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Secondary Data for Clinical Pharmacists' Decision Support: Evaluating 'Triple Whammy' Interactions Within INTERPOLAR
Joachim A Koeck1, Helene Köster2, Markus Loeffler3
1Pharmacy Department, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
Studies in Health Technology and Informatics
|May 23, 2026
Summary
The INTERPOLAR study successfully extracted data on triple whammy (TW) drug interactions, identifying a 0.7% prevalence of these potentially harmful combinations in patients, aiding in acute kidney injury (AKI) risk assessment.
Area of Science:
- Pharmacovigilance
- Clinical Informatics
- Nephrology
Background:
- The 'triple whammy' (TW) interaction involves three drug classes increasing the risk of acute kidney injury (AKI).
- The INTERPOLAR consortium developed a core data set (CDS) tool chain to extract clinical data from FHIR servers.
- This data is enriched with Clinical Pharmacist (CP)-reported medication review data.
Purpose of the Study:
- To evaluate the feasibility of extracting and analyzing data on TW interactions in an inpatient setting.
- To assess the accuracy and completeness of extracted data for TW interactions and serum creatinine (SCr) values.
- To determine how Clinical Pharmacists addressed identified TW interactions.
Main Methods:
- Patients with TW interactions were extracted from the INTERPOLAR database across six standard care wards.
- Medication and serum creatinine (SCr) data were collected and checked for completeness and accuracy.
- The handling of TW interactions by Clinical Pharmacists (CP) was evaluated.
Main Results:
- A prevalence of 0.7% (21 out of 2,805 cases) for TW administrations was identified.
- Extracted data accuracy was high: 95% for TW administration lines and 97% for SCr values.
- CPs recommended medication changes in 10 out of 21 TW cases, but only 6 patients had sufficient SCr data to assess potential AKI.
Conclusions:
- Data extraction was precise enough to identify inpatient TW interactions.
- Data gaps were primarily due to delayed FHIR server updates.
- Limitations include the exclusion of intravenous medication data in the analysis.
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