Quality of prescribing decision support in primary care: still a work in progress

Clinical software governance and real-world testing involving users are urgently needed

In this issue of the Journal, a study from the National Prescribing Service (NPS) examines the quality of drug interaction alerts generated by nine clinical software systems currently used by general practitioners and pharmacists in Australia for prescribing or dispensing medications (Sweidan et al).1 The findings will come as no surprise to those who have repeatedly expressed concern about the shortcomings of clinical decision support software.2,3 Only half of the six prescribing systems examined by the NPS alerted users to all 20 of the major drug–drug interactions tested, which can occur with commonly used drugs and with the potential to trigger serious adverse reactions. The best of the three dispensing systems detected 19 of these drug interactions. Yet Australian GPs are heavily reliant on such software alerts: 88% of respondents to a recent national survey reported relying on their prescribing software to check for drug–drug interactions.4 Any failure of decision support systems to provide adequate drug safety alerts is thus likely to pose risks to patient safety.