Authors (including presenting author) :
Chan TH(1), Chan CY(2), Li WYE(1), Fan SY(1), Liu HK(1), Shum HP(2)
Affiliation :
(1) Department of Pharmacy, Pamela Youde Nethersole Eastern Hospital (2) Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital
Introduction :
Pharmacists-led computerized renal screening (CRS) system was designed and implemented in PYNEH to estimate renal function in different renal contexts and facilitate pharmacists in identifying antibiotics that required renal dosage adjustment and making recommendations.
Objectives :
This pilot study aimed to 1) evaluate the impact of CRS on optimal antibiotics renal dosage prescribing in an intensive care unit (ICU) and 2) assess the efficiency of CRS.
Methodology :
This was a pilot, two-phase, retrospective study to evaluate antibiotics prescription in ICU. In phase 1, a retrospective review of antibiotic dosage appropriateness was conducted. In phase 2, pharmacists utilized CRS to review ICU antibiotic orders daily, determine dosage appropriateness and provide renal dosage recommendations to ICU physicians. The primary outcome was the difference in the percentage of suboptimal antibiotic dosage prescribed between the two phases. The secondary outcome was the difference in time required to recommend renal dosage adjustments per medication order during routine in-patient operation and through CRS.
Result & Outcome :
166 and 156 patients were recruited in phases 1 and 2, respectively. With pharmacist-led CRS dosage recommendations, significantly fewer suboptimal antibiotic dosage was prescribed in ICU (Phase 1: 8.1% vs Phase 2: 1.3%, p < 0.05). The physician acceptance rate of pharmacist recommendations was 80%. Utilizing CRS, significantly less time was required to recommend a renal dosage adjustment per medication order (Phase 1: 3.88 ± 1.29 minutes vs Phase 2: 2.76 ± 1.47 minutes, p < 0.05). The CRS system facilitated pharmacists in optimizing and individualizing antibiotics dosage based on renal function more systematically and efficiently, resulting in more frequent prescriptions with optimal antibiotic dosage in a critical care setting.
