The Life-Changing Magic of Tidying Up the Medication List

Beben, Tomasz; Rifkin, Dena E.

doi:10.2215/cjn.0000000000000291

Cited by 1 publication

(2 citation statements)

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“…The process falls short when clinicians lack up-to-date information on patient comorbid conditions and medication use. Gaps in information are particularly common in dialysis care because the majority of US dialysis clinics use EHR systems that do not communicate with local health system EHRs . Such challenges with interoperable EHRs and clinical decision support systems and missteps in cross-clinician communication have been associated with reliance on the dialysis clinic for detection of potentially dangerous prescribing practices …”

Section: Discussionmentioning

confidence: 99%

“…Gaps in information are particularly common in dialysis care because the majority of US dialysis clinics use EHR systems that do not communicate with local health system EHRs. 36,47 Such challenges with interoperable EHRs and clinical decision support systems 45,46 and missteps in cross-clinician communication have been associated with reliance on the dialysis clinic for detection of potentially dangerous prescribing practices. 37 In 2022, the Centers for Medicare & Medicaid Services introduced a medication reconciliation measure to the End-Stage Renal Disease Quality Incentive Program, a Medicare pay-for-performance program.…”

Section: Qt-prolonging Medications In Individuals Receiving Hemodialysismentioning

confidence: 99%

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Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis

Wang,

Assimon

et al. 2024

JAMA Netw Open

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ImportanceIndividuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades de pointes (TdP), which is associated with higher risk of sudden cardiac death. Little is known about the prescription and dispensation patterns of QT-prolonging medications among people receiving dialysis, hindering efforts to reduce drug-related harm from these and other medications in this high-risk population.ObjectiveTo examine prescription and dispensation patterns of QT-prolonging medications with known TdP risk and selected interacting medications prescribed to individuals receiving hemodialysis.Design, Setting, and ParticipantsThis cross-sectional study included patients 60 years or older who were enrolled in Medicare Parts A, B, and D receiving in-center hemodialysis from January 1 to December 31, 2019. Analyses were conducted from October 20, 2022, to June 16, 2023.ExposuresNew-user prescriptions for the 7 most frequently filled QT-prolonging medications characterized by the timing of the new prescription relative to acute care encounters, the type of prescribing clinician and pharmacy that dispensed the medication, and concomitant use of selected medications known to interact with the 7 most frequently filled QT-prolonging medications with known TdP risk.Main Outcomes and MeasuresThe main outcomes were the frequencies of the most commonly filled and new-use episodes of QT-prolonging medications; the timing of medication fills relative to acute care events; prescribers and dispensing pharmacy characteristics for new use of medications; and the frequency and types of new-use episodes with concurrent use of potentially interacting medications.ResultsOf 20 761 individuals receiving hemodialysis in 2019 (mean [SD] age, 74 [7] years; 51.1% male), 10 992 (52.9%) filled a study drug prescription. Approximately 80% (from 78.6% for odansetron to 93.9% for escitalopram) of study drug new-use prescriptions occurred outside of an acute care event. Between 36.8% and 61.0% of individual prescriptions originated from general medicine clinicians. Between 16.4% and 26.2% of these prescriptions occurred with the use of another QT-prolonging medication. Most potentially interacting drugs were prescribed by different clinicians (46.3%-65.5%).Conclusions and RelevanceIn this cross-sectional study, QT-prolonging medications for individuals with dialysis-dependent kidney failure were commonly prescribed by nonnephrology clinicians and from nonacute settings. Prescriptions for potentially interacting medications often originated from different prescribers. Strategies aimed at minimizing high-risk medication-prescribing practices in the population undergoing dialysis are needed.

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Section: Discussionmentioning

confidence: 99%