Pro-active provision of drug information as a technique to address overdosing in intensive-care patients with renal insufficiency

Abstract

Purpose To correct overdosing of drugs requiring adjustment based on renal function in intensive-care patients. Methods In a prospective intervention study, we estimated individual glomerular filtration rate and assessed whether medication required dose adjustment based on renal function. Senior clinicians received a structured report containing recommendations as to whether and how to adjust dosage in the individual patient (intervention). Prevalence of overdosed drugs (primary outcome), extent of overdoses, and reasons for nonacceptance of recommendations (secondary outcomes) were assessed. Results Of 138 screened intensive-care patients, 68 (49%) had renal impairment, and 110 (14%) of the 805 prescribed drugs required consideration of renal function. A potential overdose was found in 53/110 drugs (48%) and this rate decreased to 26/110 (24%, P<0.001) after the intervention. The average extent of overdose was reduced from 54% before to 31% after the intervention (P<0.001). The main reasons expressed by the physicians for nonacceptance of recommendations were a large therapeutic index or minor overdoses of the involved drugs. ConclusionsIn intensive-care patients, overdosing of drugs requiring adjustment based on renal function is still very common. Drug information counselling significantly decreased the prevalence and extent of overdose.

How to improve drug dosing for patients with renal impairment in primary care - a cluster-randomized controlled trial

“…Most previously published evidence on effective interventions to improve correct dosage adjustment in CKD patients comes from inpatient settings [20,21,23], even though dosage-related medication errors are equally relevant in outpatient primary care settings [40]. Clinical decision support systems (CDSS) have been successful in reducing medication errors and adverse drug events in inpatient settings [41-44].…”

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