Tiering drug–drug interaction alerts by severity increases compliance rates. J Am Med Inform Assoc. 2009;16(1):40–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Mallet L, Spinewine A, Huang A. The challenge of managing drug interactions in elderly people. Lancet. 2007;370(9582):185–91.PubMedCrossRefGoogle Scholar
  25. 25.
    White CM, Dunn A, Tsikouris J, Waberski W, Felton K, Freeman-Bosco L, et al. An assessment of the safety of short-term amiodarone therapy in cardiac surgical patients with fentanyl-isoflurane anesthesia. Anesth Analg. 1999;89(3):585–9.PubMedGoogle Scholar
  26. 26.
    Larson RJ, Fisher ES. Should aspirin be continued in patients started on warfarin? J Gen Intern Med. 2004;19(8):879–86.PubMedCrossRefGoogle Scholar
  27. 27.
    Schneitman-McIntire O, Farnen TA, Gordon N, Chan J, Toy WA. Medication misadventures resulting in emergency department visits at and HMO medical center. Am J Health Syst Pharm. 1996;53(12):1416–22.PubMedGoogle Scholar
  28. 28.
    McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36(9):1331–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Cristiano S. Moura
    • 1
    Email author
  • Nília M. Prado
    • 1
  • Najara O. Belo
    • 1
  • Francisco A. Acurcio
    • 2
  1. 1.Federal University of BahiaVitória da ConquistaBrazil
  2. 2.Federal University of Minas GeraisBelo HorizonteBrazil

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