Early Detection and Prevention of Drug-Induced Liver Injury (DILI): Roles of Nursing, Pharmacy, and Laboratory Services

Abstract

Drug-induced liver injury (DILI) represents a significant and often underrecognized cause of acute liver failure, hospitalization, and medication discontinuation, necessitating a proactive, interprofessional approach to early detection and prevention. The complexity of DILI, which can arise from predictable dose-dependent hepatotoxins such as acetaminophen or from idiosyncratic reactions to medications like amoxicillin-clavulanate, isoniazid, and antiepileptics, demands that healthcare professionals move beyond isolated practice toward integrated teamwork. Nurses serve as frontline sentinels, leveraging continuous patient observation to identify subtle clinical signs such as fatigue, anorexia, scleral icterus, dark urine, and asterixis, while also providing essential patient education regarding symptom recognition and the importance of adherence to laboratory monitoring schedules. Pharmacists contribute through comprehensive medication reconciliation, identification of cumulative hepatotoxic burdens, application of risk stratification tools such as Hy’s Law criteria, therapeutic drug monitoring, and prospective drug utilization review that intercepts dangerous duplications or interactions before liver injury occurs. Laboratory professionals ensure analytical accuracy of liver function tests, implement reflex testing algorithms to exclude alternative etiologies, establish critical value thresholds, and communicate results through structured protocols that trigger timely interventional responses. The synergy among these three disciplines, facilitated by standardized handoff frameworks like SBAR or I-PASS, shared decision-making protocols, electronic health record alerts, and dedicated DILI response teams, creates a multilayered safety net capable of detecting hepatotoxicity at its earliest, most reversible stages. Overcoming traditional professional silos through interprofessional education, simulation-based training, and systems engineering approaches enables healthcare institutions to transition from passive surveillance to active prevention, ultimately reducing the incidence of severe DILI, acute liver failure, and unnecessary mortality. When nursing, pharmacy, and laboratory services function as an integrated unit, DILI transforms from an unpredictable complication into a largely preventable iatrogenic event.