title: Effectiveness of pharmacist dosing adjustment for critically ill patients receiving continuous renal replacement therapy: a comparative study.
abstract: BACKGROUND
  The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions.
  
  
  METHODS
  A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment.
  
  
  RESULTS
  The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P<0.001). However, there was no significant difference between length of ICU stay and mortality after pharmacist dosing adjustment, which was 8.93 days vs 7.68 days (P=0.26) and 30.10% vs 27.36% (P=0.39), respectively.
  
  
  CONCLUSIONS
  Pharmacist dosing adjustment for patients receiving CRRT was well accepted by physicians, and was related with lower adverse drug event rates and ICU cost savings. These results may support the development of strategies to include a pharmacist in the multidisciplinary ICU team.
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital, Hangzhou, People's Republic of China.
authors.forename: Sai-Ping
authors.initials: SP
authors.lastname: Jiang
authors.affiliation: Department of Pharmacy, Children's Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Zheng-Yi
authors.initials: ZY
authors.lastname: Zhu
authors.affiliation: Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.
authors.forename: Xiao-Liang
authors.initials: XL
authors.lastname: Wu
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital, Hangzhou, People's Republic of China.
authors.forename: Xiao-Yang
authors.initials: XY
authors.lastname: Lu
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital, Hangzhou, People's Republic of China.
authors.forename: Xing-Guo
authors.initials: XG
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, the First Affiliated Hospital, Hangzhou, People's Republic of China.
authors.forename: Bao-Hua
authors.initials: BH
authors.lastname: Wu
keywords: CRRT; adverse drug event; cost saving; drug dosing adjustment; pharmacist interventions