Reducing Excessive Medication Administration in Hospitalized Adults With Renal Dysfunction

Abstract

Medication errors are common and harm hospitalized patients. The authors designed and implemented an automated system to complement an existing computerized order entry system by detecting the administration of excessive doses of medication to adult in-patients with renal insufficiency. Its impact, in combination with feedback to prescribers, was evaluated in 3 participating nursing units and compared with the remainder of a tertiary care academic medical center. The baseline rate of excessive dosing was 23.2% of administered medications requiring adjustment for renal insufficiency given to patients with renal impairment on the participating units and 23.6% in the rest of the hospital. The rate fell to 17.3% with nurse feedback and 16.8% with pharmacist feedback in the participating units (P<.05 for each, relative to baseline). The rates of excessive dosing for the same time periods were 26.1% and 24.8% in the rest of the hospital. Automated detection and routine feedback can reduce the rate of excessive administration of medication in hospitalized adults with renal insufficiency.

Systematic review of clinical decision support interventions with potential for inpatient cost reduction

“…A majority of the studies (55.1%) took place in a general hospital setting ([14-17,19,24-26,28,30,32,33,37],[41-43,46,48-50,52-56,60-62,64,66,67],[69-72,74,76-78,80,85,87,90]. 29.5% of the studies occurred in an ICU setting [18,23,31,34-36,39,40,44,47],[51,57-59,63,65,68,73,79,82],[86,88,89], and 15.4% took place in an ED setting [13,20-22,27,29,38,45,75,81],[83,84].…”

Reducing Preventable Medication Safety Events by Recognizing Renal Risk

“…Computerized provider order entry systems with a variety of automated clinical decision support tools have been demonstrated to reduce prescribing errors in hospitalized patients with impaired renal function. 1,[19][20][21] However, computerized alerts have far from eliminated wrongchoice, dose, and frequency errors in patients with renal impairment. 20 In the absence of a CPOE system with embedded clinical decision support, automated laboratory surveillance systems can calculate an estimated CrCl as part of each new SCr order.…”

“…Evidence suggests that medication safety may be improved through accurate assessment of renal function and appropriate dosing of renally cleared medications. 1 This article will describe the medication errors occurring in renal risk groups, the types of medication errors that can occur with these risk groups, and ways for the clinical nurse specialist to support nurses in improving the care of patients at renal risk through a more comprehensive assessment of renal function.…”

Recommendations for a Clinical Decision Support for the Management of Individuals with Chronic Kidney Disease

“…the systematic literature search, the search of meeting presentations and abstracts, and the search of the gray literature) led to the identification of a relatively small volume of literature related to CDS applications in CKD (Table 2). In summary, four published articles were found, all of which focused on CDS as a tool for the prevention of medication errors in patients with abnormal renal function (16,(24)(25)(26)(27). Only one published abstract was found (28).…”