Drug prescribing in patients with renal impairment optimized by a computer-based, semi-automated system

Díaz, Ana Such; Fuente, Javier Sáez de la; Esteva, Laura; Pardo, A; Barrueco, Nélida; Esteban, Concepción; Rodríguez, Ismael Escobar

doi:10.1007/s11096-013-9843-3

Cited by 22 publications

(26 citation statements)

References 19 publications

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“…While almost half of the studies were cross‐sectional, 21 studies implemented interventions to reduce IP . Of these interventions, almost half were manual decision aids (n = 10), others were computerised decision support aids to physicians and pharmacists (n=9) and in the remaining studies (n=2), physicians were prompted with calculated eGFR values (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…Forty‐three of the included studies were rated as moderate or high quality (can be accessed on supporting information). All studies defined their inclusion criteria and evaluated IP objectively with comparators described clearly, where applicable .…”

Section: Resultsmentioning

confidence: 99%

“…Most studies have used the CG to estimate renal function for drug dosing (n=26), whereas 16 studies used MDRD . Six other studies employed either Jelliffe's equation or a combination of formulas to determine renal function status (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…The extent physicians accepted pharmacists’ recommendations were also measured in some studies (n=7) . The acceptance rate varied from 31.4% to 95.7% .…”

Section: Resultsmentioning

confidence: 99%

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Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

et al. 2017

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The extent physicians accepted pharmacists’ recommendations were also measured in some studies (n=7) . The acceptance rate varied from 31.4% to 95.7% .…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

et al. 2017

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“…Another study that also used this time period is that by Such et al 28. A larger number of modifications in nephrotoxic prescriptions was observed in the post-intervention phase than in the pre-intervention phase (29% vs 20%).…”

Section: Discussionmentioning

confidence: 99%

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

et al. 2017

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ObjectiveElectronic alert systems have shown their capacity for improving the detection of acute kidney injury (AKI). The aim of this study was to design and implement a clinical decision support system (CDSS) for improving drug selection and reducing nephrotoxic drug use in patients with AKI.MethodsThe study was designed as an intervention study comparing a pre and post cohort of patients admitted during April 2014 and April 2015, respectively (phase I and phase II). The intervention was a CDSS which provided kidney function and nephrotoxic drug information. Furthermore, an interruptive alert was designed to detect patients suffering an AKI event while taking a nephrotoxic drug and to see if the dose was then reduced or the drug was discontinued by the physicians.ResultsOne-third of the inpatients were included in the analysis because they met the inclusion criteria (1004 and 1002 patients in phases I and II, respectively). 735 and 761 of them received at least one nephrotoxic alert (73% vs 76%; p=0.763). 65 and 88 patients suffered AKI during admission (6.5% vs 8.8%; p=0.051). In phase I, patients received 384 nephrotoxic alerts (55%) with 78 (20%) of them provoking a change or discontinuation of the nephrotoxic drug. In phase II this value increased to 154 out of 526 (29%) after implementation of the CDSS (p<0.01).ConclusionsA CDSS with interruptive alerts that inform of the development of AKI in real time in patients with nephrotoxic drug prescription has a positive impact on the judicious use of these drugs.

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Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center

Cheung

Cooper

et al. 2020

J Am Coll Clin Pharm

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Introduction: Kidney disease is a major worldwide public health problem. An increased risk for adverse drug events is associated with drug dosing errors in hospitalized patients with renal impairment. A pharmacist-driven renal protocol may improve dosing compliance by allowing pharmacists to monitor renal function and adjust drug doses as needed.Objectives: To evaluate the utilization and financial impact of a pharmacist-driven renal dosing protocol.Methods: This was a retrospective cohort study of patients admitted to an academic medical center from 1 April 2017 to 30 May 2017 who had drug(s) from the protocol dose adjusted by a pharmacist. Outcomes of interest included protocol use frequency, patient characteristics, type of dose adjustments, and when adjustments were made. Two subgroup analyses were performed to: (1) determine cost savings of the seven most adjusted drugs and (2) determine if any missed opportunities for dose adjustments for cefepime.Results: A total of 422 dosage adjustments, performed on 317 patients, were included. The mean age of the patients was 63 years with 51.2% female. The majority (62.8%) had no history of renal dysfunction, 22.4% had chronic kidney disease, 14.8% had end-stage renal disease, and 25.3% had acute kidney injury on admission.Most dose adjustments (73.5%) were dose decreases, while 24.4% were dose increases. The seven most commonly adjusted drugs contributed to a cost savings of approximately $3919.87 per duration of therapy which extrapolates to an annual cost savings of $23 519.22. Of all the cefepime orders reviewed over a 7-day period, 84% were dosed correctly, 9% needed dose adjustments that could have been made sooner, and 7% had incorrect dose based on renal function.Conclusion: This analysis demonstrates that implementation of a pharmacist-driven renal dose adjustment protocol was consistently utilized at our institution and resulted in cost savings.

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Drug prescribing in patients with renal impairment optimized by a computer-based, semi-automated system

Cited by 22 publications

References 19 publications

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions

Improvement of drug prescribing in acute kidney injury with a nephrotoxic drug alert system

Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center

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