Impact of alerts in the computerized physician order entry on drug dosage adequacy for chronic kidney disease patients
(2011) ESCP 40th International Symposium on Clinical Pharmacy — Location: Dublin, Ireland (19.October.2011)
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- Introduction. Chronic kidney disease requires drug dosage adjustments. Alerts in the computerized prescription system (based on local guidelines[1]) were implemented to detect drug overdosage in kidney disease patients. The objective of this study was to evaluate the effectiveness of these alerts in improving prescription adequacy. Materials & Methods. Case control study comparing the frequency of errors in dosage adjustment before and after the implementation of alerts, in 975-bed hospital Cliniques Universitaires St Luc in Brussels. Patients met inclusion criteria when their GFR (Glomerular Filtration Rate) was inferior to 60 ml/min/1.73 m2 or with a creatinine value above 1.4 mg/ml. Patients hospitalized in wards without computerized prescription were excluded. All the prescriptions of the included patients were checked with guidelines, on two periods of six days before and after the implementation of alerts (September 2009 and September 2010) and classified as adequate, inadequate (in adapted or contra-indicated) or undefined. Other measures included the number of patients concerned, the total number of drug prescribed, the proportion of drugs triggering an alert. Results. 615 patients were included in the study (n = 301 in 2009 vs 314 in 2010). 62.6%, 10.2% and 8.3% of these patients were in chronic kidney diseases stage 3, 4 and 5 respectively. Most of the patients (54.5%) were aged between 70 and 89 years. 6367 prescriptions were evaluated (n = 2882 in 2009 vs 3485 in 2010) of which 15.8% triggered an alert. Among these, 25.4% and 24.6% resulted in an overdosage despite the alert in 2009 and in 2010 respectively (OR 0.97; 95% CI 0.72 to 1.29). The most frequent errors involved paracetamol, perindopril, tramadol, levocetirizine, allopurinol. Discussions, Conclusion. The implementation of alerts non-significantly decreased the proportion of inappropriate prescriptions. The reasons why physicians ignore the alerts require further research. The presence of clinical pharmacists in the wards, having face-to-face interaction with the prescribers, would probably further increase the quality of prescription. References 1. Sources: Compendium; Drug Prescribing in Renal Failure: Dosing Guidelines for Adults, George R. Aronoff; Drug information Handbook.
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Desmedt, S., Henrard, S., Wouters, D. M., Spinewine, A., & Dalleur, O. (2011). Impact of alerts in the computerized physician order entry on drug dosage adequacy for chronic kidney disease patients. International Journal of Clinical Pharmacy, 34(1), 215-216. https://hdl.handle.net/2078.5/216236 (Original work published 2011)