Using serum creatinine concentrations to screen for inappropriate dosage of renally eliminated drugs.
The impact on drug therapy and costs of a program to identify and correct unadjusted dosage in renally impaired patients is described. The program was instituted in May 1988 by the clinical pharmacy staff at a 272-bed hospital. Each day the clinical pharmacist uses laboratory data to list patients with serum creatinine concentrations greater than 1.5 mg/dL. The pharmacist screens the pharmacy profiles of listed patients and calculates creatinine clearance for patients receiving renally eliminated drugs. If, after reviewing the patient's medical record, the pharmacist judges that a dosage adjustment may be appropriate, he writes a confidential note to the physician. From May 1988 through June 1989, 2341 patients with elevated serum creatinine were monitored. During that period, 162 notes were left; recommendations from 142 (88%) of the notes were accepted by physicians. Most of the notes were written for patients receiving antimicrobials or histamine H2-receptor antagonists. The program, which requires 20-30 minutes of pharmacist time per day, avoided $5003 in drug acquisition costs and cost $2700 to administer during the one-year period. When the costs associated with drug preparation and administration are considered, net cost avoidance was $5040. An intervention program in which notes to physicians are written when patients with abnormal serum creatinine values are receiving drugs for which a dosage adjustment appears indicated (1) has medical staff acceptance, (2) helps to satisfy standards of the Joint Commission on Accreditation of Healthcare Organizations, and (3) saves money.
University of Montana School of Pharmacy, Missoula 59812.
J P
JP
Peterson
V J
VJ
Colucci
S E
SE
Schiff
D017046:Cost Savings / Q000379:methods; D003404:Creatinine / Q000008:administration & dosage / Q000097:blood*; D004334:Drug Administration Schedule; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics / Q000592:standards*; D006744:Hospital Bed Capacity, 100 to 299; D016304:Hospitals, Private / Q000191:economics; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D007674:Kidney Diseases / Q000378:metabolism; D008510:Medication Systems, Hospital / Q000191:economics*; D009009:Montana; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D016730:Program Development
D004364:Pharmaceutical Preparations; D003404:Creatinine