sign in sign up
<<
Home , Drug interaction

SUPPLEMENTARY FILE

Appendix A. Clinical decision support alerts evaluated

 Dose (overdose) o Medications that are uncommonly ordered as standing (scheduled frequency and not pro re nata) . Metoprolol (intravenous) .  Lorazepam  . (subcutaneous) .  Fentanyl  Morphine   Drug-allergy o Alerts identified as ‘Very High’ importance o Definite (match of ordered medication and documented allergen) o Potentially life-threatening reactions . Anaphylaxis . Angioedema . Bronchospasm . Hepatotoxicity . Renal toxicity . Shortness of breath . Swelling . Other (see comments)  Evaluated free-text manually to match one of the above life- threatening reactions  Drug-drug o Amiodarone/dronedarone and o o ‘Contraindicated’ combinations per databank o Level 1 combinations from proprietary databank used in legacy electronic health record at our institution (i.e., combinations that were not allowed to be ordered together and required removal of one part of combination to progress with order) o QTc-prolonging agents . Amiodarone . . Fluconazole . . Levofloxacin . Methadone . Risperidone o Other . Randomized selection of ‘High’ severity alerts, based on frequency from pilot  Top 50% most frequent (n=3) o Angiotensin converting inhibitors – Angiotensin II blockers/Trimethoprim o Propofol – QT-prolonging medications o – Selected CYP3A4 inhibitors  Bottom 50% most frequent (n=5) o Ethacrynic – o Haloperidol – o / – Medications affecting gastric pH o – Monoamine oxidase inhibitorss o Posaconazole – QT-prolonging medications  Geriatric o All alerts  Renal o Medications with recommendation to not use in patient with renal impairment o Medications from proprietary databank used in legacy electronic health record at our institution . . Glyburide . Hydrochlorothiazide . . Metformin .

Appendix B. Geriatric alert appropriateness evaluation

Appendix C. Adverse drug events by alert type

Type of Alert Alert Details Classification

Allergy - Definite Medication: Vancomycin Inappropriate override

Documented reaction: Red man syndrome Definite ADE

Override reason: Does not apply to patient Severity: Serious

ADE: Small papule itchy skin rash

Allergy - Definite Medication: Vancomycin Inappropriate override

Documented reaction: Blisters, sloughing Definite ADE rash Severity: Serious Override reason: Benefit outweighs risks

ADE: Superficial sloughing and de-roofed blisters to left upper back

Allergy - Definite Medication: Oyxcodone/acetaminophen Inappropriate override

Documented reaction: Hallucinations Possible ADE

Override reason: Will monitor Severity: Serious

ADE: Hallucinations (e.g., rats crawling on ceiling)

Allergy - Definite Medication: Oyxcodone/acetaminophen Appropriate override

Documented reaction: Vomiting Possible ADE

Override reason: Will monitor Severity: Significant

ADE: Vomiting

DDI Medications: Amiodarone, digoxin Appropriate override

Override reason: Will monitor Possible ADE

ADE: Wide-complex tachycardia Severity: Serious

DDI Medications: Amiodarone, digoxin Appropriate override

Override reason: Patient tolerated before Possible ADE

ADE: Bradycardia Severity: Serious DDI - QTc Medications: Amiodarone, azithromycin Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 513 Severity: Serious

DDI - QTc Medications: Amiodarone, fluconazole Appropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 505 Severity: Serious

DDI - QTc Medications: Amiodarone, haloperidol Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 546 Severity: Serious

DDI - QTc Medications: Fluconazole, ciprofloxacin Appropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 546 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 530 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 501 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Appropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 525 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 525 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Appropriate override

Override reason: N/A Possible ADE ADE: QTc to 508 Severity: Serious

DDI - QTc Medications: Levofloxacin, Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 517 Severity: Serious

DDI - QTc Medications: Propofol, amiodarone Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 507 Severity: Serious

DDI - QTc Medications: Propofol, ciprofloxacin Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 621 Severity: Serious

DDI - QTc Medications: Propofol, escitalopram Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 527 Severity: Serious

DDI - QTc Medications: Propofol, levofloxacin Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 612 Severity: Serious

DDI - QTc Medications: Propofol, levofloxacin Appropriate override

Override reason: Benefit outweighs risk Possible ADE

ADE: QTc to 528 Severity: Serious

DDI - QTc Medications: Propofol, levofloxacin Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 518 Severity: Serious

DDI - QTc Medications: Amiodarone, azithromycin Inappropriate override

Override reason: Will monitor Possible ADE

ADE: Wide-complex tachycardia Severity: Serious

DDI - QTc Medications: Amiodarone, haloperidol Inappropriate override Override reason: N/A Possible ADE

ADE: QTc to 523 Severity: Serious

DDI - QTc Medications: Amiodarone, levofloxacin Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 600 Severity: Serious

DDI - QTc Medications: Amiodarone, propofol Inappropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 584 Severity: Serious

DDI - QTc Medications: Amiodarone, tacrolimus Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 590 Severity: Serious

DDI - QTc Medications: Ciprofloxacin, tacrolimus Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 590 Severity: Serious

DDI - QTc Medications: Fluconazole, propofol Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 616 Severity: Serious

DDI - QTc Medications: Fluconazole, propofol Inappropriate override

Override reason: benefit outweighs risk Possible ADE

ADE: QTc to 502 Severity: Serious

DDI - QTc Medications: Haloperidol, amiodarone Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 523 Severity: Serious

DDI - QTc Medications: Haloperidol, levofloxacin Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 512 Severity: Serious DDI - QTc Medications: Haloperidol, levofloxacin Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 510 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Inappropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 524 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Inappropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 506 Severity: Serious

DDI - QTc Medications: Haloperidol, quetiapine Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 500 Severity: Serious

DDI - QTc Medications: Levofloxacin, propofol Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 618 Severity: Serious

DDI - QTc Medications: Propofol, amiodarone Inappropriate override

Override reason: N/A Possible ADE

ADE: QTc to 584 Severity: Serious

DDI - QTc Medications: Propofol, ciprofloxacin Inappropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 696 Severity: Serious

DDI - QTc Medications: Propofol, escitalopram Inappropriate override

Override reason: Will monitor Possible ADE

ADE: QTc to 506 Severity: Serious

DDI - QTc Medications: Propofol, levofloxacin Inappropriate override

Override reason: N/A Possible ADE ADE: QTc to 557 Severity: Serious

DDI - QTc Medications: Trazodone, Inappropriate override

Override reason: N/A Possible ADE

ADE: Ventricular tachycardia Severity: Life-threatening

DDI - Medications: Tamsulosin, voriconazole Inappropriate override Contraindicated Override reason: N/A Possible ADE

ADE: Hypotension Severity: Serious

DDI - Medications: Dofetilide, prochlorperazine Inappropriate override Contraindicated Override reason: Will monitor Possible ADE

ADE: QTc to 526 Severity: Serious

DDI - Medications: Dofetilide, haloperidol Inappropriate override Contraindicated Override reason: N/A Possible ADE

ADE: QTc to 544 Severity: Serious

DDI - Medications: , Inappropriate override Contraindicated Override reason: N/A Possible ADE

ADE: Hallucination Severity: Significant

DDI - QTc Medications: Trazodone, voriconazole Appropriate override

Override reason: N/A Possible ADE

ADE: QTc to 517 Severity: Serious

Dose Medication: Lorazepam Inappropriate override

Override reason: N/A Possible ADE

ADE: Confusion, delirium Severity: Serious

Dose Medication: Lorazepam Inappropriate override

Override reason: N/A Possible ADE

ADE: Lethargy Severity: Serious

Dose Medication: Lorazepam Appropriate override Override reason: N/A Possible ADE

ADE: Altered mental status Severity: Serious

Dose Medication: Lorazepam Inappropriate override

Override reason: N/A Possible ADE

ADE: Somnolence Severity: Serious

Geriatric Medication: Amitryptyline Inappropriate override

Override reason: N/A Definite ADE

ADE: Confusion Severity: Serious

Renal Medication: Inappropriate override

Override reason: N/A Possible ADE

ADE: Acute injury Severity: Serious

Renal Medication: Chlorothiazide Inappropriate override

Override reason: N/A Possible ADE

ADE: Acute kidney injury Severity: Serious

Renal Medication: Chlorothiazide Inappropriate override

Override reason: N/A Possible ADE

ADE: Acute kidney injury Severity: Serious

Renal Medication: Mannitol Inappropriate override

Override reason: N/A Definite ADE

ADE: Acute kidney injury, Osm >320 Severity: Serious

ADE = adverse drug event; DDI = drug-drug interaction