Recent publications have shown that many adverse drug reactions can be prevented and detected through the use of systems interventions.  For example, many health systems have instituted new technologies to minimize patient injury due to medication errors and drug-drug interactions.{Evans}{Bates 1998}{Gebhart}  Tools like computerized physician order and prescription entry{Bates 1998} and bar coding systems{Gebhart} have demonstrated  tangible benefits.  The potential for reducing medication errors by using computerized medical records  as well as drug-interaction screening software that detects and alerts the physician and/or pharmacist to potentially serious drug interactions has been recognized.{Committee}
These technological solutions do have limitations, however.  The fragmentation of healthcare delivery may result in incomplete records.  More significant is the fact that, although this information is available, it is not uniformly or optimally incorporated into decision making. This is exemplified in the observation by Cavuto et al. that pharmacists filled prescriptions for drug combinations that were known to interact even though computerized drug interaction software was in place. {Cavuto} This problem perists as shown in the 2000 paper by Smalley et al. on prescription errors with cisapride.{2842}
These findings should reinforce the need for the healthcare practitioner to develop their own systems approach to prescribing without creating undesireable drug interactions.  A fundamental understanding of the clinical pharmacology of drug interactions and a framework for avoiding preventable drug interactions remains critically important.  Incorporation of up-to-date computerized databases is valuable, and frequent consultation with other members of the healthcare team, such as nurses and pharmacists, is essential.
Bates DW, Leape LL, Cullen DJ, Laird N, Petersen LA, Teich JM et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998; 280(15):1311-1316
Evans RS, Pestotnik SL, Classen DC, Horn SD, Bass SB, Burke JP. Preventing adverse drug events in hospitalized patients. Ann Pharmacother 1994; 28(4):523-527.
Gebhart F. VA facility slashes drug errors via bar-coding. Drug Topics 1999; 1:44.
Committee on Quality of Health Care in America: Institute of Medicine. To err is human: building a safer health system. Washington, D.C.: National Academy Press, 2000.
Cavuto NJ, Woosley RL, Sale M. Pharmacies and prevention of potentially fatal drug interactions. JAMA 1996; 275:1086-1087.
Smalley W, Shatin D, Wysowski DK, Gurwitz J, Andrade SE, Goodman M et al. Contraindicated use of cisapride: impact of food and drug administration regulatory action. JAMA 2000; 284(23):3036-3039.