Co-prescribing of linezolid and serotonergic agents in a general hospital setting.

BACKGROUND: Co-prescription of linezolid and serotonergic agents (SSRIs, SNRIs, NaSSA, TCAs) can lead to serotonin syndrome, this study seeks to identify prescribing practise of these agents. METHODS: Study of all general hospital inpatients prescribed intravenous linezolid in a 3-month period, using drug charts and clinical notes. RESULTS: Co-prescription occurred in 20% with SSRIs most frequently concurrently used. There were no cases of serotonin syndrome. There was no evidence in clinical notes of vigilance for potential interaction. CONCLUSION: Co-prescription is common; awareness of potentially serious interaction is not evident in current practice.

Use of a computer to detect and respond to clinical events: its effect on clinician behavior.

A computer was used to prospectively detect and suggest responses to simple, medication-related events as reflected in a computerized record in a prospective, randomized study of a diabetes clinic with primary-care responsibility. There were two categories of event/suggestions: when the last observation of a test required for medication control was too old, the computer suggested a repeat; and when an abnormality with therapeutic implications was detected, the computer suggested a specific change in therapeutics. Clinicians responded to 36% of events in the first category with computer reminders and 11% without (P less than 0.0001); they responded to 28% of events in the second category with computer assistance and 13% without (P less than 0.026). For the most clinically significant of these second category events, the difference was even greater: 47% with and 4% without computer assistance (P less than 0.0004). I believe that computer detection and response (in the form of reminders) to simple clinical events will change clinician behavior.