Effect of Alerts for Drug Dosage Adjustment in Inpatients with Renal Insufficiency

Sellier, Élodie; Colombet, Isabelle; Sabatier, Brigitte; Breton, Gaëlle; Niès, Julie; Zapletal, Eric; Arlet, Jean‐Benoît; Somme, Dominique; Durieux, Pierre

doi:10.1197/jamia.m2805

Cited by 46 publications

(42 citation statements)

References 27 publications

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“…Among several pathways to adverse outcomes, AKI can lead to therapeutic failure or toxicity from rapid changes in drug elimination (1,(4)(5)(6)(7)(8). Although the rate of adverse drug events (ADEs) during AKI is not known, the ADE rate in patients with a stable, elevated serum creatinine (SCr) is significantly higher than the general inpatient population (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Adverse Drug Events during AKI and Its Recovery

Cox

McCoy

Matheny

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The impact of AKI on adverse drug events and therapeutic failures and the medication errors leading to these events have not been well described.Design, setting, participants, & measurements A single-center observational study of 396 hospitalized patients with a minimum 0.5 mg/dl change in serum creatinine who were prescribed a nephrotoxic or renally eliminated medication was conducted. The population was stratified into two groups by the direction of their initial serum creatinine change: AKI and AKI recovery. Adverse drug events, potential adverse drug events, therapeutic failures, and potential therapeutic failures for 148 drugs and 46 outcomes were retrospectively measured. Events were classified for preventability and severity by expert adjudication. Multivariable analysis identified medication classes predisposing AKI patients to adverse drug events.Results Forty-three percent of patients experienced a potential adverse drug event, adverse drug event, therapeutic failure, or potential therapeutic failure; 66% of study events were preventable. Failure to adjust for kidney function (63%) and use of nephrotoxic medications during AKI (28%) were the most common potential adverse drug events. Worsening AKI and hypotension were the most common preventable adverse drug events. Most adverse drug events were considered serious (63%) or life-threatening (31%), with one fatal adverse drug event. Among AKI patients, administration of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antibiotics, and antithrombotics was most strongly associated with the development of an adverse drug event or potential adverse drug event.Conclusions Adverse drug events and potential therapeutic failures are common and frequently severe in patients with AKI exposed to nephrotoxic or renally eliminated medications.

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Section: Introductionmentioning

confidence: 99%

Adverse Drug Events during AKI and Its Recovery

Cox

McCoy

Matheny

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Also coinciding with the study by McCoy et al , our study designed an alert display to show the prescriber data for the kidney function along with a list of drugs and the corresponding specific recommendations based on the patient’s renal status. Other studies, such as the one designed by Sellier et al , have been designed in a similar way 27. Physicians and pharmacists could visualise the tool that had been designed 26.…”

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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“…patient selection in the context of a more personalized practice of medicine) [44][45][46]. In the pharmaceutical domain at HEGP, the EHR/CDW integration was found invaluable in the evaluation of the frequency of both drug prescription and drug dispensing errors [47][48], the impact of alerts on drug dosage adjustment [49], the role of pharmacy drug order validation [50], but also to automatically detect drug-drug interactions [51] or to perform in-silico evaluations of decision rules for further integration into the operational environment of the CPOE [52].…”

Section: The Use-quality Circlementioning

confidence: 99%

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Degoulet

2016

Yearb Med Inform

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SummaryContext: Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. Objective: This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Methods: Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique -Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. Results: In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Conclusion: Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety. KeywordsEvaluation of clinical information systems; return on investment; outcome research; acceptance models; information system success criteria Yearb Med Inform 2016:256-63 http://dx

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Effect of Alerts for Drug Dosage Adjustment in Inpatients with Renal Insufficiency

Cited by 46 publications

References 27 publications

Adverse Drug Events during AKI and Its Recovery

Adverse Drug Events during AKI and Its Recovery

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

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

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