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Evaluation of a pharmacist‐driven renal dosing protocol at an academic medical center
Author(s) -
Cheung Dora,
Go Amy,
Cooper Margaret,
Schwarz Kerry
Publication year - 2020
Publication title -
journal of the american college of clinical pharmacy
Language(s) - English
Resource type - Journals
ISSN - 2574-9870
DOI - 10.1002/jac5.1230
Subject(s) - dosing , medicine , pharmacist , cefepime , renal function , kidney disease , retrospective cohort study , emergency medicine , clinical pharmacy , intensive care medicine , cohort , medical record , pharmacy , antibiotics , family medicine , antibiotic resistance , imipenem , microbiology and biotechnology , biology
Kidney disease is a major worldwide public health problem. An increased risk for adverse drug events is associated with drug dosing errors in hospitalized patients with renal impairment. A pharmacist‐driven renal protocol may improve dosing compliance by allowing pharmacists to monitor renal function and adjust drug doses as needed. Objectives To evaluate the utilization and financial impact of a pharmacist‐driven renal dosing protocol. Methods This was a retrospective cohort study of patients admitted to an academic medical center from 1 April 2017 to 30 May 2017 who had drug(s) from the protocol dose adjusted by a pharmacist. Outcomes of interest included protocol use frequency, patient characteristics, type of dose adjustments, and when adjustments were made. Two subgroup analyses were performed to: (1) determine cost savings of the seven most adjusted drugs and (2) determine if any missed opportunities for dose adjustments for cefepime. Results A total of 422 dosage adjustments, performed on 317 patients, were included. The mean age of the patients was 63 years with 51.2% female. The majority (62.8%) had no history of renal dysfunction, 22.4% had chronic kidney disease, 14.8% had end‐stage renal disease, and 25.3% had acute kidney injury on admission. Most dose adjustments (73.5%) were dose decreases, while 24.4% were dose increases. The seven most commonly adjusted drugs contributed to a cost savings of approximately $3919.87 per duration of therapy which extrapolates to an annual cost savings of $23 519.22. Of all the cefepime orders reviewed over a 7‐day period, 84% were dosed correctly, 9% needed dose adjustments that could have been made sooner, and 7% had incorrect dose based on renal function. Conclusion This analysis demonstrates that implementation of a pharmacist‐driven renal dose adjustment protocol was consistently utilized at our institution and resulted in cost savings.