Background Accurate and complete electronic health record (EHR) information is essential for patient safety, especially when drugs with a narrow therapeutic range are involved.
Purpose To evaluate the quality and quantity of information recorded in EHRs concerning pharmaceutical interventions (PIs) generated by therapeutic drug monitoring (TDM).
Materials and Methods For 6 months, all onco-haematology in-patients were evaluated who were receiving vancomycin (≥3 doses). Renal function (RF) was classified into four categories: severe, moderate and mild renal impairment (RI) and normal RF for creatinine clearance (by Cockcroft-Gault equation) <10, 10–50, 50–90, >90 ml/min, respectively. PIs were classified into three categories of importance (high, moderate and low) according to the pharmacotherapy follow-up and the relation between plasma concentration and optimal therapeutic range.
The completeness of EHRs regarding the RF and TDM process (ordering, result and PI-related parameters) was assessed.
A binary logistic regression with odds ratio (OR) was performed using SPSS v.15.0.
Results TDM was performed for 39 (81%) of 48 patients receiving vancomycin. The median age was 57 years (95%CI: 52–62); 26 were male (68%); 21(54%) had mild to moderate RI.
There were 76 PIs [median 2/patient (IQR: 2)], 51(67%), 4 (5%) and 21 (28%) of high, medium and low importance, respectively; 67(88%) were accepted.
The EHRs did not record RF evolution, TDM requests and results or PIs in 53 (70%), 23 (30%), 39 (51%) and 61 (80%) cases respectively.
OR for recorded TDM results related to highly important PIs compared to low-importance PIs, for recorded TDM ordering related to moderate RI compared to normal RF and records for RF evolution related to moderate RI compared to normal RF were 3 (95%CI: 1–9; p = 0.046), 0.3(95%CI: 0.8–0.9; p = 0.04) and 4(95%CI: 1–16; p = 0.029), respectively. A significant linear trend was observed. OR for all other variables was non-significant.
Conclusions The low percentage recording of TDM-related variables and pharmacist interventions in EHR potentially limits interprofessional communication and the decision-making process. This fact highlights the need for clinical pharmacists to safeguard the information they have discovered by recording their interventions in the EHR as a clinical episode in comprehensive patient care. This will increase the visibility of the pharmacist and the effect of his/her actions.
No conflict of interest.
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