Improving Prescribing Safety in Patients with Renal Insufficiency in the Ambulatory Setting: The Drug Renal Alert Pharmacy (DRAP) Program

Bhardwaja, Bharati; Carroll, Nikki M.; Raebel, Marsha A.; Chester, Elizabeth A.; Korner, Eli J.; Rocho, Bob; Brand, David W.; Magid, David J.

doi:10.1592/phco.31.4.346

Cited by 53 publications

(95 citation statements)

References 27 publications

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“…Four of the five studies were conducted in an integrated care facility (Health Maintenance Organisation (HMO)) [20,21,33,34] and one in a hospital [14]. Three studies were randomised controlled trials (RCTs) [20,33,34], while two were before-after intervention design studies [14,21]. The publication dates for the studies ranged from 2007–2011.…”

Section: Resultsmentioning

confidence: 99%

The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review

Ojeleye

Avery

Gupta

et al. 2013

BMC Med Inform Decis Mak

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BackgroundElectronic Patient Medication Record (ePMR) systems have important safety features embedded to alert users about potential clinical hazards and errors. To date, there is no synthesis of evidence about the effectiveness of these safety features and alerts at the point of pharmacy order entry. This review aims to systematically explore the literature and synthesise published evidence about the effectiveness of safety features and alerts in ePMR systems at the point of pharmacy order entry, in primary and secondary care.MethodsWe searched MEDLINE, EMBASE, Inspec, International Pharmaceutical Abstracts, PsycINFO, CINHAL (earliest entry to March 2012) and reference lists of articles. Two reviewers examined the titles and abstracts, and used a hierarchical template to identify comparative design studies evaluating the effectiveness of safety features and alerts at the point of pharmacy order entry. The two reviewers independently assessed the quality of the included studies using Cochrane Collaboration’s risk of bias tool.ResultsThree randomised trials and two before-after studies met our criteria. Four studies involved integrated care facilities and one was hospital-based. The studies were all from the United States (US). The five studies demonstrated statistically significant reduction in medication errors in patients with renal insufficiency, pregnant women dispensed US Food Drug and Administration (FDA) risk category D (evidence of fetal risk but therapeutic benefits can outweigh the risk) or X (evidence suggests that risk to the fetus outweighs therapeutic benefits) medication, first dispensing of inappropriate medications in patients aged 65 and above, co-dispensing of interacting drugs, and adverse drug events related to hyperkalaemia.ConclusionsThis systematic review shows that the safety features of ePMR systems are effective in alerting users about potential clinical hazards and errors during pharmacy order entry. There are however, problems such as false alerts and inconsistencies in alert management. More studies are needed from other countries and pharmacy practice settings to assess the effectiveness of electronic safety features and alerts in preventing error and reducing harm to patients.

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Section: Resultsmentioning

confidence: 99%

The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review

Ojeleye

Avery

Gupta

et al. 2013

BMC Med Inform Decis Mak

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“…42 Adherence to complex medication regimens is crucial to stabilizing renal disease processes and slowing the progression of renal disease and comorbidities. Ambulatory care pharmacist specialists contribute significantly to prevention and management of chronic renal disease and end-stage renal disease through both case-based 43 and populationbased 44 approaches.…”

Section: Layar Armentioning

confidence: 99%

Defining and advancing ambulatory care pharmacy practice: It is time to lengthen our stride

Helling

Johnson

2014

American Journal of Health-System Pharmacy

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“…In a randomized trial, the DARP program led to a lower rate of medication errors compared with usual care. 53 The Nephrology CP also investigated the impact of an annual cap on brand-name prescription medication expenditures on sevelamer adherence and discontinuation for patients with end-stage renal disease. Patients with a capped brand-name prescription medication benefit were associated with fewer days of medication use compared with patients without a capped benefit.…”

Section: Nephrologymentioning

confidence: 99%

Ambulatory Clinical Pharmacy Specialty Services: The Kaiser Permanente Colorado Experience

Hill¹,

Herner²,

Delate³

et al. 2014

JMCP

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H ealth care in the United States is increasingly being delivered during ambulatory care visits. 1 As new investment in health care shifts from the inpatient to outpatient setting, the role of ambulatory clinical pharmacists (CP) are expanding. While dispensing pharmacists provide clinical screening and patient education for potential drugrelated problems, CPs provide services that complement the care provided by dispensing pharmacists by directly advising and educating other health care providers and patients on appropriate pharmaceutical use and dosing.Initial involvement of CPs in the ambulatory setting occurred primarily in the primary care setting. Early studies examined the impact of CPs and reported improved outcomes with clinical pharmacy management of care on patient compliance, [2][3][4][5][6] diabetes, 7 patient-specific drug information, 8 and treatment of infections.9 Systematic reviews of CP involvement in ambulatory settings note that while the quality of research (e.g., weak methodology, small sample sizes) is limited, the participation of CPs in health care has resulted in positive cost-effective care.10-12 A 2010 Cochrane review summarizing randomized controlled studies of CP involvement noted that most of the studies meeting inclusion took place in a primary care or community pharmacy setting rather than a specialties setting. 12CP involvement in ambulatory specialty areas has expanded into a broader array of disease states. Reports noting CP involvement in psychiatry practices were first published in the 1970s. 13,14 Currently, settings with CP involvement in specialty clinics include primarily health maintenance organizations, teaching institutions, and Veterans Affairs (VA) health systems.15 Other nonfee-for-service settings that may have specialty CP involvement include community clinics and other non-VA government health care systems. Systematic reviews summarizing the roles and/or impact of CP involvement in various specialty areas have been published. These areas include mental health, [16][17] 25 Knapp et al.'s (2005) 2004 survey of 233 ambulatory sites with CP involvement reported that the most common area of specialty CP involvement was oncology (28% of participating sites).15 Less than 10% of participating sites had CP involvement in neurology, heart failure, or psychiatry management, while involvement in other medical specialties was not reported by most participating sites.15 Accordingly, C O M M E N TA R YCP involvement in many specialties in the ambulatory setting has not been described in the literature, and little research on the clinical and economic outcomes of CP involvement has been conducted in specialty settings. [16][17][18]

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Improving Prescribing Safety in Patients with Renal Insufficiency in the Ambulatory Setting: The Drug Renal Alert Pharmacy (DRAP) Program

Abstract: The DRAP program was successful in reducing medication errors for patients with renal insufficiency in an ambulatory setting and was demonstrated to have sustainability after study completion.

Cited by 53 publications

References 27 publications

The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review

The evidence for the effectiveness of safety alerts in electronic patient medication record systems at the point of pharmacy order entry: a systematic review

Defining and advancing ambulatory care pharmacy practice: It is time to lengthen our stride

Ambulatory Clinical Pharmacy Specialty Services: The Kaiser Permanente Colorado Experience

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