*Purpose: Immunosuppressant drug-drug interactions can result in immunosuppressant toxicity or subtherapeutic levels causing rejection. If not identified and managed appropriately, these interactions may result in graft failure.

*Methods: A best practice alert (BPA), a clinical decision tool, was implemented in our electronic medical records (EMR) to address immunosuppressant drug interaction at the point of prescribing. The BPA alerts (Appendix 1) the prescriber when a medication is added or discontinued from the patient’s medical profile that may result in changes in tacrolimus levels. This alert was implemented in a phased approach to assess volume, make improvements, and review pharmacy support needed for such an alert (Appendix 2). In the final phase, pharmacy alerted all physician specialists of interactions and next steps on monitoring.

*Results: In the first phase (Appendix 3), there were a total of 30 alerts, 13 on discontinued and 17 on new initiated medications. In 13 out of the 30 (43%), specialists were NOT aware prior to pharmacy outreach and 27 messages were sent to specialists to monitor tacrolimus levels and adjust dose as needed. In the second phase (5/22/2021 to 11/17/2021), there were a total of 37 alerts, 16 on discontinued and 21 on new medications. In 27 out of the 37 alerts (73%), providers were not aware prior to pharmacy outreach and 20 EMR encounters were documented and sent to specialists to monitor tacrolimus levels and adjust dose as needed.

*Conclusions: By implementing BPA in a phased-approach, workflows were developed and implemented to have clinical pharmacy support in communicating drug interactions, appropriate follow-up and dose adjustments to ensure allograft clinical outcomes were not negatively impacted.

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