Development of Dosage Adjustment System for In-patients with Renal Impairment at Prasat Hospital, Surin Province
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Abstract
Objective: To develop a dosage adjustment system for inpatients with renal impairment, to compare proportion of appropriate dose adjustment before and after implementation of the system and to evaluate the impact on drug cost. Methods: This study was a 4-pahse action research. Phase 1 (planning) was holding the meeting of Pharmacy and Therapeutic Committee (PTC) to set up practice guideline and roles of each professional. Phase 2 (acting) involved the arrangement of a meeting to inform relevant staff on the guideline. Phase 3 (observing) was the period of data collection on dose adjustments from 4 patient wards including male medical ward, female medical ward, surgical ward, and intensive care unit (ICU), at a 3 month period before and after the implementation of the system. Phase 4 (reflecting) was the presentation of the result to the PTC. Results: Key components of the dosage adjustment system included an automatic calculation of creatinine clearance (CrCL) appearing on computer screen, establishing the list of medicines and common methods for dose adjustment within the hospital and the HosXp® program that provided information for dosing adjustment. Overall, proportion of drug items prescribed to renal impaired patient with appropriate dose adjustment increased significantly from 65.67% to 72.58 (p<0.001). This proportion increased in every studied ward with ICU from 49.4% to 62.9% (p=0.072), female medical ward from 69.8% to 72.2% (p=0.116), male medical ward from 69.8% to 74.9% (p=0.384) and surgery ward from 59.7% to 74.9 (p<0.001). After implementation of the system, 3 drugs with the highest rate of inappropriate dosage adjustment were colchicine tablet 0.6 mg, ceftazidime inj.1 g and glipizide tablet 5 mg. Proportion of loss resulting from inappropriate dosage adjustment decreased from 24.5% to 17.2%. Conclusion: The system developed for dosage adjustment is effective in increasing the appropriateness of medication use in renal impaired patients.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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