Secondary Data for Clinical Pharmacists' Decision Support: Evaluating 'Triple Whammy' Interactions Within INTERPOLAR.

INTRODUCTION

The 'triple whammy' (TW) interaction consists of three drug classes that enlarge the risk for an acute kidney injury (AKI). Inside the INTERPOLAR consortium a core data set (CDS) tool chain was developed to extract data from a clinical FHIR-server into a study database and enrich the data with Clinical Pharmacist (CP)-reported medication review data.

METHODS

Patients with TW-interactions were extracted from the local INTERPOLAR database for six standard care wards along with medication and serum creatinine data (SCr). The extracted TW data was checked for completeness and accuracy. Additionally, it was evaluated how this interaction was addressed by CP.

RESULTS

Twenty-one of 2,805 cases showed at least one correct TW-administration (prevalence 0.7%). Data was found to be correct for 95% of all TW-administration lines (364/390 lines) and 97% of SCr values (73/75 values). Most patients with TW-administrations were admitted to surgical wards (18/21 patients). In 10/21 cases CP recommended changing the medication. Only for 6/21 TW patients enough SCr values were measured to calculate a potential adverse outcome (AKI).

DISCUSSION: Data could be extracted with sufficient precision to identify inpatient TW-interactions. Missing data mainly resulted from delayed resource arrival at the FHIR server. Limitations include the missing handling of intravenous medication compositions.