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Renal Drug DosingEffectiveness of Outpatient Pharmacist-Based vs. Prescriber-Based Clinical Decision Support SystemsFinancial support for this project was provided by the KPCO Pharmacy Department. We wish to thank Thomas J Koehler, RPh for his contribution of programming the CDSS renal dose adjustment alerts in the EHR and Assistant KPCO Nephrology Regional Department Chief Brent Arnold, MD for his leadership in developing and sponsoring the prescriber-based CDSS.
15 January 2016
accepted: 28 June 2016
19 December 2017 (online)
The purpose of this study was to compare the effectiveness of an outpatient renal dose adjustment alert via a computerized provider order entry (CPOE) clinical decision support system (CDSS) versus a CDSS with alerts made to dispensing pharmacists.
This was a retrospective analysis of patients with renal impairment and 30 medications that are contraindicated or require dose-adjustment in such patients. The primary outcome was the rate of renal dosing errors for study medications that were dispensed between August and December 2013, when a pharmacist-based CDSS was in place, versus August through December 2014, when a prescriber-based CDSS was in place. A dosing error was defined as a prescription for one of the study medications dispensed to a patient where the medication was contraindicated or improperly dosed based on the patient’s renal function. The denominator was all prescriptions for the study medications dispensed during each respective study period.
During the pharmacist-and prescriber-based CDSS study periods, 49,054 and 50,678 prescriptions, respectively, were dispensed for one of the included medications. Of these, 878 (1.8%) and 758 (1.5%) prescriptions were dispensed to patients with renal impairment in the respective study periods. Patients in each group were similar with respect to age, sex, and renal function stage. Overall, the five-month error rate was 0.38%. Error rates were similar between the two groups: 0.36% and 0.40% in the pharmacist-and prescriber-based CDSS, respectively (p=0.523). The medication with the highest error rate was dofetilide (0.51% overall) while the medications with the lowest error rate were dabigatran, fondaparinux, and spironolactone (0.00% overall).
Prescriber-and pharmacist-based CDSS provided comparable, low rates of potential medication errors. Future studies should be undertaken to examine patient benefits of the prescriber-based CDSS.
Citation: Vogel EA, Billups SJ, Herner SJ, Delate T. Renal drug dosing: Effectiveness of outpatient pharmacist-based vs. prescriber-based clinical decision support systems.
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