4CPS-220 Clinical pharmacist interventions in hospitalised patients with renal impairment

Abstract

Background

The need for dose adjustment in patients with renal impairment is well known. Despite globally implemented interventions for improvement in dose adjustment, there is dazing noncompliance to dosing recommendations in renal impairment, which came into focus in the 21 st century.

Purpose

To determine the degree of drug dose adjustment in hospitalised patients with renal impairment, frequency and type of drugs that need to be adjusted with regard to creatinine clearance (CrCl). To assess the acceptance rate of the clinical pharmacist interventions addressed to doctors.

Material and methods

Prospective interventional study was conducted at the Department of Internal Medicine during a 3 month period. Using the Cockroft–Gault equation, patients with renal impairment were identified at admission and their pharmacotherapy were reviewed daily. Prescribed drugs which required dose adjustment in renal impairment were classified as adjusted or unadjusted. For the latter, written pharmaceutical intervention was sent to the concerned doctor.

Results

Almost one-third of all admitted patients had CrCl <60 mL/min at admission. Three hundred and nine patients were included in the study, with 99 (32%) patients having at least one unadjusted drug. Out of 514 prescriptions which required dose adjustment 148 (28.5%) were not adjusted. Patients with CrCl <15 mL/min and those who died had the highest percentage of unadjusted drugs, 53% and 44%, respecitvely. The C group of drugs and the J group had the most of the total number of unadjusted prescriptions with 55% and 29%, respectively. The highest proportion of drugs not in agreement with the recommendations were within the J group with 52%, and they were followed by the C and A group, with 33% each. Overall, 123 pharmaceutical interventions were made, out of which 50 (40.6%) were accepted and 73 (59.4%) were unaccepted. Twenty-five interventions were not sent, which totals 16.9% of the total number of improperly dosed drugs.

Conclusion

Nearly every third admitted patient had impaired renal function. Frequent dose unadjustments increase the risk of adverse drug reactions. Clinical pharmacists can increase the rate of proper dose adjustments in patients with renal impairment. The implementation of systemically provided pharmaceutical care in hospital wards can facilitate positive treatment outcomes and increase patient safety.

References and/or Acknowledgements

Many thanks to Professor Vesna Bačić Vrca

No conflict of interest