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Drug interaction alerts
Responding to drug interaction alerts is difficult
From Dr K. E. Neil, MRPharmS
A recent Broad Spectrum article (PJ, 22 November, p708) draws
attention to some of
the problems associated with responding to drug interactions in primary
care and particularly community pharmacy. This is an area in which I
have been interested for some time.
The problems with drug interaction alerts highlighted by John Wilson
are common to both general practice and community pharmacy. They leave
health professionals feeling overwhelmed and it is therefore not surprising
that many of these copious warnings are ignored.
Dr Ivan H. Stockley from the University of Nottingham is recognised as
a world expert in the field of drug interactions and has produced a comprehensive
reference book. This is an essential guide to the clinical relevance
of drug interactions and provides concise advice regarding their management.
I take my own copy to all locum placements and find that general practitioners
are grateful when I relay the practical information it contains.
I find that one of the most difficult problems relates to those interactions
that require close monitoring. Community pharmacists do not currently
have access to biochemical data and the decision to contact the GP is
a difficult one. Added to time restraints, dealing with drug interaction
queries is extremely difficult and good support staff are essential.
When working as a community pharmacist, I find myself selectively contacting
GPs I know who welcome such intervention, or occasionally asking patients
when they last had a blood test.
There is work under way to improve drug interaction software and Dr Stockley
has produced a database including short advisory messages for GPs and
pharmacists. The National Patient Safety Agency is currently involved
in work to identify hazardous interactions with the aim of making warnings
relating to these interactions difficult to override. In the meantime,
I would encourage readers to consult ‘Stockley’s drug interactions’.1 Readers may also be interested in the
prescribing safety series currently running in Prescriber (www.escriber.com),
which includes examples of detailed case studies taken from our work
on the prescribing of
hazardous or contraindicated drug combinations in general
practice.2
Karen Neil
Nottingham
References
1. I. H. Stockley (editor). Stockley’s drug interactions, 6th edition.
London: Pharmaceutical Press; 2002.
2. Chen YF, Avery AJ, Neil KE. Assessing the occurrence and preventability
of prescribing potentially hazardous/contraindicated drug combinations
in general (family) practice. Pharmacoepidemiol Drug Safety 2001;10:S53.
Serious interactions may be overlooked
From Mr P. J. Beckley, MRPharmS
As a pharmacist working in a “prescription factory” receiving
many prescriptions with more than 10 items, usually for patients over
80 years old, I would like to express my appreciation to John Wilson
for drawing attention to the problem caused by computerised
drug interaction alerts (PJ, 22 November, p708).
My system even flashes up an “interaction” between identical
drugs, eg, diclofenac, and I have been concerned for some time that serious
interactions may be overlooked in such a maze of misleading information.
I sincerely hope that the companies responsible for these programs will
consider the issues raised in this excellent article and work with community
pharmacists to resolve them.
Peter Beckley
Crawley, West Sussex
Overhaul has already been done
From Dr I. H. Stockley, FRPharmS
The title of John Wilson’s Broad Spectrum article (“Crying
wolf! Why computerised drug interaction alerts need an overhaul” (PJ,
22 November, p708) neatly sums up his conclusions after tussling with
some obviously irritating and unhelpful interaction alerts while doing
locums. But Mr Wilson, I have already done this overhauling exercise.
It is very much past history. What needs to be done now is the replacement
of these alerting systems by something much better.
My overhaul almost precisely followed Mr Wilson’s list of recommendations.
I went through the vast list of interactions to filter off the “noise” of
unimportant interactions, retaining only those where the pharmacist needs
to do something in response. I wrote a series of short alerts saying
what happens (and sometimes why) when particular pairs of drugs interact.
Each alert was given a broad “hazard/severity” rating with
an indication of incidence and magnitude wherever possible; and all of
them were rounded off with a suggested course of action for the pharmacist.
I also designed the alerts to be linked to a coloured traffic-light coding
system.
You can see these “Stockley Drug Interaction Alerts” in action
on NDC’s “Pharmacy Manager” computer system in the
United Kingdom. A new combined system of alerts appropriate for both
doctors and pharmacists has also recently been written.
I think that these alerts are practically tailor-made for Mr Wilson’s
requirements. But do not just take my word for it. See for yourself.
Ivan Stockley
Willoughby-on-the-Wolds,
Leicestershire |
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