International Journal for Quality in Health Care 15:331-335 (2003)
© 2003 International Society for Quality in Health Care
Paper |
Medication misuse in hospitalized patients with renal impairment
1 Public Health Department, University Hospital Pitié Salpêtrière (AP-HP, Paris VI), France
2 Nephrology Department, University Hospital Pitié Salpêtrière (AP-HP, Paris VI), France
3 Biochemistry Laboratory, University Hospital Pitié Salpêtrière (AP-HP, Paris VI), France
4 Infectious Diseases Department, University Hospital Pitié Salpêtrière (AP-HP, Paris VI), France
5 Pharmacology Department, University Hospital Pitié Salpêtrière (AP-HP, Paris VI), France
6 INSERM Unit U444 and Epidemiology and Biostatistics Department, University Hospital Bichat (AP-HP, Paris VII), Paris, France
Objectives. The potential consequences of medication misuse in renal impairment have not been assessed in a population of in-patients. The purpose of this study was to determine the frequency and potential consequences of a lack of dosage adjustment in hospitalized patients with renal impairment.
Design. Order sheets for in-patients having a creatinine above 0.7 mg/dl were analysed. We considered the appropriateness of prescriptions for medications having potential nephrotoxicity and/or eliminated through renal excretion or metabolism (TEM medications) and having manufacturer's guidelines for dosage adjustment in renal impairment.
Main measures. On the basis of these guidelines, each line of prescription was rated as ‘appropriate order’, ‘inappropriate dosage’, or ‘contra-indicated order’. Experts also rated prescriptions as potentially fatal or severe, serious, significant, or without potential for increased adverse effects.
Results. Two hundred and two order sheets were completed for 164 patients. They totalled 1469 lines of prescription, 85% of which were TEM medications, with guidelines for dosage adjustment for 71% of them (n = 886). Of these 886 prescriptions, 34% were inappropriate, 14% being contra-indicated and 20% with inappropriate dosage given the patient's renal function. Among the 202 order sheets, 75% included at least one inappropriate prescription. Sixty-three per cent included at least one prescription with potentially adverse consequences, 3% of these having potentially fatal or severe consequences.
Conclusion. This study confirms that physicians do not take into account sufficiently patient renal function when prescribing. In light of these results, improving the quality of drug prescription in patients with renal impairment could be of importance for improving the quality of care.
Keywords: dosage adjustment, prescribing, quality of care, renal impairment
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y. Hassan, R. J Al-Ramahi, N. A. Aziz, and R. Ghazali Impact of a Renal Drug Dosing Service on Dose Adjustment in Hospitalized Patients with Chronic Kidney Disease Ann. Pharmacother., October 1, 2009; 43(10): 1598 - 1605. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. S Field, P. Rochon, M. Lee, L. Gavendo, J. L Baril, and J. H Gurwitz Computerized Clinical Decision Support During Medication Ordering for Long-term Care Residents with Renal Insufficiency JAMIA, July 1, 2009; 16(4): 480 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. S. Blix, K. K. Viktil, T. A. Moger, and A. Reikvam Use of renal risk drugs in hospitalized patients with impaired renal function--an underestimated problem? Nephrol. Dial. Transplant., November 1, 2006; 21(11): 3164 - 3171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A van Dijk, N. R. Drabbe, M. Kruijtbosch, and P. A. De Smet Drug Dosage Adjustments According to Renal Function at Hospital Discharge Ann. Pharmacother., July 1, 2006; 40(7): 1254 - 1260. [Abstract] [Full Text] [PDF]
|
|