BACKGROUND: Approximately 8.7 million (3%) Americans have various degrees of chronic renal insufficiency (CRI). Patients with CRI are susceptible to adverse drug events related to improper dose adjustment of drugs that are eliminated primarily unchanged through the kidney. Renal dosing errors are an important quality-of-care problem in the inpatient setting, yet little is known about dosing errors for patients with renal insufficiency in the outpatient setting. METHODS: Electronic records were queried to identify patients with CRI (estimated creatinine clearance < 50 mL/min) who visited the ambulatory care clinic at least once from January 1, 2003 through December 31, 2003. RESULTS: Of the total of 224 patients identified with CRI, 157 (70%) received one or more of 17 drugs with high rates of renal elimination. A total of 207 drugs requiring dose adjustment were prescribed to these patients, and 52 (25%) were prescribed at an inappropriately high dose. For 127 (57%) of the 224 patients, CRI was not documented. Patients with documented CRI were equally likely to be prescribed an inappropriately high dose of a target drug. DISCUSSION: Incorrect dosing of medications among patients with CRI is common in the ambulatory care setting. Strategies for preventing medication dosing errors can target the prescribing and monitoring stages of pharmaceutical care.
BACKGROUND: Approximately 8.7 million (3%) Americans have various degrees of chronic renal insufficiency (CRI). Patients with CRI are susceptible to adverse drug events related to improper dose adjustment of drugs that are eliminated primarily unchanged through the kidney. Renal dosing errors are an important quality-of-care problem in the inpatient setting, yet little is known about dosing errors for patients with renal insufficiency in the outpatient setting. METHODS: Electronic records were queried to identify patients with CRI (estimated creatinine clearance < 50 mL/min) who visited the ambulatory care clinic at least once from January 1, 2003 through December 31, 2003. RESULTS: Of the total of 224 patients identified with CRI, 157 (70%) received one or more of 17 drugs with high rates of renal elimination. A total of 207 drugs requiring dose adjustment were prescribed to these patients, and 52 (25%) were prescribed at an inappropriately high dose. For 127 (57%) of the 224 patients, CRI was not documented. Patients with documented CRI were equally likely to be prescribed an inappropriately high dose of a target drug. DISCUSSION: Incorrect dosing of medications among patients with CRI is common in the ambulatory care setting. Strategies for preventing medication dosing errors can target the prescribing and monitoring stages of pharmaceutical care.
Authors: Janelle Guirguis-Blake; Gina A Keppel; John Holmes; Rex W Force; William Kriegsman; Laura-Mae Baldwin Journal: Fam Pract Date: 2018-09-18 Impact factor: 2.267
Authors: Yan Chen; Leila R Zelnick; Andrew N Hoofnagle; Catherine K Yeung; Laura M Shireman; Brian Phillips; Calder C Brauchla; Ian de Boer; Linda Manahan; Susan R Heckbert; Jonathan Himmelfarb; Bryan R Kestenbaum Journal: J Am Soc Nephrol Date: 2020-11-25 Impact factor: 10.121
Authors: A Clara Drenth-van Maanen; Rob J van Marum; Paul A F Jansen; Jeannette E F Zwart; Wouter W van Solinge; Toine C G Egberts Journal: PLoS One Date: 2015-06-08 Impact factor: 3.240
Authors: Insook Cho; Sarah P Slight; Karen C Nanji; Diane L Seger; Nivethietha Maniam; Patricia C Dykes; David W Bates Journal: BMC Nephrol Date: 2014-12-15 Impact factor: 2.388
Authors: Hanneke Joosten; Iefke Drion; Kees J Boogerd; Emiel V van der Pijl; Robbert J Slingerland; Joris P J Slaets; Tiele J Jansen; Olof Schwantje; Reinold O B Gans; Henk J G Bilo Journal: BMJ Open Date: 2013-01-24 Impact factor: 2.692