Choosing wisely in practice: How sick day rules help prevent medication-related complications

Area of Science:

• Clinical Pharmacy
• Internal Medicine
• Nephrology

Background:

• Sick Day Rules are a multidisciplinary procedure to adjust medications during acute illness.
• These rules aim to prevent drug-related complications, particularly acute kidney injury.
• International Sick Day Rules concepts are being adapted for Czech clinical practice.

Purpose of the Study:

• To introduce the international concept of Sick Day Rules.
• To propose the application of Sick Day Rules in Czech clinical practice.
• To outline medication management strategies during acute illness to prevent complications.

Main Methods:

• Literature search and analysis of PubMed and Google Scholar databases.
• Keywords included Sick Day Rules, medication complications, and medicine re-initiation.
• Utilized consensus documents, clinical reviews, and Choosing Wisely initiative frameworks.

Main Results:

• Identified situations for Sick Day Rules: vomiting, diarrhea, reduced fluid intake, orthostatic issues.
• Recommended self-monitoring: blood glucose, urine ketones, hydration, nutrition.
• Temporary suspension advised for SGLT2 inhibitors, metformin, RAAS inhibitors, diuretics, NSAIDs, aliskiren; insulin management is individualized.

Conclusions:

• Sick Day Rules provide a unified framework to reduce drug-related complications and improve treatment safety.
• Systematic implementation in the Czech Republic is feasible with education and clear instructions.
• Patient preference for physician-led recommendations highlights the need for clear communication.