Reducing Preventable Medication Safety Events by Recognizing Renal Risk

Abstract

Results indicated that identification of patients with hidden renal risk can be improved by routinely assessing serum creatinine and estimated creatinine clearance levels during renal assessments. Clinical nurse specialists can use this evidence to promote safer nursing care of renal patients.

Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients

“…In our study, 54% of the patients had some degree of renal insufficiency, and the prevalence of "hidden renal insufficiency" (serum creatinine levels within the normal range but reduced estimated GFR) was high, especially among the women (Table 1). Our findings that women are more likely to have a "hidden renal insufficiency" is in agreement with findings in other studies [37,38]. In our study, 39% of the women and 20% of the men (of 144 women and 133 men in whom creatinine clearance could be estimated) suffered from "hidden renal insufficiency," which increases the risk of getting too high drug doses.…”

“…Medication safety can potentially be improved through a more comprehensive assessment of the renal function. Calculation of an estimated creatinine clearance is easily and quickly done and could be part of a routine assessment by a nurse to identify patients at risk of having DRPs [37]. Other routines are already implemented to identify at-risk patients, e.g., calculation of body mass index (BMI) to identify patients at risk of malnutrition, and calculation of risk of pressure ulcers by using the modified Norton scale.…”

“…To avoid IDU in the elderly, an accurate assessment of the renal function is extremely important [36,37]. Although serum creatinine is the most common laboratory test used for identifying renal impairment, it fails to detect such in many patients, particularly elderly women [36][37][38][39]. In our study, 54% of the patients had some degree of renal insufficiency, and the prevalence of "hidden renal insufficiency" (serum creatinine levels within the normal range but reduced estimated GFR) was high, especially among the women (Table 1).…”

Risk Factors Associated with the Requirement for Pharmaceutical Intervention in the Hospital Setting: A Systematic Review of the Literature

“…Poor renal function was the fourth most frequently reported risk factor, listed in nine papers [ 18 , 23 – 25 , 35 , 44 , 46 , 47 , 51 ]. However, as long ago as 1966, Smith et al [ 51 ] recognised that this risk factor is only likely to increase the rate of ADRs when using certain groups of drugs that are eliminated renally.…”

“…Regression analysis used to identify risk factors 2102 patients of 4331 admissions ✓ ✓ × ✓ ADRs included “accepted” side-effects e.g. Nausea and vomiting from chemotherapy Fields et al [ 35 ] United States Community Hosiptal Two community non-teaching hospitals. Prospective study using a multi-method approach—voluntary self-reports, e-prescribing, laboratory triggers and pharmacist intervention surveillance 1052 medication safety events; of these 318 were classified as errors ✓ Analysed data from medication errors only and did not address other ADEs Gurwitz and Avorn [ 36 ] United States Literature review examining the association of age with ADRs Medline search for articles between 1966 and 1990 × Review over 20 years old but principles likely to still apply Hoonhout et al [ 37 ] Netherlands MCS Analysis of MRAEs identified by retrospective chart review of patients admitted to 21 hospitals in 2004 140 patients of 7889 admissions ✓ ✓ Difficult to make comparisons to other studies due to differing definition of MRAEs; however, conclusions look similar to other studies …”