Pharmacogenomics (PGx) implementation has become increasingly widespread. One of the most important aspects of this implementation process is the development of appropriate clinical decision support (CDS). Major PGx resources, such as the Clinical Pharmacogenetics Implementation Consortium, provide valuable recommendations for the development of CDS for specific gene-drug pairs but do not specify whether the administration route of a drug is clinically relevant. It is also unknown if PGx alerts for nonorally and non-intravenously administered PGx-relevant medications should be suppressed to reduce alert fatigue. The purpose of this scoping review was to identify studies and their clinical, pharmacokinetic and pharmacodynamic outcomes to better determine if CDS alerts are relevant for nonorally and non-intravenously administered PGx-relevant medications. Although this scoping review identified multiple PGx studies, the results of these studies were inconsistent, and more evidence is needed regarding different routes of medication administration and PGx.
Keywords: alert fatigue; clinical decision support; data standardization; medication administration route; pharmacodynamics; pharmacogenomics; pharmacokinetics.
Pharmacogenomics (PGx) is the study of how a person's genes and DNA may impact their response to certain medications. There are many hospitals and large academic medical centers that have begun using pharmacogenomic testing to better help guide treatment decisions for patients. Currently, there are few standards in place to guide these institutions on how to put a patient's pharmacogenomic information into their personal medical chart. To help create these standards, a consensus is needed on what types of medication orders will alert physicians to patients who may have pharmacogenomic-related concerns. One area that must be addressed to help with these standardizations involves the route of administration of a medication. Do pharmacogenomic considerations depend on how a medication is given to the patient (e.g., by mouth or through a vein or muscle)? The purpose of this scoping review was to assess the evidence surrounding this question in the hopes of clarifying what types of medication orders should trigger alerts to physicians. If the administration route results in no concerns regarding a patient's pharmacogenomic data, then the physician should not be shown an alert for that medication order. Too many of these alerts may cause ‘alert fatigue’ and lead to more errors in medication ordering, which may result in patient harm. It is important to address this area of pharmacogenomics to ensure this information is being used appropriately for patient care.