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Standardized antimicrobial desensitization protocols helped to optimize patient care and antimicrobial stewardship while enabling more efficient use of pharmacy and AIP resources and fostering enhanced pharmacist-physician collaboration.

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