Background Chronic kidney disease (CKD) is an emerging problem worldwide due to the ageing population and increasing prevalence of risk factors, making it necessary to adjust dosage in some commonly prescribed drugs at hospital admission.
Purpose To determine the frequency of the need for drug dosing adjustment in patients with CKD at hospital admission to the emergency department (ED), and the pharmacological groups most frequently involved in these adjustments.
Material and methods Cross sectional study in a referral area hospital of 330 beds and 275 emergencies/day. In this hospital a medication reconciliation procedure (MRP) was implemented at hospital admission by ED in 2012 that selects patients with higher risk of reconciliation error (RE). We analysed first the frequency of patients with CKD regarding all selected by the MRP during the years 2012 to 2014. Second, we determined the frequency with which the pharmacist made recommendations for dosing adjustment in some of the drugs prescribed in the ED in these patients, and the frequency of acceptance by the emergency physician. Third, the pharmacological groups most frequently involved in these recommendations were noted.
Results Of the 424 patients selected by the MRP, 20% were patients with CKD as the underlying disease at hospital admission via the ED. Of these 85 patients with CKD, 36.5% had been prescribed some drug that required dosage adjustment. The pharmacist made 41 recommendations (1.32 recommendations per patient), and 90.2% were accepted by the emergency physician. Anticoagulants, antibiotics and antidiabetic drugs were the three pharmacological groups most frequently involved in recommendations for dosage adjustment, accounting for 26.8%, 19.5% and 17.1% of recommendations, respectively. Finally, the drugs with the most recommendations were enoxaparin (17.1% of recommendations), levofloxacin (12.1%), allopurinol (12.2%) and enalapril (9.8%); these 4 drugs accounted for 51.2% of the recommendations.
Conclusion The three pharmacological groups most commonly involved in recommendations for dosage adjustment posed a high risk to the patient in terms of improper dosing. Hence we consider it essential that the pharmacist participates in the patient care team in the ED so that incorrect prescriptions can be avoided.
References and/or Acknowledgements Thanks to the ED.
No conflict of interest.
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