Authors (including presenting author) :
Chan M, Mak K, Mak CK
Affiliation :
Pharmacy Department, Tseung Kwan O Hospital
Introduction :
Adverse drug events are common among hospitalized patients with renal impairment. Outcomes can be detrimental when dosage are not appropriately adjusted, especially for drugs with narrow therapeutic windows. However, enforcing renal dosage review can be a challenge in busy pharmacy.
Launching of inpatient medication order entry (IPMOE) has facilitated pharmacists to review patients’ medication profile, calculate renal function and communicate with prescribers. An enhancement project was implemented in an acute hospital pharmacy by utilizing IPMOE functions and in-house dosage references to facilitate pharmacists to review inpatient orders and effectively offer appropriate renal dosing recommendations to clinicians when needed.
Objectives :
The objective of the project was to enhance safe use of medicatons for patients with renal impairment. A before-and after study was conducted to evaluate the impact of the project.
Methodology :
Twelve high risk medications including aminoglycosides, anticoagulants, acyclovir, digoxin and vancomycin were labelled as high risk medications for patients with renal impairment and prompts were set in IPMOE to alert pharmacists. Dual monitors were set up at inpatient workstations to allow pharmacists to effectively review patients’ laboratory data from electronic patient record while vetting orders. Furthermore, in-house renal dosing references for over 100 commonly prescribe medications were prepared using information gathered from product package leaflets and drug reference books and made readily accessible to users. The project was implemented in July 2017; pharmacists would use IPMOE function to check renal function of high risk patients (e.g. elderly) and review dosage using references tables provided. Clinicians would be notified when dosage adjustments were recommended. Number and type of drugs involved within a-4 month period a year before and after the launch of the project was reviewed.
Result & Outcome :
From July to October 2018, a total of 874 renal dosage recommendations (comprised 0.51% of total orders) were made. This was compared to data in July – Oct 2016 when 337 recommendations (0.24% of total orders) were made. Recommendations involving high risk medications rose from 14 (4.2%) in the year before to 89 (10.2%) a year after. Acceptance rate in both periods were comparable and over 87% in both cases.
The project was implemented successfully and assisted pharmacists to effectively identify and review drug orders for patients with renal impairment. It was welcomed by pharmacists and it enhanced the safety of patients with renal impairment.
Co-location with:
