1
|
Alosaimi HM, Alwatban RA, Alshammari HM, Alshammari AH, Alanazi SS, Alreshidi MA, Alreshidi AA, Alsayed AS, Alfaraj FA, Alzayer KA, Alzaher AA, Almutairi KM, Almutairi MS, Aljasir RH, Alshammari MK. Navigating nephrology: unveiling pharmacist perspectives on renal dose adjustment in Saudi Arabia - a comprehensive cross-sectional analysis. J Pharm Policy Pract 2024; 17:2344223. [PMID: 38798764 PMCID: PMC11123559 DOI: 10.1080/20523211.2024.2344223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Introduction Chronic kidney disease (CKD) is a major public health concern in Saudi Arabia. it is pertinent to mention that in the Southwestern region of Saudi Arabia. Hypertension and diabetes mellites are considered the major drivers of CKD. Research has documented worldwide the inappropriate dose adjustments in patients, ranging from 25% to 77%, of drugs requiring dose modifications. Pharmacists are pivotal members of the healthcare team, tasked with addressing issues pertaining to medications. This study aims to unveil pharmacist perspectives on renal dose adjustment in Saudi Arabia an important step in gauging their involvement in promoting healthy behaviours. Method A cross-sectional study design was conducted from December 2023 to January 2024 among pharmacists working in diverse healthcare settings, including clinical and hospital pharmacies, retail, and community pharmacies who had direct encounters with patients diagnosed with CKD. A validated questionnaire, the Renal Dose Adjustment-13 (RDQ-13) was used for this study. For comparing the knowledge, attitude, and perception scores of pharmacists statistical tests like One-Way ANOVA, and independent t-test; while for factors influencing the knowledge, attitude, and perception scores a multivariate linear regression was performed. The statistical significance level was set at 0.05. Results A total of 379 pharmacists completed the questionnaire, the knowledge score of pharmacists was 22.06 ± 2.81, while the attitude score was 8.56 ± 2.62 and the practice score was 5.75 ± 2.25. The findings of multivariate linear regression analysis indicated a statistically significant positive association between knowledge score and pharmacist's age while for practice score the findings revealed a statistically negative association between working setting and designation of pharmacists. Conclusion The pharmacist in Saudi Arabia exhibited a proficient knowledge score of drug dosage adjustment pertinent to renal function while the attitude and practice score was less as compared to the knowledge score.
Collapse
Affiliation(s)
- Hind M. Alosaimi
- Department of Pharmacy Services Administration, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Kingdom of Saudi Arabia
| | - Rshed A. Alwatban
- Department of Clinical Pharmacy, Northern Border University, Rafha, Kingdom of Saudi Arabia
| | - Haifa M. Alshammari
- Department of Pharmacy, Aldawaa Pharmacy Eastern Region, Dammam, Kingdom of Saudi Arabia
| | - Ahmed H. Alshammari
- Pharmacy Department, Rafha Central Hospital, North Zone, Kingdom of Saudi Arabia
| | - Shatha S. Alanazi
- Department of Clinical Pharmacy, Northern Border University, Rafha, Kingdom of Saudi Arabia
| | - Meshal A. Alreshidi
- Department of Pharmaceutical Care, King Khaled Hospital, Hail, Kingdom of Saudi Arabia
| | - Abeer A. Alreshidi
- Department of Pharmaceutical Care, King Khaled Hospital, Hail, Kingdom of Saudi Arabia
| | - Abrar S. Alsayed
- Pharmacy Department, Royal Commission Hospital, Yanbu, Kingdom of Saudi Arabia
| | - Furat A. Alfaraj
- Department of Pharmacy, Eastern Health Cluster, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | - Kawther A. Alzayer
- Department of Nursing, Eastern Health Cluster, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Aymen A. Alzaher
- Department of Pharmacy, Eastern Health Cluster, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | | | - Manar S. Almutairi
- Department of Pharmacy, Qassim University, Qassim, Kingdom of Saudi Arabia
| | - Reema H. Aljasir
- Department of Pharmacy, Qassim University, Qassim, Kingdom of Saudi Arabia
| | - Mohammed K. Alshammari
- Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Clinical Pharmacy, Rafha Central Hospital, Northern Borders Health Cluster, Rafha, Kingdom of Saudi Arabia
| |
Collapse
|
2
|
Berry K, Postlmayr L, Shiltz D, Parker J, Ice C. Impact of an inpatient pharmacist-driven renal dosing policy on order verification time and patient safety. SAGE Open Med 2024; 12:20503121241233223. [PMID: 38379810 PMCID: PMC10878201 DOI: 10.1177/20503121241233223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024] Open
Abstract
Research regarding pharmacist-driven renal dosing policies has focused on cost savings or prevention of adverse drug events. However, little is known about how these policies influence time from order signature to order verification or how this efficiency may reduce the incidence of adverse outcomes. Objectives: The primary endpoint compared time from prescriber electronic order signature to pharmacist electronic order verification between pre- and post-renal dosing policy implementation. The secondary endpoint evaluated electrocardiogram QTc prolongation attributed to fluconazole accumulation in renal impairment. Methods: This retrospective analysis included adults with a creatine clearance ⩽50 mL/min who received at least two inpatient doses from a 34-medication renal dosing protocol between January-February 2020 and April-May 2020. Results: 502 patients met eligibility for the primary outcome. The pre- and post-policy cohorts shared similar baseline characteristics. Time from order signature to verification was 9 and 8 min in the pre- and post-policy groups, respectively (p = 0.0861). In all, 56 patients met inclusion criteria for the secondary outcome. The QTc interval during fluconazole increased relative to baseline in 3 of 7 (43%) pre-policy and 4 of 5 (80%) post-policy. The QTc interval exceeded 500 ms in two patients, both in the post-policy cohort. Conclusions: There was no difference in order signature to verification time. Post-policy fluconazole renal adjustment did not reduce QTc prolongation.
Collapse
Affiliation(s)
- Kayla Berry
- Michigan Medicine, University of Michigan Health, Ann Arbor, MI, USA
| | - Laura Postlmayr
- Sinai-Grace Hospital—Detroit Medical Center, Detroit, MI, USA
| | - Dane Shiltz
- College of Pharmacy, Ferris State University, Grand Rapids, MI, USA
- Butterworth Hospital Pharmacy, Spectrum Health, Grand Rapids, MI, USA
| | - Jessi Parker
- Scholarly Activity and Scientific Support Spectrum Health, Grand Rapids, MI, USA
| | - Calvin Ice
- Butterworth Hospital Pharmacy, Spectrum Health, Grand Rapids, MI, USA
| |
Collapse
|
3
|
AlQashqri H. Renally Inappropriate Medications in the Old Population: Prevalence, Risk Factors, Adverse Outcomes, and Potential Interventions. Cureus 2023; 15:e49111. [PMID: 38125263 PMCID: PMC10732268 DOI: 10.7759/cureus.49111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Like most organs, the renal system decreases in function as we age. In the elderly, chronic kidney disease is common. When patients with chronic kidney disease take nephrotoxic medications, they are more likely to suffer adverse drug reactions, be hospitalized, and spend an extended period in the hospital. Calculating the renal clearance of a drug dose based on its glomerular filtration rate, or creatinine clearance, is necessary. Multiple tools are available for identifying renally inappropriate medications (RIMs). RIM prescriptions can be influenced by various factors, which vary according to the study. A higher number of medications means a higher likelihood of using RIMs. Numerous studies have investigated RIMs. The most contraindicated drug in renal insufficiency patients was a non-steroidal anti-inflammatory medication. A variety of interventions have been used to reduce RIM prescriptions to varying degrees of success.
Collapse
Affiliation(s)
- Hamsa AlQashqri
- Community and Family Medicine, Umm Al-Qura University, Makkah, SAU
| |
Collapse
|
4
|
Zafar R, Rehman IU, Shah Y, Ali Z, Ming LC, Khan TM. Knowledge, attitude and perceptions of pharmacists regarding renal dose adjustment among chronic kidney disease patients in Pakistan. J Pharm Policy Pract 2023; 16:102. [PMID: 37726861 PMCID: PMC10507879 DOI: 10.1186/s40545-023-00606-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/13/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a significant public health challenge. CKD patients have compromised renal function, which not only alters the pharmacokinetics of drugs but also their pharmacodynamics. Adjusting drug doses for these patients is essential to achieve the intended clinical outcomes, prevent adverse drug events, and halt further progression of the disease. Pharmacists play a pivotal role in ensuring safe and appropriate therapy for CKD patients. However, there is a noticeable absence of national dosing guidelines for CKD in Pakistan, coupled with a scarcity of studies exploring the knowledge, attitude, and perception of renal dose adjustments in the country. This study aimed to evaluate the knowledge, attitudes, and perceptions of pharmacists in the Khyber Pakhtunkhwa province and Islamabad regarding renal dose adjustments. METHODOLOGY A cross-sectional study was conducted to gauge the knowledge, attitude, and perception of pharmacists working in various cities of Khyber Pakhtunkhwa and the capital city, Islamabad, from February to May 2023. The Renal Dosing Questionnaire-13 (RDQ-13) scale was employed for this purpose. The survey link was disseminated through emails, and the RDQ-13 scale was also completed in person by pharmacists from hospitals, clinics, community, and retail settings who interact with CKD patients. Univariate linear regression was employed, and factors with a p value < 0.25 were subjected to multivariate linear regression. For comparing knowledge, attitude, and perception scores of pharmacists, the independent t test and one-way ANOVA were utilized as appropriate. A p value < 0.05 was deemed statistically significant. RESULTS Of the 384 pharmacists approached, 270 completed the RDQ-13 scale, resulting in a response rate of 70.3%. The overall knowledge score regarding renal dose adjustment was 21.24 ± 2.18 (mean ± SD). Attitude scores averaged at 10.04 ± 1.81, and perception scores at 7.19 ± 2.15. Multivariate analysis indicated a positive correlation between the pharmacists' perception scores and gender, with male pharmacists scoring higher than their female counterparts. CONCLUSIONS The study underscores the importance of instituting targeted training programs for pharmacists, ensuring access to dependable resources, and promoting research and results dissemination in the realm of renal pharmacotherapy to enhance public health outcomes.
Collapse
Affiliation(s)
- Roheena Zafar
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan.
- Department of Pharmacy, Northwest General Hospital and Research Centre, Peshawar, 25100, Pakistan.
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan.
| | - Yasar Shah
- Department of Pharmacy, Abdul Wali Khan University Mardan, Mardan, 23200, Pakistan
| | - Zahid Ali
- Department of Pharmacy, University of Peshawar, Peshawar, 25120, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, 47500, Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, 54000, Pakistan
| |
Collapse
|
5
|
Li YJ, Chang YL, Chou YC, Hsu CC. Hypoglycemia risk with inappropriate dosing of glucose-lowering drugs in patients with chronic kidney disease: a retrospective cohort study. Sci Rep 2023; 13:6373. [PMID: 37076583 PMCID: PMC10115797 DOI: 10.1038/s41598-023-33542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
The incidence rates and consequences of inappropriate dosing of glucose-lowering drugs remain limited in patients with chronic kidney disease (CKD). A retrospective cohort study was conducted to estimate the frequency of inappropriate dosing of glucose-lowering drugs and to evaluate the subsequent risk of hypoglycemia in outpatients with an estimated glomerular filtration rate (eGFR) of < 50 mL/min/1.73 m2. Outpatient visits were divided according to whether the prescription of glucose-lowering drugs included dose adjustment according to eGFR or not. A total of 89,628 outpatient visits were included, 29.3% of which received inappropriate dosing. The incidence rates of the composite of all hypoglycemia were 76.71 and 48.51 events per 10,000 person-months in the inappropriate dosing group and in appropriate dosing group, respectively. After multivariate adjustment, inappropriate dosing was found to lead to an increased risk of composite of all hypoglycemia (hazard ratio 1.52, 95% confidence interval 1.34, 1.73). In the subgroup analysis, there were no significant changes in the risk of hypoglycemia regardless of renal function (eGFR < 30 vs. 30-50 mL/min/1.73 m2). In conclusion, inappropriate dosing of glucose-lowering drugs in patients with CKD is common and associated with a higher risk of hypoglycemia.
Collapse
Affiliation(s)
- Yun-Jhe Li
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yueh-Ching Chou
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Road, Taipei, 112, Taiwan
- Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chen Hsu
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Road, Taipei, 112, Taiwan.
- Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
6
|
Kobayashi S, Sugama N, Nagano H, Takahashi M, Kushiyama A. Renally inappropriate medications in elderly outpatients and inpatients with an impaired renal function. Hosp Pract (1995) 2023; 51:76-81. [PMID: 36695817 DOI: 10.1080/21548331.2023.2173412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIMS The purpose of this study was to investigate differences in the frequency of renally inappropriate medications (RIMs) in outpatient and inpatient among three institutions. METHODS We collected prescription and renal function data for patients over 65 years of age from the drug department system. We selected 50 kinds of the most frequently used medicines which require dose adjustment according to a patient's renal function. RESULTS Outpatient RIM was seen in 611 cases (6.17%), and inpatient prescription RIM was seen in 317 cases (5.29%), showing a significant difference between the groups (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.35). However, in a multivariate analysis, when the renal function was included, that difference between outpatients and inpatients became insignificant (OR 1.16, 95% CI 0.98-1.37). The distribution of prescription with or without RIM in outpatient and inpatient settings depended on the CKD stage. Outpatients with a better CKD stage (stage 1-3) had a higher rate of RIM than inpatients, while patients with a worse CKD stage (stage 4 or 5) had a higher rate of RIM than outpatients. CONCLUSION The rate of RIM in outpatients tends to be high, and attention should be paid to RIM in inpatients with a severe CKD stage.
Collapse
Affiliation(s)
- Shotaro Kobayashi
- Department of Pharmacy, Sonoda Daiichi Hospital, Tokyo, Japan.,Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
| | - Norio Sugama
- Department of Pharmacy, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Hiroyuki Nagano
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan.,Department of Pharmacy, Saitama Medical University Hospital, Saitama, Japan
| | - Masahiro Takahashi
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
| | - Akifumi Kushiyama
- Department of Pharmacotherapy, Meiji Pharmaceutical University, Kiyose City, Japan
| |
Collapse
|
7
|
Sancar M, Altiparmak O, Altan A, Demirtunc R, Izzettin FV, Okuyan B. Evaluation of medication dose adjustments in patients with impaired renal function using different online drug information databases. Eur J Hosp Pharm 2022; 29:255-258. [PMID: 33115798 PMCID: PMC9660662 DOI: 10.1136/ejhpharm-2020-002395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Clinical pharmacist-led medication dose adjustment is required to provide safe and effective pharmacotherapy in patients with impaired renal function. This study aimed to assess clinical pharmacist-led medication dose adjustments in hospitalised patients with impaired renal function by comparing three online drug information databases. METHODS This retrospective observational study was conducted in an internal medicine ward between November 2016 and February 2017 among hospitalised patients with at least one estimated glomerular filtration rate (eGFR) value <60 mL/min/1.73 m2. Clinical pharmacist-led medication dose adjustments according to eGFR were performed by comparing three online drug information databases: Micromedex, Medscape and Lexicomp. The number of items related to dose adjustments detected during the study period and the concordance between databases were evaluated. RESULTS This study was conducted among 100 hospitalised patients (mean age 74.6±13.2 years) with impaired renal function. Clinical pharmacists detected at least one medication dose adjustment in 71.0% of patients. Among these patients, it was found that physician-led medication dose adjustments were made in only 15.5% of them. Of 1053 medications, the number of medications that required dose adjustments were 149 (14.2%), 151 (14.3%) and 163 (15.5%) according to Micromedex, Medscape and Lexicomp, respectively. The Fleiss kappa coefficient was 0.875 and the agreement of the three clinical decision support systems were almost perfect. CONCLUSIONS In renal dose adjustments, Micromedex, Lexicomp and Medscape are concordant as online drug information databases. Clinical pharmacists could detect medication dose adjustment requirements in hospital patients with impaired renal function. The potential positive impact of clinical pharmacist-led medication dose adjustment should be investigated in further studies.
Collapse
Affiliation(s)
- Mesut Sancar
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Oznur Altiparmak
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Aysenur Altan
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| | - Refik Demirtunc
- Department of Internal Medicine, University of Health Science, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Fikret Vehbi Izzettin
- Clinical Pharmacy Department, Bezmialem Vakif University, Faculty of Pharmacy, Istanbul, Turkey
| | - Betul Okuyan
- Faculty of Pharmacy, Clinical Pharmacy Department, Marmara University, Istanbul, Turkey
| |
Collapse
|
8
|
Althomali A, Altowairqi A, Alghamdi A, Alotaibi M, Althubaiti A, Alqurashi A, Harbi AA, Algarni MA, Haseeb A, Elnaem MH, Alsenani F, Elrggal ME. Impact of Clinical Pharmacist Intervention on Clinical Outcomes in the Critical Care Unit, Taif City, Saudi Arabia: A Retrospective Study. PHARMACY 2022; 10:pharmacy10050108. [PMID: 36136841 PMCID: PMC9498917 DOI: 10.3390/pharmacy10050108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/28/2022] [Accepted: 08/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Objectives: Clinical pharmacists are now playing a significant role in hospitals aiming to reduce medication errors, adverse drug reactions, and healthcare costs. Therefore, the main objective of this study was to assess the interventions provided by a clinical pharmacist in the intensive care unit at the King Faisal Hospital in Taif city. (2) Methods: For this single-center retrospective study, patients were included from December 2021 to May 2022. In the present study, all the interventions of clinical pharmacists made over six months were included. The Intensive care unit (ICU) ward was covered by three clinical pharmacists, and the interventions made were categorized into four groups: (1) interventions related to indications; (2) interventions regarding safety; (3) interventions regarding dosing, and (4) miscellaneous. Descriptive statistics was applied to evaluate the results in the form of frequencies and percentages. Analysis was performed using the statistical package SPSS 20.0. (3) Results: Overall, a total of 404 interventions were recommended for 165 patients during the six- month period of study. Among them, 370 interventions (91.5%) were accepted by physicians. Among all the interventions, the majority were suggested regarding ‘indication’ (45.7%), including the addition of drugs, drugs with no indications, and duplication. The acceptance rate of clinical pharmacist intervention was 98.5%. (4) Conclusions: This retrospective study shows that clinical pharmacists played a critical role in optimizing drug therapy which could subsequently help to prevent drug-related issues and lower drug costs. More research is needed to do a thorough cost-benefit analysis.
Collapse
Affiliation(s)
- Abdullah Althomali
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Ahmed Altowairqi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Afnan Alghamdi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | - Musim Alotaibi
- Ministry of Health, King Faisal Medical Complex, Taif 26514, Saudi Arabia
| | | | | | - Adnan Al Harbi
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Majed Ahmed Algarni
- Clinical Pharmacy Department, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia
| | - Abdul Haseeb
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University, Kuantan 53100, Pahang, Malaysia
| | - Faisal Alsenani
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
| | - Mahmoud E. Elrggal
- College of Pharmacy, Umm Al Qura University, Makkah 21955, Saudi Arabia
- Correspondence: or
| |
Collapse
|
9
|
Sonoda A, Kondo Y, Iwashita Y, Nakao S, Ishida K, Irie T, Ishitsuka Y. In-Hospital Prescription Checking System for Hospitalized Patients with Decreased Glomerular Filtration Rate. KIDNEY360 2022; 3:1730-1737. [PMID: 36514725 PMCID: PMC9717669 DOI: 10.34067/kid.0001552022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/08/2022] [Indexed: 01/12/2023]
Abstract
Background Clinical decision support systems (CDSS) are reported to be useful in preventing dosage errors in renally excreted drugs by alerting hospital pharmacists to inadequate dosages for hospitalized patients with decreased GFR. However, it is unclear whether CDSS can reduce dosage errors in renally excreted drugs in hospitalized patients. To prevent dosage errors in renally excreted drugs, we introduced a prescription checking system (PCS) for in-hospital prescriptions. This retrospective study aimed to evaluate whether a prescription audit by hospital pharmacists using the PCS reduced the rate of dosage errors in renally excreted drugs. Methods The target drugs were allopurinol, cibenzoline, famotidine, and pilsicainide. Interrupted time series analysis was used to evaluate trends in the 4-weekly dosage error rates over 52 weeks before PCS implementation and 52 weeks after PCS implementation. Results Before and after PCS implementation, 474 and 331 prescriptions containing one of the targeted drugs, respectively, were generated. The estimated baseline level of the 4-weekly dosage error rates was 34%. The trend before the PCS implementation was stable with no observable trend. The estimated level change from the last point in the pre-PCS implementation to the first point in the PCS implementation was -20% (P<0.001). There was no change in the trend after PCS implementation. Conclusions We demonstrated that a prescription audit by hospital pharmacists using the PCS reduced the rate of dosage errors in the target renally excreted drugs in hospitalized patients. Although further studies are needed to confirm whether our results can be generalized to other health facilities, our findings highlight the need for a PCS to prevent the overdose of renally excreted drugs.
Collapse
Affiliation(s)
- Akihiro Sonoda
- Department of Pharmacy, Izumi Regional Medical Center, Akune, Japan
| | - Yuki Kondo
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Shoji Nakao
- Department of Pharmacy, Izumi Regional Medical Center, Akune, Japan
| | - Kazuhisa Ishida
- Department of Pharmacy, Izumi Regional Medical Center, Akune, Japan
| | - Tetsumi Irie
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan,Department of Pharmaceutical Packaging Technology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yoichi Ishitsuka
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| |
Collapse
|
10
|
Parakkal SA, Hakeem FA, Madathil H, Nemr HS, Ghamdi FH. Pharmacist-driven renal dose optimization practice—outcomes of a retrospective study in ambulatory care settings. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022. [DOI: 10.1093/jphsr/rmac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Previous studies indicate a higher prevalence of inappropriate drug usage in patients with renal disease in ambulatory care settings and a higher rate of non-compliance with the renal dose adjustment protocol. This study aimed to investigate the number of renal dose adjustments recommended by pharmacists in ambulatory care settings, acceptance rate by the physicians and medications involved.
Methods
This two-year retrospective study was conducted in an ambulatory care pharmacy in a Saudi Arabian tertiary care hospital. Based on the renal protocol at the study site, the pharmacists recommended dose adjustments for inappropriate medication orders, and the outcomes were documented electronically. A quantitative descriptive analysis of this practice was performed by retrieving the pharmacists’ documentation from electronic health records. Only protocol-compliant recommendations with proper documentation were included in the study.
Key findings
A total of 302 renal dose adjustments were recommended by pharmacists for 269 patients involving 47 medications, with an average of 1.12 recommendations per patient. The average monthly recommendation was 12.58 (median: 11; SD: 5.174; 95% Confidence Interval (CI), 12 to 13.16). Of the 302 recommendations, 219 (72.52%) were accepted by the physician, and 71 (23.51%) were not. The most common medications accepted for renal dosage adjustment included levofloxacin (8.94%), metformin (5.29%), amoxicillin-clavulanate (5.29%), cetirizine (4.97%), diclofenac (4.64%), ciprofloxacin (3.97%) and nitrofurantoin (3.31%).
Conclusions
The pharmacist’s renal dose recommendations have a high acceptance rate in ambulatory care. This study demonstrated that ambulatory care pharmacists play a substantial clinical role in reducing inappropriate drug use in patients with renal disease.
Collapse
Affiliation(s)
- Sainul Abideen Parakkal
- Pharmacy Service Department, Johns Hopkins Aramco Healthcare , Dhahran , Kingdom of Saudi Arabia
| | - Faisal Ahmed Hakeem
- Pharmacy Service Department, Johns Hopkins Aramco Healthcare , Dhahran , Kingdom of Saudi Arabia
| | - Hafees Madathil
- Pharmacy Service Department, Johns Hopkins Aramco Healthcare , Dhahran , Kingdom of Saudi Arabia
| | - Habib Shaker Nemr
- Pharmacy Service Department, Johns Hopkins Aramco Healthcare , Dhahran , Kingdom of Saudi Arabia
| | - Fuad Hamed Ghamdi
- Pharmacy Service Department, Johns Hopkins Aramco Healthcare , Dhahran , Kingdom of Saudi Arabia
| |
Collapse
|
11
|
Bassett E, Frantzen L, Zabel K. Evaluation of Pharmacist Renal Dose Adjustments and Planning for Future Evaluations of Pharmacist Services. Hosp Pharm 2021; 56:416-423. [PMID: 34720140 DOI: 10.1177/0018578720918363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Clinical pharmacy services are known to improve patient outcomes. Pharmacists contribute to patient care in the acute care setting in multiple ways, including providing advice and information to patients and the health care team, performing medication histories to prevent waste and support medication adherence, analyzing the cost-effectiveness of medications, and ensuring patient safety through patient monitoring and medication review. Specific clinical pharmacist services include managing intravenous to oral medication adjustments, renal dose adjustments, and performing pharmacokinetic dosing of medications, among others. Many of these clinical services are performed daily but are not evaluated for clinical quality or compliance with policies. Evaluating these clinical services may provide a multitude of benefits to pharmacy departments, health systems, and patients. Methods: The purpose of this study was to evaluate pharmacist use and percent compliance of a renal dose adjustment policy upon initial order verification and discharge. This was completed through retrospective chart review to determine if dose adjustments were made appropriately and descriptive statistics were used to establish pharmacist compliance. Those orders that were inappropriately adjusted were analyzed for trends that could lead to possible policy improvements or pharmacist education opportunities. The completed evaluation also led to the development of an evaluation system that can be utilized to routinely assess clinical pharmacist services. Conclusions: The results of this study are being used to develop and support future clinical service evaluations, inspire process improvements, and improve patient outcomes and pharmacist accountability.
Collapse
Affiliation(s)
| | | | - Katie Zabel
- HealthEast St. Joseph's Hospital, St. Paul, MN, USA
| |
Collapse
|
12
|
Okoro RN. Clinical pharmacist as a member of the multidisciplinary kidney care team in low‐ and middle‐income countries: An opportunity to reduce the incidence of drug‐related problems. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Roland Nnaemeka Okoro
- Department of Clinical Pharmacy and Pharmacy Administration University of Maiduguri Maiduguri Nigeria
| |
Collapse
|
13
|
Silva-Almodóvar A, Hackim E, Wolk H, Nahata MC. Potentially Inappropriately Prescribed Medications Among Medicare Medication Therapy Management Eligible Patients with Chronic Kidney Disease: an Observational Analysis. J Gen Intern Med 2021; 36:2346-2352. [PMID: 33506400 PMCID: PMC8342663 DOI: 10.1007/s11606-020-06537-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Potentially inappropriately prescribed medications (PIPMs) among patients with chronic kidney disease (CKD) may vary among clinical settings. Rates of PIPM are unknown among Medicare-enrolled Medication Therapy Management (MTM) eligible patients. OBJECTIVES Determine prevalence of PIPM among patients with CKD and evaluate characteristics of patients and providers associated with PIPM. DESIGN An observational cross-sectional investigation of a Medicare insurance plan for the year 2018. PATIENTS Medicare-enrolled MTM eligible patients with stage 3-5 CKD. MAIN MEASURES PIPM was identified utilizing a tertiary database. Logistic regression assessed relationship between patient characteristics and PIPM. KEY RESULTS Investigation included 3624 CKD patients: 2856 (79%), 548 (15%), and 220 (6%) patients with stage 3, 4, and 5 CKD, respectively. Among patients with stage 3, stage 4, and stage 5 CKD, 618, 430, and 151 were with at least one PIPM, respectively. Logistic regression revealed patients with stage 4 or 5 CKD had 7-14 times the odds of having a PIPM in comparison to patients with stage 3 disease (p < 0.001). Regression also found PIPM was associated with increasing number of years qualified for MTM (odds ratio (OR) 1.46-1.74, p ≤ 0.005), female gender (OR 1.25, p = 0.008), and increasing polypharmacy (OR 1.30-1.57, p ≤ 0.01). Approximately 14% of all medications (2879/21093) were considered PIPM. Majority of PIPMs (62%) were prescribed by physician primary care providers (PCPs). Medications with the greatest percentage of PIPM were spironolactone, canagliflozin, sitagliptin, levetiracetam, alendronate, pregabalin, pravastatin, fenofibrate, metformin, gabapentin, famotidine, celecoxib, naproxen, meloxicam, rosuvastatin, diclofenac, and ibuprofen. CONCLUSION Over one-third of Medicare MTM eligible patients with CKD presented with at least one PIPM. Worsening renal function, length of MTM eligibility, female gender, and polypharmacy were associated with having PIPM. Majority of PIPMs were prescribed by PCPs. Clinical decision support tools may be considered to potentially reduce PIPM among Medicare MTM-enrolled patients with CKD.
Collapse
Affiliation(s)
- Armando Silva-Almodóvar
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, OH, USA. .,SinfoníaRx: A TRHC Solution, Tucson, AZ, USA.
| | - Edward Hackim
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Hailey Wolk
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, OH, USA
| | - Milap C Nahata
- Institute of Therapeutic Innovations and Outcomes (ITIO), The Ohio State University College of Pharmacy, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
14
|
McConachie S, Martirosov D, Wang B, Desai N, Jarjosa S, Hsaiky L. Surviving the surge: Evaluation of early impact of COVID-19 on inpatient pharmacy services at a community teaching hospital. Am J Health Syst Pharm 2021; 77:1994-2002. [PMID: 32469045 PMCID: PMC7314258 DOI: 10.1093/ajhp/zxaa189] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose The coronavirus disease 2019 (COVID-19) pandemic has presented novel challenges to healthcare systems; however, an analysis of the impact of the pandemic on inpatient pharmacy services has not yet been conducted. Methods Results of an observational assessment of operational and clinical pharmacy services at a community teaching hospital during the first weeks of the COVID-19 pandemic are presented. Service outcomes of the inpatient pharmacy were evaluated from February 1 to April 8, 2020. Outcomes during the weeks preceding the first COVID-19 admission (February 1 to March 11, 2020) and during the pandemic period (March 12 to April 8, 2020) were compared. Evaluated outcomes included daily order verifications, clinical interventions, and usage of relevant medications. An exploratory statistical analysis was conducted using Student’s t test. Results During the pandemic period, the number of new order verifications decreased from approximately 5,000 orders per day to 3,300 orders per day (P < 0.01), a reduction of 30% during the first 4 weeks of the pandemic compared to the weeks prior. Average daily pharmacokinetic dosing consults were reduced in the pandemic period (from 82 to 67; P < 0.01) compared to the prepandemic period; however, total daily pharmacist interventions did not differ significantly (473 vs 456; P = 0.68). Dispensing of hydroxychloroquine, azithromycin, enoxaparin, and sedative medications increased substantially during the pandemic period (P < 0.01 for all comparisons). Conclusion The operational and clinical requirements of an inpatient pharmacy department shifted considerably during the first weeks of the COVID-19 pandemic. Pharmacy departments must be adaptable in order to continue to provide effective pharmaceutical care during the pandemic.
Collapse
Affiliation(s)
- Sean McConachie
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI.,Beaumont Hospital, Dearborn, Dearborn, MI
| | | | - Bryan Wang
- Beaumont Hospital, Dearborn, Dearborn, MI
| | - Neha Desai
- Beaumont Hospital, Dearborn, Dearborn, MI
| | | | | |
Collapse
|
15
|
McConachie SM, Hanni CM, Wilhelm SM. Deviant Dosing: A Post hoc Analysis of Pharmacist Characteristics Related to Renal Dosing Decisions. Ann Pharmacother 2021; 56:65-72. [PMID: 33969741 DOI: 10.1177/10600280211016328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A recent study demonstrated that pharmacists presented with multiple estimating equations deviated from recommended dosing guidance more often than pharmacists who were presented with a single estimate on clinical vignettes. OBJECTIVES To identify characteristics associated with an increased tendency to deviate from approved recommendations. METHODS Participant data were split into 2 cohorts: pharmacists who chose a dose that was inconsistent with dosing recommendations on at least 1 of the 4 vignettes and pharmacists who did not deviate on a single case. Bivariate analysis of demographic- and practice-related variables were conducted between groups using the χ2, Mann-Whitney U, or Student t-test for nominal, ordinal, and continuous variables, respectively. Statistically different covariates between groups (P < 0.05) were assessed using multivariable linear regression. RESULTS Survey data from 154 inpatient pharmacists, 71 of whom deviated on at least 1 clinical vignette, were analyzed. On univariate analysis, deviator pharmacists were more likely to have completed postgraduate residency training (68% vs 41%; P < 0.05) and board certification (39% vs 20%; P < 0.05). Deviator pharmacists were also more likely to have been presented with multiple renal estimates as opposed to a single estimate and had differing renal dosing practices at baseline (P < 0.05). Following multivariable regression, residency training, mismatched baseline renal practices, and multiple renal estimates remained independent predictors (P < 0.05) of dosing deviation. CONCLUSION AND RELEVANCE Higher clinical training, practice variation, and multiple renal estimates may affect renal dosing practices. Prospective, statistically powered studies are needed to verify these hypotheses.
Collapse
Affiliation(s)
- Sean M McConachie
- Wayne State University, Detroit, MI, USA.,Beaumont Hospital, Dearborn, MI, USA
| | | | | |
Collapse
|
16
|
Kane-Gill SL, Barreto EF, Bihorac A, Kellum JA. Development of a Theory-Informed Behavior Change Intervention to Reduce Inappropriate Prescribing of Nephrotoxins and Renally Eliminated Drugs. Ann Pharmacother 2021; 55:1474-1485. [PMID: 33855858 DOI: 10.1177/10600280211009567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Goals of managing patients with acute kidney injury (AKI) are mitigating disease progression and ensuring safety while providing supportive care because no effective treatment exists. One strategy recommended in guidelines to meet these goals is optimizing medication management. Unfortunately, guideline implementation appears to be lacking as observed by the frequent occurrence of medication errors and adverse drug events. OBJECTIVE To address this performance gap in the care of hospitalized patients receiving nephrotoxins and renally eliminated drugs, we sought to provide a potential intervention based on theory-informed behavior change. METHODS Formative research with a qualitative analysis identifying what needs to change in patient care was completed by obtaining clinician opinion and expert opinion and reviewing the published literature. Frontline providers, including 8 physicians, 4 pharmacists, and a multiprofessional group of authors, provided insight into possible barriers to appropriate prescribing. Capability, Opportunity, Motivation and Behavior model and Theoretical Domain Framework were applied to characterize behavior change interventions and inform a potential implementation intervention for changing inappropriate prescribing behaviors. RESULTS Lack of knowledge about appropriate drug management in patients at risk for adverse outcomes was provided as a major barrier. Other reported barriers included a lack of: (1) tools to assist with drug management, (2) motivation to make changes, (3) routinization, and (4) an accountable clinician. CONCLUSIONS AND RELEVANCE Assigning a designated clinician to execute a stepwise, routine care process following the checklist provided is a recommended intervention to overcome barriers. The intended impact is behavior change that reduces inappropriate prescribing.
Collapse
Affiliation(s)
- Sandra L Kane-Gill
- School of Pharmacy, Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | | | - John A Kellum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Antibiotic dosing adjustments in hospitalized patients with chronic kidney disease: a retrospective chart review. Int Urol Nephrol 2021; 54:157-163. [PMID: 33738646 DOI: 10.1007/s11255-021-02834-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infections in patients with chronic kidney disease (CKD) are a major cause of hospitalization. The pharmacokinetics of renally eliminated antibiotics may lead to drug accumulation, resulting in potential toxicity. The renal dosing adjustment of antibiotics is crucial to avoid toxicity and decrease mortality. In Lebanon, limited data are available on antibiotic dose adequacy in CKD. OBJECTIVES To estimate the prevalence of inappropriately dosed antibiotics in non-dialysis CKD patients and to identify possible risk factors that may be associated with unadjusted renal dosing. METHODS A retrospective chart review was conducted at two tertiary-care hospitals in Lebanon. International Statistical Classification of Diseases (ICD-10) code for CKD was used to search the databases. Demographic and clinical data were collected for patients who received antibiotics that requires renal dosing adjustment. Lexi-Comp online Drug Information database was the guideline used to evaluate the appropriateness of dosing. RESULTS A total of 495 antibiotic orders were dispensed to 190 patients. 51.6% of patients received antibiotics without renal dose adjustments. The most inappropriately dosed class was penicillins (39.8%), while fluoroquinolones were the most adequately adjusted. Piperacillin/tazobactam was the most frequently prescribed drug (30.6%) without renal dose adjustment. Respiratory infections (OR 1.301, CI 95% 1.327-1.915) and multimorbidity (OR 1.183, CI 95% 1.358-2.081) were statistically highly significant associations for unadjusted antibiotic dosing from the fitted multivariable-adjusted logistic models. CONCLUSION Our study revealed a high frequency of guideline-discordant antibiotic dosing in patients with CKD. This dosing error is preventable by increasing awareness of prescribing physicians and collaborating with clinical pharmacists.
Collapse
|
18
|
Manias E, Kusljic S, Wu A. Interventions to reduce medication errors in adult medical and surgical settings: a systematic review. Ther Adv Drug Saf 2020; 11:2042098620968309. [PMID: 33240478 PMCID: PMC7672746 DOI: 10.1177/2042098620968309] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: Medication errors occur at any point of the medication management process, and are a major cause of death and harm globally. The objective of this review was to compare the effectiveness of different interventions in reducing prescribing, dispensing and administration medication errors in acute medical and surgical settings. Methods: The protocol for this systematic review was registered in PROSPERO (CRD42019124587). The library databases, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched from inception to February 2019. Studies were included if they involved testing of an intervention aimed at reducing medication errors in adult, acute medical or surgical settings. Meta-analyses were performed to examine the effectiveness of intervention types. Results: A total of 34 articles were included with 12 intervention types identified. Meta-analysis showed that prescribing errors were reduced by pharmacist-led medication reconciliation, computerised medication reconciliation, pharmacist partnership, prescriber education, medication reconciliation by trained mentors and computerised physician order entry (CPOE) as single interventions. Medication administration errors were reduced by CPOE and the use of an automated drug distribution system as single interventions. Combined interventions were also found to be effective in reducing prescribing or administration medication errors. No interventions were found to reduce dispensing error rates. Most studies were conducted at single-site hospitals, with chart review being the most common method for collecting medication error data. Clinical significance of interventions was examined in 21 studies. Since many studies were conducted in a pre–post format, future studies should include a concurrent control group. Conclusion: The systematic review identified a number of single and combined intervention types that were effective in reducing medication errors, which clinicians and policymakers could consider for implementation in medical and surgical settings. New directions for future research should examine interdisciplinary collaborative approaches comprising physicians, pharmacists and nurses. Lay summary Activities to reduce medication errors in adult medical and surgical hospital areas Introduction: Medication errors or mistakes may happen at any time in hospital, and they are a major reason for death and harm around the world. Objective: To compare the effectiveness of different activities in reducing medication errors occurring with prescribing, giving and supplying medications in adult medical and surgical settings in hospital. Methods: Six library databases were examined from the time they were developed to February 2019. Studies were included if they involved testing of an activity aimed at reducing medication errors in adult medical and surgical settings in hospital. Statistical analysis was used to look at the success of different types of activities. Results: A total of 34 studies were included with 12 activity types identified. Statistical analysis showed that prescribing errors were reduced by pharmacists matching medications, computers matching medications, partnerships with pharmacists, prescriber education, medication matching by trained physicians, and computerised physician order entry (CPOE). Medication-giving errors were reduced by the use of CPOE and an automated medication distribution system. The combination of different activity types were also shown to be successful in reducing prescribing or medication-giving errors. No activities were found to be successful in reducing errors relating to supplying medications. Most studies were conducted at one hospital with reviewing patient charts being the most common way for collecting information about medication errors. In 21 out of 34 articles, researchers examined the effect of activity types on patient harm caused by medication errors. Many studies did not involve the use of a control group that does not receive the activity. Conclusion: A number of activity types were shown to be successful in reducing prescribing and medication-giving errors. New directions for future research should examine activities comprising health professionals working together.
Collapse
Affiliation(s)
- Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Snezana Kusljic
- Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Wu
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Seiberth S, Bauer D, Schönermarck U, Mannell H, Stief C, Hasford J, Strobach D. Correct use of non-indexed eGFR for drug dosing and renal drug-related problems at hospital admission. Eur J Clin Pharmacol 2020; 76:1683-1693. [PMID: 32651616 PMCID: PMC7661404 DOI: 10.1007/s00228-020-02953-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
Purpose Two to seven percent of the German adult population has a renal impairment (RI) with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. This often remains unrecognized and adjustment of drug therapy is lacking. To determine renal function in clinical routine, the CKD-EPI equation is used to calculate an indexed eGFR (ml/min/1.73m2). For drug dosing, it has to be individualized to a non-indexed eGFR (ml/min) by the patient’s body surface area. Here, we investigated the number of patients admitted to urological wards of a teaching hospital with RI between July and December 2016. Additionally, we correctly used the eGFRnon-indexed for drug and dosage adjustments and to analyse the use of renal risk drugs (RRD) and renal drug-related problems (rDRP). Methods In a retrospective observational study, urological patients with pharmacist-led medication reconciliation at hospital admission and eGFRindexed (CKD-EPI) of 15–59 ml/min/1.73m2 were identified. Indexed eGFR (ml/min/1.73m2) was recalculated with body surface area to non-indexed eGFR (ml/min) for correct drug dosing. Medication at admission was reviewed for RRD and based on the eGFRnon-indexed for rDRP, e.g. inappropriate dose or contraindication. Results Of 1320 screened patients, 270 (20.5%) presented with an eGFRindexed of 15–59 ml/min/1.73m2. After readjustment, 203 (15.4%) patients had an eGFRnon-indexed of 15–59 ml/min. Of these, 190 (93.6%) used ≥ 1 drugs at admission with 660 of 1209 (54.7%) drugs classified as RRD. At least one rDRP was identified in 115 (60.5%) patients concerning 264 (21.8%) drugs. Conclusion Renal impairment is a common risk factor for medication safety in urologic patients admitted to a hospital. Considerable shifts were seen in eGFR-categories when correctly calculating eGFRnon-indexed for drug dosing purposes. The fact that more than half of the study patients showed rDRP at hospital admission underlines the need to consider this risk factor appropriately. Electronic supplementary material The online version of this article (10.1007/s00228-020-02953-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Sarah Seiberth
- Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Dominik Bauer
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Hanna Mannell
- Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joerg Hasford
- Institute of Medical Data Processing, Biometrics and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Dorothea Strobach
- Hospital Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Doctoral Program Clinical Pharmacy, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| |
Collapse
|
20
|
Cheung D, Go A, Cooper M, Schwarz K. Evaluation of a
pharmacist‐driven
renal dosing protocol at an academic medical center. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Dora Cheung
- University of Colorado Hospital Aurora Colorado USA
| | - Amy Go
- University of Colorado Hospital Aurora Colorado USA
| | | | | |
Collapse
|
21
|
Scuderi C, Nalder M, Castelino R, Cervelli M, Ironside D, Jones C, Lloyd J, Mirkov S, Munro C. Standard of practice in nephrology for pharmacy services. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Carla Scuderi
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Royal Brisbane and Women’s Hospital Herston Australia
- School of Pharmacy University of Queensland Woolloongabba Australia
| | - Michelle Nalder
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- The Royal Melbourne Hospital Parkville Australia
| | - Ronald Castelino
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Faculty of Health and Medicine University of Sydney Sydney Australia
- Blacktown Hospital Western Sydney Local Health District Blacktown Australia
| | - Matthew Cervelli
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Renal Unit Royal Adelaide Hospital Adelaide Australia
- MJC Pharma Pty Ltd Adelaide Australia
| | - Danielle Ironside
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Royal Brisbane and Women’s Hospital Herston Australia
| | - Ceridwen Jones
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- Royal Prince Alfred Hospital Camperdown Australia
| | - Jess Lloyd
- The Princess Alexandra Hospital Brisbane Australia
| | - Sanja Mirkov
- Nephrology Leadership Committee The Society of Hospital Pharmacists of Australia Collingwood Australia
- School of Pharmacy The University of Auckland Auckland New Zealand
- Ramsay Pharmacy Group Sydney Australia
| | - Courtney Munro
- The Society of Hospital Pharmacists of Australia Collingwood Australia
| |
Collapse
|
22
|
Subeesh VK, Abraham R, Satya Sai MV, Koonisetty KS. Evaluation of prescribing practices and drug-related problems in chronic kidney disease patients: A cross-sectional study. Perspect Clin Res 2020; 11:70-74. [PMID: 32670831 PMCID: PMC7342333 DOI: 10.4103/picr.picr_110_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/05/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022] Open
Abstract
Aim: The primary intent of the study is to analyze the prescribing pattern and to identify the various drug-related problems (DRPs) associated with the therapy in chronic kidney disease (CKD) patients. Subjects and Methods: A prospective observational study was conducted in 160 patients diagnosed with any stages of CKD. The prescribing pattern was studied and DRPs were identified, reported, and categorized as per the Pharmaceutical Care Network Europe classification V 5.01. The association between categorical variables was analyzed using the Chi-square test. The predictors of DRPs were identified using binary logistic regression analysis. Results: The mean age of the study population was 50.08 ± 15.32 years with male predominance (71%). The average number of drugs per prescription was found to be 9.16 ± 3.01. The most prescribed drug category was antihypertensives and the most commonly prescribed drugs were diuretics. A total of 337 DRPs were identified, out of which the most common DRP was drug interactions (60%), followed by frequency errors (11.6%). Logistic regression analysis identified comorbidities more than three (odds ratio 2.09), antihypertensives more than two (odds ratio 1.9), alcoholism (odds ratio 1.5), and polypharmacy (odds ratio 1.2) as the predictors of DRPs even though they were not statistically significant at P = 0.01. Conclusion: DRPs increase the risk of deterioration of the disease state and increase the length of hospital stay. Identification and resolving of the DRPs will lead to better patient care and proper treatment. Early identification and modification of the above-mentioned predictors could possibly prevent/reduce DRPs.
Collapse
Affiliation(s)
- Viswam K Subeesh
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Rishma Abraham
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Minnikanti Venkata Satya Sai
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| | - Kranthi Swaroop Koonisetty
- Department of Pharmacy Practice, Faculty of Pharmacy, M. S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
| |
Collapse
|
23
|
Sukkha S, Rattanavipanon W, Chamroenwit B, Sanganurak M, Nathisuwan S, Chaikledkaew U, Kongwatcharapong J. Quality assessment and cost saving of renal dosing recommendation by clinical pharmacists at medical wards in Thailand. Int J Clin Pharm 2020; 42:610-616. [DOI: 10.1007/s11096-020-01016-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/16/2020] [Indexed: 12/30/2022]
|
24
|
Processes and determinants of integration of eGFR in physicians' drug prescriptions: a qualitative study of semi-structured interviews. Prim Health Care Res Dev 2019; 20:e143. [PMID: 31640822 PMCID: PMC6842646 DOI: 10.1017/s1463423619000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM Our objective was to explore the processes and determinants leading physicians to integrate estimated glomerular filtration rate (eGFR) in their drug prescriptions. BACKGROUND Access to patients' eGFR would allow primary care pharmacists to optimise their role in the procedure of safe prescribing. Some rare physicians actively integrate eGFR in their prescriptions, in a sporadically and uncoordinated manner. METHODS Qualitative study using semi-directed interviews conducted among 12 French physicians who integrated eGFR in their drug prescriptions, (February 2016-April 2017). These voluntary participants were recruited through different means: Twitter®, forums, direct contact and snowball sampling. Data analysis was based on the grounded theory approach, underpinned by a comprehensive perspective of interactionist orientation. FINDINGS Residency and training, professional experience - including experiences of adverse drug reactions - and the membership in various communities of professionals were key drivers for the integration of eGFR in prescriptions. The theoretical aim was above all safe prescribing in order to reduce adverse drug reactions, with the control by a dispensing pharmacist and/or other healthcare professionals. Nevertheless, none of the physicians had received any feedback from any healthcare professionals. Despite their disappointment, the physicians remained convinced of the interest of integrating eGFR in their prescriptions and would continue to do so. Characteristics associated with integration of eGFR in drug prescriptions belong partly to Roger's theory of innovations. If a widespread diffusion of this habit takes place, it will be necessary to evaluate its adoption by both physicians and pharmacists.
Collapse
|
25
|
Teh XR, Lee SWH. Pharmacists’ attitude, self‐reported knowledge and practice of dosage adjustment among chronic kidney disease patients in Malaysia. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Xin R. Teh
- Pharmacy Department Hospital Selama Perak Malaysia
- Healthcare Statistics Unit National Clinical Research Centre Kuala Lumpur Malaysia
| | - Shaun W. H. Lee
- School of Pharmacy Monash University Malaysia Subang Jaya, Selangor Malaysia
- Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well‐being Cluster, Global Asia in the 21st Century (GA21) Platform Monash University Malaysia Selangor Malaysia
| |
Collapse
|
26
|
Kondo Y, Ishitsuka Y, Kawabata N, Iwamoto N, Takahashi R, Narita Y, Kadowaki D, Hirata S, Uchino S, Irie T. Knowledge and awareness of nonpharmacist salespersons regarding over-the-counter drug use in patients with chronic kidney disease in Japan. PLoS One 2019; 14:e0213763. [PMID: 30893364 PMCID: PMC6426248 DOI: 10.1371/journal.pone.0213763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/28/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Patients with chronic kidney disease (CKD) depend on advice from healthcare professionals to avoid using unsuitable over-the-counter (OTC) drugs. Recently, qualified, registered nonpharmacist salespersons became licensed to sell OTC drugs in Japan. However, registered salespersons’ knowledge and awareness of precautions regarding unsuitable OTC drugs for use in patients with CKD are unclear. Objectives This study aimed to clarify the awareness, knowledge, and implementation of precautions by registered salespersons regarding OTC drugs used by patients with CKD. Additionally, we evaluated the change of registered salespersons’ knowledge and awareness of this topic generated by a pharmacist intervention. Methods A questionnaire survey and pharmacist intervention were applied to 175 registered salespersons. The intervention comprised a 50-minute lecture imparted by a pharmacist who was trained in nephrology. The knowledge, awareness, and implementation of precautions by participants with respect to nonsteroidal anti-inflammatory drugs (NSAIDs) and antacids were evaluated before and after the intervention. Results Approximately half of the registered salespersons reported previous experience with selling OTC drugs that were inappropriate for patients with CKD (NSAIDs, 48.0%; antacids, 39.7%). Few participants recognized the need to check renal function when selling those drugs to such patients (NSAIDs, 25.7%; antacids, 47.5%). The registered salespersons’ awareness and knowledge were significantly higher after the intervention than before it. Conclusion The results indicate that before the intervention, the registered salespersons had low levels of awareness and knowledge regarding OTC drug use in patients with CKD despite having prior experience selling unsuitable OTC drugs. However, the pharmacist intervention improved the registered salespersons’ awareness and knowledge. The educational program for registered salespersons might be necessary to prevent inappropriate OTC drug use by patients with CKD.
Collapse
Affiliation(s)
- Yuki Kondo
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
- * E-mail:
| | - Yoichi Ishitsuka
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
| | - Nobuhiro Kawabata
- Kagoshima Pharmaceutical Association, 2-8-15 Yojiro, Kagoshima, Japan
| | - Nobuhide Iwamoto
- Kagoshima Pharmaceutical Association, 2-8-15 Yojiro, Kagoshima, Japan
| | - Risa Takahashi
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
| | - Yuki Narita
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
| | - Daisuke Kadowaki
- Laboratory of Clinical Pharmaceutics, Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Kumamoto, Japan
| | - Sumio Hirata
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
- Center for Clinical Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
| | - Satoru Uchino
- Kagoshima Pharmaceutical Association, 2-8-15 Yojiro, Kagoshima, Japan
| | - Tetsumi Irie
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
- Center for Clinical Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University, 5–1 Oe-honmachi, Chuo-ku, Kumamoto, Japan
| |
Collapse
|
27
|
Choi KS, Lee E, Rhie SJ. Impact of pharmacists' interventions on physicians' decision of a knowledge-based renal dosage adjustment system. Int J Clin Pharm 2019; 41:424-433. [PMID: 30864079 DOI: 10.1007/s11096-019-00796-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 01/28/2019] [Indexed: 12/30/2022]
Abstract
Background Early interventions with clinical decision support system (CDSS) guidance have ensured appropriate drug dosing for patients with renal impairment. However, the low rates of physician compliance with CDSS alerts have been reported. Objective We investigated whether designated pharmacist interventions were associated with physician' acceptance of the knowledge-based renal dosage adjustment system (K-RDS) for patients with reduced renal function. Setting A retrospective, single-center study was conducted using a healthcare information system at a tertiary teaching hospital. Methods This study compared physicians' acceptance of the K-RDS with and without designated pharmacists. The severity of prescription errors and the impact of service provided by the pharmacist were evaluated using the validated method developed by Overhage and Lukes. From April to June 2017, we enrolled patients who were ≥ 20 years of age and admitted with an estimated glomerular filtration rate under 50 ml/min on medications that required dose adjustments. Main outcomes measure The number of dosing alerts of the K-RDS and physicians' acceptance rates were compared between a control group guided by the central pharmacy only and a group with assigned designated pharmacists. The factors associated with the physicians' acceptance rate were also analyzed using a multivariate logistic regression method. The impact of service provided by the pharmacist were considered as 'highly significant' (categories: 1-2). Severity of prescription errors were defined as 'serious' if they corresponded to categories 1-2 of the Overhage and Lukes scale for severity, and interventions were relevant if they corresponded to categories 1-3 in the impact of service provided by the pharmacist scale. Results Among 1363 prescription interventions, 491 (36.0%) were performed by designated pharmacists. The K-RDS alert acceptance rate by the physicians was 54.4% in the designated pharmacist group and 47.0% in the control group (p = 0.0233). The statistically significant association was found in the designated pharmacists group in 'highly significant' service provided by the pharmacist (p < 0.001, OR 1.772; 95% CI 1.362-2.305) and 'serious' severity of prescription errors (p = 0.012, OR 1.657; 95% CI 1.116-2.460). The presence of designated pharmacists (OR 1.353, p = 0.0272), patient's gender (OR 0.758, p = 0.0016), department specialty (OR 0.659, p < 0.0001), eGFR (OR 1.538 if < 10 ml/min; OR 1.519 if 10-40 ml/min, p < 0.0001), and medications (OR 6.058-43.992 depending on the medication category, p < 0.0001) were significant factors affecting physicians' acceptance. Conclusion Pharmacists' interventions effectively improved physicians' acceptance of the K-RDS alerts.
Collapse
Affiliation(s)
- Kyung Suk Choi
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.,Department of Pharmacy, Seoul National University Bundang Hospital, Seoungnam-si, Republic of Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seoungnam-si, Republic of Korea
| | - Sandy Jeong Rhie
- Division of Life and Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea. .,College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea.
| |
Collapse
|
28
|
McConachie SM, Hanni CM, Raub JN, Kucemba M, Wilhelm SM. National assessment of renal estimation for drug dosing among pharmacists. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2018. [DOI: 10.1002/jac5.1057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Sean M. McConachie
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
- Beaumont Hospital; Dearborn Michigan
| | | | - Joshua N. Raub
- Detroit Receiving Hospital & University Health Center; Detroit Michigan
| | | | - Sheila M. Wilhelm
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences; Wayne State University; Detroit Michigan
| |
Collapse
|
29
|
Wazzan AAA, Tommelein E, Foubert K, Bonassi S, Onder G, Somers A, Petrovic M, Boussery K. Development and Application of the GheOP 3S-Tool Addendum on Potentially Inappropriate Prescribing (PIP) of Renally Excreted Active Drugs (READs) in Older Adults with Polypharmacy. Drugs Aging 2018; 35:343-364. [PMID: 29508369 DOI: 10.1007/s40266-018-0530-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Renal function progressively worsens with age. Potentially inappropriate prescribing (PIP) of renally excreted active drugs (READs) is common in older adults, leading to an increased rate of iatrogenic illness. The Ghent Older People's Prescription community Pharmacy Screening (GheOP3S-) tool is an effective, explicit instrument that was developed for community pharmacists (CPs) to detect PIP. So far, this tool does not assess PIP of the frequently used READs in older patients with renal impairment. OBJECTIVES This study aimed to expand the GheOP3S-tool with the first addendum to screen for PIP of frequently used READs, and to perform a cross-sectional analysis using the addendum and the medication history of a group of older adults with polypharmacy. METHODS The addendum was developed in three steps: (1) collection of individual and combined READs, (2) collection of dose-adjustment recommendations, and (3) expert panel evaluation. Consequently, the addendum was applied retrospectively on the medication list of 60 older adults with polypharmacy and with four renal function-estimating equations. RESULTS The addendum includes 61 READs recommendations for dose/drug-adjustment alternatives, laboratory test follow-ups, and patients' referral to specialists' care. In the cross-sectional analysis, 35-78% of patients were diagnosed with renal impairment, depending on the equations used for renal function estimation. Among patients with renal impairment, 21-46% of the prescribed READs were deemed potentially inappropriate by the GheOP3S-tool addendum. CONCLUSION The GheOP3S-tool was expanded with an addendum on PIP of READs in renal impairment for older patients. The cross-sectional analysis using the addendum suggests that PIP of READs is common in older patients with polypharmacy and renal impairment. Using this addendum, CPs might contribute to diminishing PIP of READs.
Collapse
Affiliation(s)
- Abdul Aziz Al Wazzan
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium. .,Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy. .,Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Eline Tommelein
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium
| | - Katrien Foubert
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium
| | - Stefano Bonassi
- Clinical and Molecular Epidemiology, IRCCS San Raffaele Pisana, Rome, Italy.,Department of Human Sciences and Quality of Life Promotion, San Raffaele University, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annemie Somers
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium.,Department of Pharmacy, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium
| | - Mirko Petrovic
- Department of Internal medicine (Geriatrics), Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 9000, Gent, Belgium
| | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000, Gent, Belgium
| |
Collapse
|
30
|
Roberts DM, Sevastos J, Carland JE, Stocker SL, Lea-Henry TN. Clinical Pharmacokinetics in Kidney Disease: Application to Rational Design of Dosing Regimens. Clin J Am Soc Nephrol 2018; 13:1254-1263. [PMID: 30042221 PMCID: PMC6086693 DOI: 10.2215/cjn.05150418] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A change in pharmacokinetics can alter drug exposure and predispose the patient to either over- or underdosing, potentially resulting in adverse drug reactions or therapeutic failure. Kidney disease is characterized by multiple physiologic effects, which induce clinically significant changes in pharmacokinetics. These vary between individuals and may be quantitated in certain instances. An understanding of pharmacokinetic concepts is, therefore, important for a rational approach to the design of drug dosing regimens for the delivery of personalized medical care. Whether kidney disease is acute or chronic, drug clearance decreases and the volume of distribution may remain unchanged or increase. AKI is defined by dynamic changes in kidney function, which complicates attempts to accurately quantify drug clearance. In contrast, changes in drug clearance progress more slowly with CKD. In general, kidney replacement therapies increase drug clearance, but the extent to which this occurs depends on the modality used and its duration, the drug's properties, and the timing of drug administration. However, the changes in drug handling associated with kidney disease are not isolated to reduced kidney clearance and an appreciation of the scale of potential derangements is important. In most instances, the first dose administered in patients with kidney disease is the same as in patients with normal kidney function. However, in some cases, a higher (loading) initial dose is given to rapidly achieve therapeutic concentrations, followed by a lower maintenance dose, as is well described when prescribing anti-infectives to patients with sepsis and AKI. This review provides an overview of how pharmacokinetic principles can be applied to patients with kidney disease to personalize dosage regimens. Patients with kidney disease are a vulnerable population and the increasing prevalence of kidney disease means that these considerations are important for all prescribers.
Collapse
Affiliation(s)
- Darren M. Roberts
- Departments of Clinical Pharmacology and Toxicology, and
- Department of Renal Medicine, The Canberra Hospital, Woden, Australian Capital Territory, Australia
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Jacob Sevastos
- Nephrology and Renal Transplantation, St. Vincent’s Hospital, Darlinghurst, New South Wales, Australia
- Department of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia; and
| | - Jane E. Carland
- Departments of Clinical Pharmacology and Toxicology, and
- Department of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia; and
| | - Sophie L. Stocker
- Departments of Clinical Pharmacology and Toxicology, and
- Department of Medicine, St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia; and
| | - Tom N. Lea-Henry
- Department of Renal Medicine, The Canberra Hospital, Woden, Australian Capital Territory, Australia
- Nephrology and Transplantation Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
| |
Collapse
|
31
|
Truong WR, Yamaki J. The Hospital Antimicrobial Use Process: From Beginning to End. Open Forum Infect Dis 2018; 5:ofy098. [PMID: 29977958 PMCID: PMC6016413 DOI: 10.1093/ofid/ofy098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/27/2018] [Indexed: 11/14/2022] Open
Abstract
Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient's treatment course. Hence, approaching AMS through the framework of a hospital's AUP is essential to improving appropriate antimicrobial use.
Collapse
Affiliation(s)
| | - Jason Yamaki
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, California
- Department of Pharmacy, Hoag Memorial Hospital Presbyterian, Newport Beach, California
| |
Collapse
|
32
|
Njeri LW, Ogallo WO, Nyamu DG, Opanga SA, Birichi AR. Medication-related problems among adult chronic kidney disease patients in a sub-Saharan tertiary hospital. Int J Clin Pharm 2018; 40:1217-1224. [DOI: 10.1007/s11096-018-0651-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/05/2018] [Indexed: 11/24/2022]
|
33
|
Saad CY, Fogel J, Rubinstein S. Awareness and Knowledge Among Internal Medicine Resident Trainees for Dose Adjustment of Analgesics and Neuropsychotropic Medications in CKD. South Med J 2018; 111:155-162. [PMID: 29505650 DOI: 10.14423/smj.0000000000000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Errors in drug dosing lead to poor patient outcomes and are common in patients with chronic kidney disease (CKD). Because the majority of patients with CKD are being treated by physicians specializing in internal medicine, we studied the awareness and knowledge that internal medicine resident trainees (IMRTs) have regarding the correct dosage of commonly used analgesic and neuropsychotropic medications for patients with CKD. METHODS We surveyed 353 IMRTs about their awareness of whether a medication needs dose adjustment in patients with CKD and knowledge for medication adjustment by level of glomerular filtration rate. RESULTS There were high percentages for lack of awareness and knowledge. For analgesics, this lack of awareness/knowledge was highest for acetaminophen (awareness 83.0%, knowledge 90.9%). For neuropsychotropics, this was highest for paroxetine (awareness 74.5%, knowledge 91.5%). Analyses for postgraduate year (PGY) -1 trainees and PGY-2 trainees for analgesics showed higher odds for lack of awareness for tramadol (PGY-1 odds ratio [OR] 2.37, 95% confidence interval [CI] 1.2-4.62, P < 0.05; PGY-2 OR 2.34, 95% CI 1.16-4.72, P < 0.05) and for lack of knowledge for meperedine (PGY-1 OR 4.01, 95% CI 1.81-8.89, P < 0.05; PGY-2 OR 3.30, 95% CI 1.44-7.59, P < 0.05). Nephrology residency rotation for the neuropsychotropic medication of gabapentin showed lower odds for both lack of awareness (OR 0.56, 95% CI 0.32-0.97, P < 0.05) and knowledge (OR 0.52, 95% CI 0.27-0.997, P < 0.05). CONCLUSIONS Awareness and knowledge are poor among IMRTs for dose adjustments of analgesics and neuropsychotropic medication classes in patients with CKD. There should be a renewed focus during IMRTs' residency on additional nephrology exposure and formal didactic educational training to help them better manage complex treatment regimens to prevent medication dosing errors.
Collapse
Affiliation(s)
- Chadi Y Saad
- From the Division of Nephrology and Hypertension, Nassau University Medical Center, East Meadow, New York, and the Department of Business Management, Brooklyn College, Brooklyn, New York
| | - Joshua Fogel
- From the Division of Nephrology and Hypertension, Nassau University Medical Center, East Meadow, New York, and the Department of Business Management, Brooklyn College, Brooklyn, New York
| | - Sofia Rubinstein
- From the Division of Nephrology and Hypertension, Nassau University Medical Center, East Meadow, New York, and the Department of Business Management, Brooklyn College, Brooklyn, New York
| |
Collapse
|
34
|
O'Shaughnessy M, Allen N, O'Regan J, Payne-Danson E, Mentre L, Davin D, Lavin P, Grimes T. Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease. QJM 2017; 110:623-628. [PMID: 28431157 PMCID: PMC6256938 DOI: 10.1093/qjmed/hcx086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. AIM We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. DESIGN Single-centre observational study. METHODS A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission. RESULTS Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P < 0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14). CONCLUSIONS PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.
Collapse
Affiliation(s)
- M O'Shaughnessy
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - N Allen
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - J O'Regan
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - E Payne-Danson
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - L Mentre
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - D Davin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - P Lavin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - T Grimes
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| |
Collapse
|
35
|
Tesfaye WH, Castelino RL, Wimmer BC, Zaidi STR. Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions. Int J Clin Pract 2017; 71. [PMID: 28544106 DOI: 10.1111/ijcp.12960] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/10/2017] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Adjusting doses of renally cleared medications and/or avoidance of nephrotoxic medications are standard clinical practices in chronic kidney disease (CKD), albeit the prevalence of inappropriate prescribing (IP) in these patients remains high. Therefore, this work sought to systematically review the prevalence of IP and compare the relative effectiveness of available interventions in reducing IP in CKD. METHODS Studies were identified searching PubMed/Medline, EMBASE, Cochrane Library, IPA, Web of Science, Ovid/Medline, CINAHL, and PsychINFO databases. Studies defining CKD based on laboratory markers and quantifying prevalence of IP were included. RESULTS Forty-nine studies from 23 countries met the inclusion criteria. An IP prevalence of 9.4%-81.1% and 13%-80.50% was reported in hospital and ambulatory settings, respectively; whereas, in long-term care facilities the prevalence ranged between 16% and 37.9%. Unsurprisingly, IP was associated with adverse drug events like increased hospital stay (Mean [SD] of 4.5 [4.8] vs 4.3 [4.5]) and high risk of mortality [40%]. Twenty-one studies reported the impact of interventions on IP; manual and computerised alerts were the main forms of interventions (n=19). The most significant reduction in IP was observed when physicians received immediate concurrent feedback from a clinical pharmacist (P<.001). Polypharmacy, comorbidities, and age were identified as predictors of IP. CONCLUSION IP has led to poor patient outcomes. Although pharmacist-based and computer-aided approaches have shown promising results, there is still room for improvement. Future studies should focus on developing a multifaceted intervention to address the widespread prevalence of IP and associated clinical outcomes in CKD patients.
Collapse
Affiliation(s)
| | - Ronald L Castelino
- Sydney Nursing School, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Barbara C Wimmer
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Syed Tabish R Zaidi
- Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
36
|
Dörks M, Allers K, Schmiemann G, Herget-Rosenthal S, Hoffmann F. Inappropriate Medication in Non-Hospitalized Patients With Renal Insufficiency: A Systematic Review. J Am Geriatr Soc 2017; 65:853-862. [PMID: 28240771 DOI: 10.1111/jgs.14809] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency. DESIGN A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients. RESULTS Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs. CONCLUSION Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
Collapse
Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| |
Collapse
|
37
|
Yang P, Chen N, Wang RR, Li L, Jiang SP. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital. Ther Clin Risk Manag 2016; 12:1517-1524. [PMID: 27785039 PMCID: PMC5066999 DOI: 10.2147/tcrm.s116789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background With the increasing incidence rate of chronic kidney disease (CKD), inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure. Objective The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients. Methods A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified. Results Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56), contraindicated (n=46), and cautiously used medicines (n=161) accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056). Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%), cardiovascular drugs (n=61, 23.19%), and antimicrobial drugs (n=55, 20.91%) represented the top three medicine categories in CKD patients. Conclusion The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary.
Collapse
Affiliation(s)
- Ping Yang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Na Chen
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Rong-Rong Wang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Lu Li
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Sai-Ping Jiang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| |
Collapse
|
38
|
Lee A, Poff A, Martin A. 130AUDIT OF APPROPRIATE PRESCRIBING IN ELDERLY NURSING HOME RESIDENTS WITH CHRONIC KIDNEY DISEASE. Age Ageing 2016. [DOI: 10.1093/ageing/afw159.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
39
|
Leriverend H, Rabillet J, Faure S. Connaissance de la fonction rénale lors de la délivrance de médicaments : une avancée dans la prise en charge. ACTUALITES PHARMACEUTIQUES 2016. [DOI: 10.1016/j.actpha.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
40
|
Patel N, Reedy M, Ramsey EZ. Implementation of active surveillance in electronic health records at pediatric institutions. Am J Health Syst Pharm 2016; 73:270-3. [PMID: 26896497 DOI: 10.2146/ajhp140887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Neil Patel
- Department of Pharmacy ServicesThe Children's Hospital of PhiladelphiaPhiladelphia, PA
| | - Michael Reedy
- Department of Pharmacy ServicesThe Children's Hospital of PhiladelphiaPhiladelphia, PA
| | - E Zachary Ramsey
- Department of Pharmacy ServicesThe Children's Hospital of PhiladelphiaPhiladelphia, PA
| |
Collapse
|
41
|
Schafer JJ, Gill TK, Sherman EM, McNicholl IR. ASHP Guidelines on Pharmacist Involvement in HIV Care. Am J Health Syst Pharm 2016; 73:468-94. [PMID: 26892679 DOI: 10.2146/ajhp150623] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor K Gill
- Internal Medicine, Via Christi Hospitals Wichita, Wichita, KS
| | - Elizabeth M Sherman
- College of Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, and South Broward Community Health Services, Memorial Healthcare System, Hollywood, FL
| | | |
Collapse
|
42
|
Community pharmacist intervention in patients with renal impairment. Int J Clin Pharm 2015; 37:1172-9. [DOI: 10.1007/s11096-015-0182-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
|
43
|
McDaniel BL, Bentley ML. The role of medications and their management in acute kidney injury. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:21-29. [PMID: 29354517 PMCID: PMC5741024 DOI: 10.2147/iprp.s52930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Prior to 2002, the incidence of acute renal failure (ARF) varied as there was no standard definition. To better understand its incidence and etiology and to develop treatment and prevention strategies, while moving research forward, the Acute Dialysis Quality Initiative workgroup developed the RIFLE (risk, injury, failure, loss, end-stage kidney disease) classification. After continued data suggesting that even small increases in serum creatinine lead to worse outcomes, the Acute Kidney Injury Network (AKIN) modified the RIFLE criteria and used the term acute kidney injury (AKI) instead of ARF. These classification and staging systems provide the clinician and researcher a starting point for refining the understanding and treatment of AKI. An important initial step in evaluating AKI is determining the likely location of injury, generally classified as prerenal, renal, or postrenal. There is no single biomarker or test that definitively defines the mechanism of the injury. Identifying the insult(s) requires a thorough assessment of the patient and their medical and medication histories. Prerenal injuries arise primarily due to renal hypoperfusion. This may be the result of systemic or focal conditions or secondary to the effects of drugs such as nonsteroidal anti-inflammatory drugs, calcineurin inhibitors (CIs), and modulators of the renin-angiotensin-aldosterone system. Renal, or intrinsic, injury is an overarching term that represents complex conditions leading to considerable damage to a component of the intrinsic renal system (renal tubules, glomerulus, vascular structures, inter-stitium, or renal tubule obstruction). Acute tubular necrosis and acute interstitial nephritis are the more common types of intrinsic renal injury. Each type of injury has several drugs that are implicated as a possible cause, with antiinfectives being the most common. Postrenal injuries that result from obstruction block the flow of urine, leading to hydronephrosis and subsequent damage to the renal parenchyma. Drugs associated with tubular obstruction include acyclovir, methotrexate, and several antiretrovirals. Renal recovery from drug-induced AKI begins once the offending agent has been removed, if clinically possible, and is complete in most cases. It is uncommon that renal replacement therapy will be needed while recovery occurs. Pharmacists can play a pivotal role in identifying possible causes of drug-induced AKI and limit their toxic effect by identifying those most likely to cause or contribute to injury. Dose adjustment is critical during changes in renal function, and the pharmacist can ensure that optimal therapy is provided during this critical time.
Collapse
Affiliation(s)
| | - Michael L Bentley
- Department of Pharmacy, Carilion Clinic, Roanoke, VA, USA
- Department of Biomedical Science, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| |
Collapse
|
44
|
Doody HK, Peterson GM, Watson D, Castelino RL. Retrospective evaluation of potentially inappropriate prescribing in hospitalized patients with renal impairment. Curr Med Res Opin 2015; 31:525-35. [PMID: 25629794 DOI: 10.1185/03007995.2015.1010036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND/AIMS Patients with chronic kidney disease require appropriate adjustment of nephrotoxic and renally cleared medications to ensure safe and effective pharmacotherapy. It is currently unclear how often appropriate medication selection and dosage adjustment occurs in practice. Therefore, this study aimed to evaluate the extent of potentially inappropriate prescribing (PIP) (the use of a contraindicated medication or inappropriately high dose according to the renal function) in patients with renal impairment from admission through to discharge from the Royal Hobart Hospital (RHH), Tasmania, Australia; to evaluate the medications most commonly implicated in PIP; and the factors associated with PIP in renal impairment. METHODS Medical records of 251 patients consecutively admitted to the RHH aged 40 years and above, with a creatinine clearance of ≤60 mL/min, and hypertension and/or diabetes mellitus in their medical history, were reviewed. PIP was assessed using the Australian Medicines Handbook and/or product information. RESULTS Of the 251 patients, 81 (32.3%) were receiving a total of 116 potentially inappropriate medications (PIMs) at the time of admission. The number of patients receiving PIMs (81 vs. 44, p<0.001 chi-square test) as well as the total number of PIMs (116 vs. 63, p<0.001 Wilcoxon signed rank test) were significantly decreased at discharge. Metformin was the most common PIM at admission. However, PIP of metformin was reduced by approximately 50% by discharge. Logistic regression analysis revealed two significant independent risk factors for PIP: a higher number of medications at admission increased risk of PIP (OR 1.1, 95% CI 1.02-1.18, p=0.010), and higher initial estimated glomerular filtration rate (eGFR) decreased the risk of PIP (OR 0.9, 95% CI 0.96-0.99, p=0.011). CONCLUSIONS Despite the limitations of lack of body weight documentation and lack of clear guidelines for dosage adjustment based on the eGFR, PIP in patients with renal impairment is common and admission to the hospital was associated with a significant reduction in PIP. More recognition of chronic kidney disease in the community and strategies to alert clinicians of the need for dosage adjustment in renal impairment are warranted.
Collapse
|
45
|
Kondo Y, Ishitsuka Y, Shigemori E, Irikura M, Kadowaki D, Hirata S, Maemura T, Irie T. Awareness and current implementation of drug dosage adjustment by pharmacists in patients with chronic kidney disease in Japan: a web-based survey. BMC Health Serv Res 2014; 14:615. [PMID: 25464858 PMCID: PMC4258280 DOI: 10.1186/s12913-014-0615-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 11/18/2014] [Indexed: 12/05/2022] Open
Abstract
Background The aims of this study were to evaluate the current awareness of and implementation by pharmacists in Japan of adjustment of drug dosage according to renal function (ADDR) in patients with chronic kidney disease (CKD) and to clarify the factors influencing implementation of ADDR by community pharmacists. Methods We conducted a web-based questionnaire of Japanese community and hospital pharmacists. Responders were compared by characteristics, rate of implementation of ADDR, experience with adverse drug events, pharmacist awareness of implementation of ADDR, and obstacles to ADDR implementation experienced by pharmacists. Additionally, the factors influencing the implementation of ADDR by community pharmacists were investigated by logistic regression analysis. Results Fewer community pharmacists had implemented ADDR than hospital pharmacists. The community pharmacists had less experience with adverse drug events caused by an inappropriate dosage than the hospital pharmacists, while the hospital pharmacists had encountered more severe adverse drug events than the community pharmacists. The community pharmacists had less awareness of ADDR implementation, and believed that problems in implementing ADDR were caused by a lack of information on the renal function of patients. In the logistic regression analysis, the factors influencing implementation of ADDR were “Routinely receiving prescriptions from nephrologists”, “Experience with adverse drug events caused by inappropriate dosage for CKD patients”, and “Awareness of the need for pharmacists to check the dosage of renally excreted drugs”; they did not include “Lack of information on patient renal function”. Conclusions This study indicates that fewer Japanese community pharmacists than hospital pharmacists implement ADDR and that implementation of ADDR by community pharmacists is hindered by their limited awareness of the importance of patient renal function. We advocate that many countermeasures be introduced to prevent CKD patients from experiencing adverse drug events caused by inappropriate dosage. Such countermeasures would include a training program to educate pharmacists about the impact of impaired renal function on dosage of drugs that are excreted by the kidneys. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0615-0) contains supplementary material, which is available to authorized users.
Collapse
|
46
|
Jiang SP, Xu YY, Wu WF, Zhang XG, Lu XY, Xiao YH, Liang WF, Chen J. Improving antimicrobial dosing in critically ill patients receiving continuous venovenous hemofiltration and the effect of pharmacist dosing adjustment. Eur J Intern Med 2014; 25:930-5. [PMID: 25153537 DOI: 10.1016/j.ejim.2014.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 07/28/2014] [Accepted: 08/01/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Appropriate antimicrobial dosing for patients receiving continuous venovenous hemofiltration (CVVH) is complex. Pharmacist participation in antimicrobial dosing adjustment for patients receiving CVVH may be advantageous. METHODS A comparative study was performed in a China hospital intensive care unit (ICU).Patients receiving CVVH in the intervention group received antimicrobial dosing adjustment service by pharmacists from January 2012 to June 2012, whereas patients in the control group received routine medical care between July 2012 and December 2012. The primary outcomes including patients' length of ICU stay, mortality in ICU, ICU hospitalization costs, and the occurrence of adverse drug events (ADEs) were then compared. RESULTS 87 and 93 patients were included in the control and intervention groups. During the intervention period, pharmacists made 256 antimicrobial dosing adjustment recommendations for 93 enrolled patients receiving CVVH, of which 224 (87.5%) recommendations were accepted by physicians. Changing in CVVH-related variables (175, 68.4%) were the most common risk factors for dosing errors, whereas β-lactams (131, 51.2%) were the most frequency of antimicrobials associated with dosing errors. Compared with the control group, pharmacist dosing adjustment resulted in £1637.7 cost savings per patient, and 2.36 times reduction of antimicrobial-related adverse drug events (ADEs) (11 vs 26, P=0.002), while length of ICU stay and mortality in ICU showed no significant difference (P>0.05). CONCLUSIONS The involvement of pharmacist to participate in the ICU team rounds for patients receiving CVVH is associated with cost savings and reduction of ADEs. Hospital may consider employing ICU pharmacists.
Collapse
Affiliation(s)
- Sai-Ping Jiang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China
| | - Yan-Yan Xu
- Department of Pharmacy, Lishui central Hospital, 289 Kuocang Road, Lishui 323000, P.R. China
| | - Wei-Fang Wu
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China
| | - Xing-Guo Zhang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China
| | - Xiao-Yang Lu
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China
| | - Yong-Hong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Wei-Feng Liang
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Jian Chen
- Intensive Care Unit, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou 310003, P.R. China.
| |
Collapse
|
47
|
Elliott RA, Putman K, Davies J, Annemans L. A review of the methodological challenges in assessing the cost effectiveness of pharmacist interventions. PHARMACOECONOMICS 2014; 32:1185-1199. [PMID: 25145799 DOI: 10.1007/s40273-014-0197-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Pharmacists' roles are shifting away from medicines supply and the provision of patient education involving acute medications towards consultation-type services for chronic medications. Determining the cost effectiveness of pharmacist interventions has been complicated by methodological challenges. A critique of 31 economic evaluations carried out alongside comparative studies of pharmacist interventions published between 2003 and 2013 (12 from the UK, six from the USA) found a range of disease-specific and cross-therapeutic interventions targeting both patients and prescribers in a range of settings evaluated through a variety of study designs. Only ten were full economic evaluations, five of which were based on randomized controlled trials (RCTs). The intervention was usually quite well described, but the comparator was not always clearly described, and some interventions are very context specific due to the variability in pharmacist services available in different countries and practice settings. Complex multidirectional aims of most pharmacist interventions have led to many process, intermediate and longer-term outcomes being included in any one study. Quality of resource use and cost data varied. Most incremental cost-effectiveness ratios (ICERs) were generated from process indicators such as errors and adherence, with only four studies reporting cost per quality-adjusted life-year (QALY). Very few studies examined the effect of uncertainty, and methods used were not very clear in some cases. The principal finding from our critique is that poor RCT study design or analysis precludes many studies from finding pharmacist interventions effective or cost effective. We conclude with a set of recommendations for future study design.
Collapse
Affiliation(s)
- Rachel A Elliott
- Division for Social Research in Medicines and Health, The School of Pharmacy, University of Nottingham, University Park, East Drive, Nottingham, NG7 2RD, UK,
| | | | | | | |
Collapse
|
48
|
Barnes KD, Tayal NH, Lehman AM, Beatty SJ. Pharmacist-driven renal medication dosing intervention in a primary care patient-centered medical home. Pharmacotherapy 2014; 34:1330-5. [PMID: 25346347 DOI: 10.1002/phar.1508] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purposes of this population management intervention were to identify patients with stage 3, 4, or 5 chronic kidney disease (CKD) and to improve care in a patient-centered medical home (PCMH). Objectives of the intervention were to (i) increase the identification of CKD, (ii) increase the use of aspirin and angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) in patients with CKD, and (iii) ensure that all medications prescribed to patients with CKD were dosed appropriately based on renal function. SETTING This intervention was completed at a National Committee for Quality Assurance tier 3 PCMH associated with a major, academic health system. PATIENTS A list of 328 patients with an estimated glomerular filtration rate of < 60 mL/min per 1.73 m(2) was generated using the electronic medical record; 146 patients underwent the intervention. MEASUREMENTS AND OBSERVATIONS A pharmacist review of the electronic medical record was completed to confirm stage 3, 4, or 5 CKD based on estimated glomerular filtration rate, to ensure that ACE-Is/ARBs and aspirin were prescribed, and to ensure that all medications were dosed appropriately based on renal dosing adjustment recommendations. Recommendations were made to improve medication use and safety in patients with CKD. Before intervention, 73% of patients were prescribed an ACE-I/ARB and 72% of patients were prescribed aspirin. After the intervention, use of these medications increased to 77% and 82% of patients, respectively. Pharmacist recommendations to adjust medication dosing based on Cockcroft-Gault calculated creatinine clearance were made for 138 medications (0.95 medication per patient); 90 (65.2%) recommendations were accepted by the patients' physicians. CONCLUSION These results demonstrate the impact of a pharmacist-driven renal medication dosing intervention within a PCMH on medication use and safety for patients with CKD.
Collapse
Affiliation(s)
- Kelli D Barnes
- Division of Pharmacy Practice and Administration, The Ohio State University College of Pharmacy, Columbus, Ohio
| | | | | | | |
Collapse
|
49
|
Gallagher J, McCarthy S, Byrne S. Economic evaluations of clinical pharmacist interventions on hospital inpatients: a systematic review of recent literature. Int J Clin Pharm 2014; 36:1101-14. [DOI: 10.1007/s11096-014-0008-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/21/2014] [Indexed: 11/25/2022]
|
50
|
Huang RY, Lin YF, Kao SY, Shieh YS, Chen JS. A retrospective case-control analysis of the outpatient expenditures for western medicine and dental treatment modalities in CKD patients in Taiwan. PLoS One 2014; 9:e88418. [PMID: 24533085 PMCID: PMC3922810 DOI: 10.1371/journal.pone.0088418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD). METHODS A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000-2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy. RESULTS OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD. CONCLUSIONS Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.
Collapse
Affiliation(s)
- Ren-Yeong Huang
- Department of Periodontology, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Shuang Ho Hospital, New Taipei City, Taiwan
- Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Shing Shieh
- Department of Oral Diagnosis, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jin-Shuen Chen
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
| |
Collapse
|