Real-time monitoring of drug laboratory test interactions: a proof of concept

Jasmijn A. van Balveren; Wilhelmine P.H.G. Verboeket-van de Venne; Carine J.M. Doggen; Lale Erdem-Eraslan; Albert J. de Graaf; Johannes G. Krabbe; Ruben E.A. Musson; Wytze P. Oosterhuis; Yolanda B. de Rijke; Heleen van der Sijs; Andrei N. Tintu; Rolf J. Verheul; Rein M.J. Hoedemakers; Ron Kusters

doi:10.1515/cclm-2021-0790

Article

Real-time monitoring of drug laboratory test interactions: a proof of concept

Jasmijn A. van Balveren , Wilhelmine P.H.G. Verboeket-van de Venne , Carine J.M. Doggen , Lale Erdem-Eraslan , Albert J. de Graaf , Johannes G. Krabbe , Ruben E.A. Musson , Wytze P. Oosterhuis , Yolanda B. de Rijke , Heleen van der Sijs , Andrei N. Tintu , Rolf J. Verheul , Rein M.J. Hoedemakers and Ron Kusters

Published/Copyright: November 9, 2021

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 60 Issue 2

Abstract

Objectives

For the correct interpretation of test results, it is important to be aware of drug-laboratory test interactions (DLTIs). If DLTIs are not taken into account by clinicians, erroneous interpretation of test results may lead to a delayed or incorrect diagnosis, unnecessary diagnostic testing or therapy with possible harm for patients. A DLTI alert accompanying a laboratory test result could be a solution. The aim of this study was to test a multicentre proof of concept of an electronic clinical decision support system (CDSS) for real-time monitoring of DLTIs.

Methods

CDSS was implemented in three Dutch hospitals. So-called ‘clinical rules’ were programmed to alert medical specialists for possible DLTIs based on laboratory test results outside the reference range in combination with prescribed drugs. A selection of interactions from the DLTI database of the Dutch society of clinical chemistry and laboratory medicine were integrated in 43 clinical rules, including 24 tests and 25 drugs. During the period of one month all generated DTLI alerts were registered in the laboratory information system.

Results

Approximately 65 DLTI alerts per day were detected in each hospital. Most DLTI alerts were generated in patients from the internal medicine and intensive care departments. The most frequently reported DLTI alerts were potassium-proton pump inhibitors (16%), potassium-beta blockers (11%) and creatine kinase-statins (11%).

Conclusions

This study shows that it is possible to alert for potential DLTIs in real-time with a CDSS. The CDSS was successfully implemented in three hospitals. Further research must reveal its usefulness in clinical practice.

Keywords: clinical decision support system (CDSS); drugs; interaction; laboratory test results

Corresponding author: Jasmijn A. van Balveren, MD, Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, Henri Dunantstraat 1, PO Box 90153, ’s-Hertogenbosch, The Netherlands; and Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands, Phone: +31 (0)73 553 27 64, Fax: +31 (0)73 5532958, LinkedIn: Jasmijn van Balveren, E-mail: ja.van.balveren@stjansdal.nl

Funding source: Stichting Kwaliteitsgelden Medisch Specialisten (SKMS)

Award Identifier / Grant number: 42678870

Acknowledgments

We thank all IT specialists of the participating hospitals and Paul de Clercq (founder of Gaston Medical) for their effort in implementing the CDSS.

Research funding: Funding from Stichting Kwaliteitsgelden Medisch Specialisten (SKMS), grant number 42678870.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

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Received: 2021-07-12

Accepted: 2021-10-28

Published Online: 2021-11-09

Published in Print: 2022-01-27

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Articles in the same Issue

https://doi.org/10.1515/cclm-2021-0790

Keywords for this article

clinical decision support system (CDSS); drugs; interaction; laboratory test results