Pediatric Informatics: Computer Applications in Child Health (Health ...

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challenges regarding their set-up, customizability, and maintenance discussed for
dose checking apply to allergy and interaction screening.
Drug-interaction checking 9 should also be considered core CDS functionality.
This clinical check is frequently performed through a separate and tandem CDS
system. As with other clinical alerting systems, noise, and alert fatigue are concerns,
although most third party system databases are typically conservative and
inclusive (i.e. theoretical, potential, and low-risk interactions are included in
warnings), with limited ability to filter these.
In this case, filtering may be available through the PharmIS, which may be used
to filter warnings from the third party CDS data bases secondarily through natural
language or logical processing (such as suppression of “interaction significance:
minor” and “level of documentation: theoretical,” etc.). Knowledge and control
of the PharmIS filtering interfaces and of which drug interaction combinations
are being filtered is essential. In addition to the technical challenges this approach
poses are issues of sharing proprietary knowledge of the CDS third-party vendors.
Drug interaction functionality is present in most systems. An important configuration
consideration is the type of medication orders or circumstances that are
included in interaction checking. For example, a drug that has been discontinued
for a patient, but which has a prolonged half-life, may need to be considered regarding
possible interactions when new drugs are prescribed. This may include drugs
which are given once in a sustained-release form or in patients (such as those with
renal or hepatic failure) with impaired excretion of a previously administered drug
(which may not be listed as active).
27.3.3.3 Identifying and Flagging Duplicate Orders/Therapies
A PharmIS should automatically screen patient medication profiles for duplicate
therapies. This issue may occur in geriatric and home health populations, 10 but
may occur in any patient. One difficulty in screening for duplication lies in how it
is defined. “Duplicate orders” may refer to an exact medication match (one drug
at one dose for a given schedule), while duplicate therapies may be considered
different drugs that have the same indication or be of the same classes (such as
furosemide and chlorothiazide (for diuresis) or ibuprofen and naproxen (for pain) ).
Differentiation of true alerts from clinically acceptable and appropriate “duplications”
(such as tapering doses of a drug or multiple routes of administration for
nursing discretion) may be challenging. Current experience of many is that the
noise of these types of alerts often far exceeds perceived benefit. Solutions may
include local configuration of PharmIS alerts (instead of utilizing a third-party CDS
product) or suppression of specific duplicate alerts (that are known to be “noisy”).
27.3.3.4 Providing Patient and Drug-Specific Warnings
Other patient and drug-specific warnings that have been provided in PharmIS
CDS include drug-laboratory test, drug-pregnancy, drug-lactation, and age-specific