Background A previous research project1 had confirmed that patients with renal impairment and poly-medication had a greater risk of suffering from medication-related problems.
Purpose Our objective was to develop a practicable method of monitoring medication which could be permanently integrated into the everyday routines of a team of pharmacists working at a general hospital without the facilities of a university medical centre.
Materials and methods Glomerular filtration rates (GFRs) were recorded on a daily basis by staff at the clinic’s laboratory. This list enabled us to monitor the medication of 425 inpatients with GFR <40 ml/min between March and June 2017 with regards to: (A) kidney-relevant adaption to renal insufficiency medication (e.g. wrong dosage, contraindications); and (B) significant drug interaction (ABDAMED categories) considered ‘substitution necessary’, and passed on the results to the doctors. The implementation of such recommendations by the physicians was checked by referring to the electronic patient record and registered in ADKA-DokuPIK.
Results In about one-third of the cases (154 patients, about six per day) the medication to be administered was changed directly or after joint consultation between the medical and pharmaceutical staff. More than half of the recommendations were immediately applied, and in roughly one-quarter of the remaining cases a decision deferred, pending further risk-benefit assessment. Therapeutic intervention (type A or B) was required for approximately 51% of the inpatients with GFRs of 10–30 ml/min, but, in contrast, only recommended for approximately 17% of inpatients with GFRs of 30–40 ml/min.
Furthermore, a drug list was designed to facilitate routine work (with a link to www.dosing.de ), as well as an information leaflet listing those drugs used in our hospital that either required dose adjustment or should not be used in cases of renal impairment.
Conclusion An increase in patient safety by means of intervention was achieved in 114 of the 154 cases, limiting patient assessment to GFRs of 10–30 ml/min (in accordance with KDIGO classification 4). This would correspond to a work-efficient intervention rate of 51% (about seven medication errors per day). After successfully presenting our results to the board of management and at the chief physicians’ conference meeting, the decision was taken to continue to provide this everyday form of clinical service despite our limited human resources situation.
References and/or acknowledgements 1. Schlosser L. Medication management for patients with renal failure. Krankenhauspharm 2017; 02/17:112–
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