Authors (including presenting author) :
Tam HY(1), Tam KY(1), Kwan HY(1), Yick PK(1), Chen J(1)
Affiliation :
(1) Department of Pharmacy, Ruttonjee & Tang Shiu Kin Hospitals
Introduction :
Appropriate renal dose adjustment (RDA) is crucial to reducing medications side effects, preventing additional nephrotoxicity and optimizing outcomes in patients with renal insufficiency. A pharmacist-initiated renal dosage adjustment service has been implemented at Ruttonjee Hospital since 2018 addressing issues on compliance with renal dosing recommendations, as well as exploring the impact of incorporating automation and Big Data to Pharmacy services.
Objectives :
The objective of this retrospective non-randomized pre-post-implementation study is to evaluate the effectiveness, efficiency and impact of the existing pharmacist-led computerized RDA service.
Methodology :
Pharmacists screened, extracted and assessed drug orders requiring renal dosage adjustment by a self-developed computerized system and made interventions if needed. The key performance indicators of the service are the changes in rates of appropriate RDA before and after implementation, the rate of prescribers’ acceptance of interventions, and the average time required for computerized screening compared with “on-the-spot checking” approach.
Result & Outcome :
From September 2018 to November 2021, the service screened 33,896 drug orders and identified 9,489 orders requiring RDA. The service achieved a significant improvement in the rate of appropriate RDA from 27.2% to 88.6% (p <0.0001). Of 1,041 interventions made, 914 (87.8%) were accepted by prescribers in which 99% of these were accepted in 24 hours. The time required per day for clinical screening shortened by 90% by switching from “on-the-spot” verifying (472.5 minutes) to computerization (55.1 minutes). The pharmacist-led computerized RDA service reinforced prescribers’ awareness of appropriate RDA at Ruttonjee Hospital, eventually enhancing medication safety and assisting physicians in safe prescribing. With the use of computerized screening tools, time cost and manpower are minimized. The results also support the vital role of pharmacists in optimizing renal dose and the input is recognized by prescribers. The concept of computerized screening and Big Data can be further expanded to other pharmacy service quality development.
