Drug dosage in patients with renal failure optimized by immediate concurrent feedback

Falconnier, Ariane D.; Haefeli, Walter E.; Schoenenberger, Ronald A.; Surber, Christian; Martin‐Facklam, Meret

doi:10.1046/j.1525-1497.2001.016006369.x

Cited by 81 publications

(89 citation statements)

References 25 publications

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“…Two earlier studies in university hospitals reported a prevalence of 15% [2] and 17% [1] in general internal medicine patients. In ICU patients with significant co-morbidity, the expected prevalence is higher and indeed almost half of our patients had renal impairment.…”

Section: Discussionmentioning

confidence: 91%

“…We then gave written recommendations for all newly admitted patients within a short-time frame of 2 h after the ward rounds as to whether and how to adjust the dosage. Because in earlier studies [1] a significant fraction of dose reductions were not executed, we also assessed the reasons why recommendations were not transferred into practice.…”

Section: Discussionmentioning

confidence: 99%

“…Inappropriate dosing of drugs in patients with renal impairment is a common drug-related problem leading to adverse events, excessive length of hospital stay, and avoidable cost [1,2]. Because of the high prevalence of renal insufficiency in critically ill patients and the fact that elimination of roughly one out of seven drugs is mainly determined by the kidneys, modification of dose, dosing interval, or both is often required.…”

Section: Introductionmentioning

confidence: 99%

“…Cl crea estimates according to the equations proposed by Cockcroft and Gault [7] or Dettli [8] are widely used. In previous studies, drug information counselling, in which dose adjustments based on calculation methods were recommended, reduced adverse drug event rates [10], the length of hospital stay [2], and direct costs [1,11]. Recently a new equation-the Modification of Diet in Renal Disease (MDRD-2) equation-has been developed [5,12] to estimate glomerular filtration rate (eGFR).…”

Section: Introductionmentioning

confidence: 99%

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

Bertsche

Fleischer

Pfaff

et al. 2009

Eur J Clin Pharmacol

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

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Bertsche

Fleischer

Pfaff

et al. 2009

Eur J Clin Pharmacol

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“…A controlled study of individual feedback on drug dosages by a clinical pharmacist to the attending physician revealed 81% dosage adjustments in the intervention group, compared with 33% in the control group (26). It has been objected that true GFR is underestimated by endogenous creatinine clearance, and even more by its surrogate calculated GFR (27).…”

Section: Discussionmentioning

confidence: 99%

Clinically important renal impairment in various groups of old persons

Nygaard

Naik²,

Ruths

et al. 2004

Scandinavian Journal of Primary Health Care

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Linking Laboratory and Pharmacy

Schiff¹,

Klass²,

Peterson³

et al. 2003

Arch Intern Med

122

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A myriad of errors and lost improvement opportunities result from failure of clinical laboratory and pharmacy information systems to effectively communicate. Pharmacotherapy could benefit from enhanced laboratory-pharmacy linkage with respect to (1) drug choice (laboratory-based indications and contraindications), (2) drug dosing (renal or hepatic, blood level-guided adjustments), (3) laboratory monitoring (laboratory signals of toxicity, baseline and ongoing monitoring), (4) laboratory result interpretation (drug interfering with test), and (5) broader quality improvement (surveillance for unrecognized toxicity, monitoring clinician response delays). Linkages can be retrospective or real-time. Many organizations could benefit now by linking existing pharmacy and laboratory data. Greater improvement is possible through implementation of electronic order entry with real-time decision support incorporating linked laboratory and pharmacy data. While many guidelines, admonitions, and rules exist regarding drugs and the laboratory, substantial new knowledge and evidence in this area are needed. Focusing on these unmet needs and accompanying logistical challenges is a priority.

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Drug dosage in patients with renal failure optimized by immediate concurrent feedback

Abstract: The proportion of doses of renally eliminated drugs adjusted to renal function can be substantially increased by immediate concurrent feedback. This saves drug costs and has the potential to prevent adverse drug reactions.

Cited by 81 publications

References 25 publications

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

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

Clinically important renal impairment in various groups of old persons

Linking Laboratory and Pharmacy

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