Background Optimisation of treatment for patients with renal insufficiency (RI) is necessary to avoid excessive or insufficient dosing of drugs. Identification and selection of adequate treatments for RI patients is mainly limited by time.

Purpose To assess data obtained data for the first 2 months after a new semi-automatic validation tool for physicians’ prescriptions of treatments for RI patients.

Material and methods A descriptive prospective study of pharmaceutical interventions was conducted. Medications prescribed to RI patients during the first 2 months after implementation of the new software (1 August 2016 to 01 October 2016) were evaluated. Farmatools application from computerised physician order entry system (CPOE) was used to obtain treatments of all kidney failure patients. Inpatients’ serum creatinine values were checked from clinical analysis laboratory based on real time blood test. Clearance of creatinine (ClCr) urine values were achieved for equation MDRD-4 (IDMS). Both databases were integrated and associated with Access using ODBC. It identifies RI patients with at least 2 stable values of ClCr <60 mg/min/1.73 m². Every day, a report on prescribed treatment for RI patients was automatically generated and a suitable treatment was proposed automatically by the new software for each patient. The pharmacist validated the generated reports each day and informed the physicians about differences detected between the original prescriptions and the semi-automatic recommendations tool, using CPOE. The number of pharmaceutical interventions carried out, medical departments and drugs involved were analysed.

Results There were 2076 inpatients during the study period. Medication prescriptions and RI were checked every day during hospitalisation for all of them. New software allowed the pharmacist to check all CLCr values and prescribed treatments of each inpatient in less than 10 min a day. A total of 33 pharmacist recommendations in 32 inpatients were recorded. internal medicine (63.6%), cardiology (12.1%) and neurology (9%) were departments with more pharmaceutical suggestions. Drugs most frequently involved were: ranitidine (27.8%), ramipril (12.1%), morphine (9.1%), enalapril (6.1%), levofloxacin (6.1%), enoxaparin (6.1%), allopurinol (6.1%), simvastatin (6.1%) and spironolactone (6.1%).

Conclusion The new semi-automatic validation tool allowed time optimisation: the assessing team of RI patients was able to check all treatments of inpatients quickly each day. More than 25% of pharmacist interventions involved ranitidine. The most frequent discrepancies detected were carried out in internal medicine and cardiology inpatients.

No conflict of interest