Implementation and Evaluation of a Clinical Decision Support Tool to Minimize Drug-Drug Interactions Among Older Patient Populations in Emergency Department and Ambulatory Care Settings

Older patients prescribed trimethoprim (TMP) with reninangiotensin-aldosterone system (RAAS) blocking agents may be at an increased risk of cardiac sudden death due to drug-induced hyperkalemia. Medication errors and clinical pharmacist observations at the University of Utah Health (UUH) reveal gaps in knowledge of the drug interaction between TMP and RAAS blocking agents. There are currently no published studies investigating the effects of a pharmacist-driven intervention on TMP prescribing patterns in the setting of concomitant RAAS blocking therapy. A pharmacist-driven BPA may be significantly impacting trimethoprim prescribing in 5 clinical areas. When the BPA fires, providers may prefer alternatives to trimethoprim in elderly patients or patients with renal insufficiency.