Appropriate dosing in patients with impaired renal function on medical wards before and after an educational...

Whereas in larger hospitals individualized dose adjustment in renal insufficiency can be provided by expert systems and pharmacists, these options are often not available in smaller hospitals.

We evaluated whether one short educational session for the medical staff of internal wards of a community hospital, focusing on creatinine clearance and dosing in renal insufficiency, and providing a list of frequently used drugs and their dosing schedule does reduce the rate of patients with unadjusted doses.

In patients with a creatinine clearance < 60 ml/min, dosing schedules for 92 drugs were determined. After a 6-month observation period (Cohort 1), an educational intervention and the above mentioned list were delivered to the medical staff. This intervention was followed by a further 6-months observation period (Cohort 2).

In Cohort 1, 55/85 patients (median age 79 y) had at least one initially inappropriately adjusted medication, and 47/85 remained so at discharge, whereas in Cohort 2 (median age 77 y), 28/85 patients had at least one initially inappropriately adjusted medication (p = 0.014 compared to Cohort 1) and 27/85 remained so at discharge (p = 0.05). In Cohort 1, 46.0% of all prescriptions with drugs which need dose adjustment (n = 220) were not adjusted. After the intervention (Cohort 2), 25.6% of all prescriptions (n = 176) followed an unadjusted dosage (p < 0.001).

This intervention was on a "low key"-level, and no further support e.g. academic detailing was effected. Despite this, we found a considerable reduction in the number of inappropriate doses in patients with impaired renal function.