Pro-active provision of drug information as a technique to address overdosing in intensive-care patients with renal insufficiency |
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Authors: | Thilo Bertsche Martina Fleischer Johannes Pfaff Jens Encke David Czock Walter E Haefeli |
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Institution: | (1) Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany;(2) Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany;(3) Department of Internal Medicine IV, Gastroenterology, University of Heidelberg, 69120 Heidelberg, Germany |
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Abstract: | Purpose To correct overdosing of drugs requiring adjustment based on renal function in intensive-care patients.
Methods In a prospective intervention study, we estimated individual glomerular filtration rate and assessed whether medication required
dose adjustment based on renal function. Senior clinicians received a structured report containing recommendations as to whether
and how to adjust dosage in the individual patient (intervention). Prevalence of overdosed drugs (primary outcome), extent
of overdoses, and reasons for nonacceptance of recommendations (secondary outcomes) were assessed.
Results Of 138 screened intensive-care patients, 68 (49%) had renal impairment, and 110 (14%) of the 805 prescribed drugs required
consideration of renal function. A potential overdose was found in 53/110 drugs (48%) and this rate decreased to 26/110 (24%,
P < 0.001) after the intervention. The average extent of overdose was reduced from 54% before to 31% after the intervention
(P < 0.001). The main reasons expressed by the physicians for nonacceptance of recommendations were a large therapeutic index
or minor overdoses of the involved drugs.
Conclusions In intensive-care patients, overdosing of drugs requiring adjustment based on renal function is still very common. Drug information
counselling significantly decreased the prevalence and extent of overdose. |
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Keywords: | Renal insufficiency Intensive care Medication errors Clinical competence Drug information services |
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