Electronic note | Electronic note + phone call | |||||
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Category | Patient’s age in years (mean ± SD) | Top 5 patients’ wards (% of actions) | Top 5 drugs (% of actions) | Patient’s age in years (mean ± SD) | Top 5 patients’ wards (% of actions) | Top 5 drugs (% of actions) |
Drug use in renal insufficiency | 74 ± 15 | 1. ED (33%) 2. Nephrology (9%) 3. Vascular sg (8%) 4. Cardiac sg (6%) 5. Pneumology (5%) | 1. Enoxaparin (43%) 2. Spironolactone (13%) 3. Metformin (13%) 4. Allopurinol (9%) 5. Vancomycin (5%) | 72 ± 15 | 1. ED (38%) 2. Nephrology (9%) 3. Abdominal Tx (9%) 4. Vascular sg (9%) 5. Cardiac sg (9%) | 1. Enoxaparin (48%) 2. Spironolactone (14%) 3. Rivaroxaban (14%) 4. Vancomycin (6%) 5. Tinzaparin (6%) |
Drugs with high potential of QTc prolongation | 70 ± 16 | 1. ED (19%) 2. Vascular sg (4%) 3. Hematology Tx (4%) 4. Cardiac sg (4%) 5. Hematology (4%) | 1. Levofloxacin (36%) 2. Ondansetron (14%) 3. Fluconazol (12%) 4. Haloperidol (10%) 5. Sotalol (9%) | 74 ± 15 | 1. ED (19%) 2. Cardiology (10%) 3. Geriatrics (6%) 4. Thoracic sg (6%) 5. Internal medicine (5%) | 1. Levofloxacin (40%) 2. Fluconazol (12%) 3. Moxifloxacin (12%) 4. Ondansetron (9%) 5. Sotalol (9%) |
Drugs with restricted indication or dosing | 47 ± 27 | 1. Pediatric hematology-oncology (13%) 2. Pneumology (11%) 3. ED (9%) 4. Daycare ward pediatrics (4%) 5. Trauma sg (4%) | 1. Meropenem high dose (36%) 2. Linezolid indication (17%) 3. Colistin dose (17%) 4. Temocillin indication (14%) 5. Rifampin indication (10%) | 50 ± 24 | 1. Pneumology (16%) 2. ED (10%) 3. Pediatric hematology-oncology (8%) 4. Septic orthopedic sg (4%) 5. Trauma sg (4%) | 1. Meropenem high dose (32%) 2. Colistin dose (20%) 3. Linezolid indication (14%) 4. Temocillin indication (14%) 5. Rifampin indication (9%) |
Overruled very severe DDIs | 70 ± 16 | 1. Thoracic sg (11%) 2. ED (8%) 3. Trauma sg (5%) 4. Urology (5%) 5. Vascular sg (4%) | 1. QTc prolonging drugsd & antiarrhythmic drugs (29%) 2. Factor Xa inhibitors & anticoagulants (15%) 3. Antiarrhythmic drugs & antipsychotics (12%) 4. Antiarrhythmic drugs & non-selective antidepressants (10%) 5. Metformin & contrast agents (5%) | 72 ± 14 | 1. Trauma sg (10%) 2. Vascular sg (8%) 3. ED (8%) 4. Internal medicine (7%) 5. Urology (7%) | 1. Factor Xa inhibitors & anticoagulants (37%) 2. QTc prolonging drugsd & antiarrhythmic drugs (17%) 3. Antiarrhythmic drugs & antipsychotics (11%) 4. CYP3A4 substrates & CYP3A4 inhibitors (8%) 5. Antiarrhythmic drugs & non-selective antidepressants (5%) |