A New Era of Medication Safety: Optimising Renal Screening Efficiency with the Use of BIG DATA in a Single Click

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Authors (including presenting author) :
Chan TH(1), Wan HC(1), Tam SKY(1), Wong YL(1), Ng KH(1), Wong CL(1), Yau KM(1), Yick PK(1)
Affiliation :
(1)Department of Pharmacy, Ruttonjee Hospital
Introduction :
Inappropriate drug dosing is a major cause of significant adverse drug reactions in patients with renal impairment. Pharmacist intervention can play a prominent role in improving patient safety by advising appropriate drug dosage in patients with renal impairment. This study was carried out to evaluate the effectiveness and efficiency of pharmacist-led Computerised-Assisted-Screening (CAS) on a large number of prescriptions with a simple procedure.
Objectives :
(1) To evaluate the effectiveness of pharmacist-initiated renal dosage interventions; (2) To assess the efficiency of innovative CAS compared with that of traditional on-the-spot renal dosage checking.
Methodology :
A prospective, controlled before-and-after study was carried out. Antimicrobials, anticoagulants and oral hypoglycaemics (25 drugs) requiring renal dosage adjustment were screened. Raw data were inputted into the self-developed CAS system. Being “digested’ by CAS, all dispensing data were captured, format-rearranged, compared against database, curated and processed automatically to produce valid cases for renal screening. Time needed for CAS and on-the-spot checking was recorded for comparison. Proportions of corrected renal dosage at t ≤ 48 hours for intervention group and control group were also recorded. Chi-square test of independence and independent-sample t-test were used.
Result & Outcome :
Medication orders of 686 and 3388 hospitalised patients were screened with CAS in controlled and intervened group respectively. 78.4% of the 105 pharmacist interventions were accepted. The relation between intervention and corrected renal dosage at t ≤ 48 hours was significant, χ2 (2, N = 123) = 26.58, p < 0.05. Corrected renal dosage was more likely to be prescribed in intervention group than in controlled group at t ≤ 48 hours. Significantly less time per day was required in CAS (M = 51.5 minutes, SD = 14.0 minutes) than on-the-spot verifying (M = 474.2 minutes, SD = 193.6 minutes), t(48) = 10.43, p < 0.05. Only 10.9% of time was needed when using CAS. 7 man-hours per day were saved by CAS. After 3 months of interventions, there was an observed trend of prescribing Amoxicillin/Clavulanate renal dosage appropriately without intervention, indicating a potential change in prescribing habit. Pharmacist-initiated interventions effectively ensured appropriate renal dosage prescribing. Utilising big data, CAS was significantly more efficient than on-the-spot checking. CAS heralds a new era of medication safety. The relation between pharmacist-initiated interventions and a change in prescribing culture warrants further investigations.

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