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Guided medication dosing for inpatients with renal insufficiency
G M Chertow1, J Lee, G J Kuperman
1Department of Medicine Research, UCSF Laurel Heights, 3333 California St, Suite 430, San Francisco, CA 94118, USA. chertowg@medicine.ucsf.edu
JAMA
|December 12, 2001
Summary
Implementing a computerized decision support system significantly improved medication dosing accuracy for inpatients with renal insufficiency. This system enhances drug prescribing and patient care by providing real-time guidance on drug dose and frequency adjustments.
Area of Science:
- Clinical Informatics
- Nephrology
- Pharmacology
Background:
- Standard prescribing practices often overlook renal insufficiency's impact on drug disposition.
- Computerized decision support systems (CDSS) can optimize prescribing and reduce medical errors.
Purpose of the Study:
- To evaluate if a CDSS integrated with computerized order entry improves drug prescribing and patient outcomes in renal insufficiency.
- To assess the impact of real-time dosing adjustments on medication appropriateness.
Main Methods:
- A controlled trial alternating between usual computerized order entry and CDSS-enhanced order entry over four 2-month periods.
- The study included 17,828 adult inpatients, with a focus on 7,490 patients with renal insufficiency.
- Outcomes measured included prescription appropriateness, length of stay, costs, and changes in renal function.
Main Results:
- The CDSS intervention significantly increased appropriate prescription rates for both drug dose (67% vs. 54%) and frequency (59% vs. 35%) compared to the control group.
- Patients receiving CDSS guidance had a slightly shorter mean length of stay (4.3 vs. 4.5 days).
- No significant differences were observed in hospital/pharmacy costs or renal function decline.
Conclusions:
- Computer-guided medication dosing for inpatients with renal insufficiency leads to improved dose and frequency selection.
- CDSS integrated into electronic health records can effectively enhance patient care and medication safety.
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