title: Drug dosing in patients with renal insufficiency in a hospital setting using electronic prescribing and automated reporting of estimated glomerular filtration rate.
abstract: In patients with impaired renal function, drug dose adjustment is often required. Non-adherence to clinical prescribing recommendations may result in severe adverse events. In previous studies, the prevalence rate of non-adherence to recommended dosing has been reported to be 19-67%. Using the clinical support system Renbase(®) as reference, we investigated the use and dosing of drugs in patients with impaired renal function in a university hospital setting using electronic prescription and automatic reporting of estimated glomerular filtration rate (eGFR). In all, 232 patients with an eGFR in the range of 10-49 ml/min./1.73 m(2) were included. We identified 436 episodes with administration of renal risk drugs (prescribed to 183 patients): 410 drugs required dose adjustment according to the eGFR and 26 should be avoided. In total, the use or dosing of 66 (15%) of the 436 renal risk drugs was not in agreement with recommendations in Renbase(®) . This reflects less disagreement with expert guidelines than reported previously, indicating a possible beneficial effect of electronic prescribing and reporting of eGFR. However, we also found that disagreement to some extent reflected inappropriate drug use. We conclude that despite implementation of electronic prescribing and automated reporting of eGFR, patients with renal insufficiency may still be exposed to inappropriate drug use, with potential increased risk of adverse effects. Initiatives to reduce medication errors such as the use of electronic decision support systems should be explored.
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: Anita L
authors.initials: AL
authors.lastname: Nielsen
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Henriksen
authors.forename: Christianna
authors.initials: C
authors.lastname: Marinakis
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hellebek
authors.forename: Henrik
authors.initials: H
authors.lastname: Birn
authors.forename: Mads
authors.initials: M
authors.lastname: Nybo
authors.forename: Jens
authors.initials: J
authors.lastname: Søndergaard
authors.forename: Anita
authors.initials: A
authors.lastname: Nymark
authors.forename: Court
authors.initials: C
authors.lastname: Pedersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D055695:Electronic Prescribing / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005919:Glomerular Filtration Rate; D019983:Guideline Adherence; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D008875:Middle Aged; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000503:physiopathology*; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations