신기능 저하 환자의 약용량 조절 적절성 평가
Assessing prescribing behavior in hospitalized patients with renal impairment
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초록
Patients with reduced renal function or geriatric patients require dose adjustment for certain drugs to maximize therapeutic action and minimize toxicity. In Seoul National University Hospital (SNUH), CDSS (Clinical decision support systems) which includes dosage adjustment guideline in renal insufficiency was integrated into the Electronic Medical Record (EMR). The aim of this study was to evaluate whether dosage adjustments carried out for hospitalized patients with renal impairment were appropriate. A cross-sectional study was carried out for a group of hospitalized patients at SNUH. Patients with calculated creatinine clearance below 50ml/min/1.73m2 were included in this analysis. Medications and laboratory data were collected from patients’medical profile. The evaluation of appropriate dosing was based on four references. A total of 638 patients had calculated creatinine clearance less than 50ml/min/1.73m2. Dosage adjustment was necessary for 88 medications and a total of 6919 lines of prescription. The analysis indicated that 78.6% of the medications were appropriate in group with creatinine clearance of 10-50ml/min/1.73m2 and 79.2% in group with creatinine clearance <10ml/min/1.73m2. Most common inappropriately prescribed medications were H2 blokers and antivirals. Approximately 21.4% of the medications were prescribed unadjusted. Compared to the results of other studies, dosage adjustments in renal impairment were relatively well carried out in our study. However, considering the risk lack of dosage adjustment may cause, other ways to intervene that consequently can improve the practitioner’s performance should be developed.
Abstract
Patients with reduced renal function or geriatric patients require dose adjustment for certain drugs to maximize therapeutic action and minimize toxicity. In Seoul National University Hospital (SNUH), CDSS (Clinical decision support systems) which includes dosage adjustment guideline in renal insufficiency was integrated into the Electronic Medical Record (EMR). The aim of this study was to evaluate whether dosage adjustments carried out for hospitalized patients with renal impairment were appropriate. A cross-sectional study was carried out for a group of hospitalized patients at SNUH. Patients with calculated creatinine clearance below 50ml/min/1.73m2 were included in this analysis. Medications and laboratory data were collected from patients’medical profile. The evaluation of appropriate dosing was based on four references. A total of 638 patients had calculated creatinine clearance less than 50ml/min/1.73m2. Dosage adjustment was necessary for 88 medications and a total of 6919 lines of prescription. The analysis indicated that 78.6% of the medications were appropriate in group with creatinine clearance of 10-50ml/min/1.73m2 and 79.2% in group with creatinine clearance <10ml/min/1.73m2. Most common inappropriately prescribed medications were H2 blokers and antivirals. Approximately 21.4% of the medications were prescribed unadjusted. Compared to the results of other studies, dosage adjustments in renal impairment were relatively well carried out in our study. However, considering the risk lack of dosage adjustment may cause, other ways to intervene that consequently can improve the practitioner’s performance should be developed.
참고문헌 (15)
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