Two Extra Minutes for Medication Safety?

As the population ages and medicine continues to advance, people are living longer and healthier; but they are also taking more medications for more medical conditions. Those medications can cause drug-drug interactions that lead to adverse drug reactions (ADR). Studies have shown that the majority of medication errors happen at the stage of prescription.

ADRs are a serious cause of mortality, morbidity and costs in the healthcare system worldwide. It’s a simple fact that clinical decision support systems (CDSS) prevent ADR; but they do come at a cost — both in terms of capital investment in a reliable system and in time spent with patients. Yet, not much research is available regarding how practical implementing a CDSS is in a hospital or physician practice workflow.

A recent study in BMC Anesthesiology sought to quantify the time cost of using a CDSS, and to make a strong case that just over two extra minutes can save lives. The study retrospectively reviewed medical records study in the chronic pain unit at the University Hospital Regensburg in Germany. The population pool consisted of 113 patients who were undergoing chronic pain therapy at the chronic pain unit from 2012 to 2013.

Information about the patient’s medication was gathered, including the type and the total amount of medications that had been prescribed. Three CDSS were selected: the two freely available internet-based interaction check systems: the “Apotheken Umschau,” WebMD’s Medscape, and the commercially available AiDKlinik^®. These systems were chosen because they are either free or commercially available, are meant to be used by both patients and physicians or by heath care professionals only, and are applicable to drugs approved in a specific country or internationally. Only patient pharmacotherapies with at least two prescribed drugs and fitting the criteria of the corresponding CDSS were analyzed.

The time needed to analyze patient pharmacotherapy for DDIs was taken with a stopwatch. Measurements included the time needed for running the analysis and printing the results. The study noted some strengths and weaknesses of the three CDSS observed and some important limitations, including the fact that the Medscape tool is more targeted toward Anglo-American countries and did not recognize some of the medications commonly used in Germany.

Overall, the results showed that applying a CDSS to examine a patient’s drug regimen for potential drug-drug interactions causes an average extra expenditure of work time of 2:09 minutes, which extends patient treatment time by 25% on average. Nevertheless, the authors believe that the extra expenditure of time employing a CDSS is outweighed by their benefits, including reduced ADR risks and safer clinical drug management.

“Importantly, a modest increase in treatment time must be set in relation to the large numbers of DDIs that were actually detected in the patient’s pharmacotherapies and the obvious necessity to avert ADRs which in principal are preventable,” the study authors noted. “Keeping in mind that ADRs are a serious cause of morbidity, mortality and costs in healthcare, it seems more reasonable to spend a rather small amount of time for a DDI check than unnecessarily risking patient welfare or to invest a definitely greater amount of time and money in order to deal with the effects of ADRs.”