| DOI: 10.29090/psa.2024.03.24.AP0704 | Pharm Sci Asia 2024; 51(4), 292-300 |
Impact of Clinical Decision Support System on Antibiotic Dosing in Patients with Renal Impairment: An Implementation Study at a Vietnamese Tertiary HospitalDinh Dinh Chinh1,+, Le Trong Hieu2,+, Nguyen Thanh Hai2, Le Minh Hong1, Nguyen-thi Hai Yen1, Linh Van Nguyen2, Jennifer Le3, Nguyen-thi Lien Huong2, Nguyen Duc Trung1,*
1 Department of Pharmacy, 108 Central Military Hospital, Hanoi, Vietnam
2
Department of Clinical Pharmacy, Faculty of Pharmacology and Clinical Pharmacy, Hanoi University of Pharmacy, Hanoi, Vietnam
3
Skaggs School of Pharmacy and Pharmaceutical Sciences University of California San Diego, California, USA
Background: Preventing adverse drug reactions is the primary goal in pharmaceutical care, especially antibiotics as it can contribute to the deterioration of renal function. At 108 Central Military Hospital, Vietnam, managing renally cleared antibiotics (RCA) poses a considerable challenge due to its large facility with 2000 beds. Implementing a clinical decision support system (CDSS) holds promise in improving RCA dosing in patients with renal impairment. Methods: A retrospective study was conducted to assess antibiotic prescriptions in adults > 18 years old with an estimated glomerular filtration rate (eGFR) calculated by both Cockcroft-Gault and MDRD-4 formula under 90 mL/min/1.73 m2 during two distinct periods: pre- and post-implementation of a CDSS, which included a drug compendium of 48 antibiotics requiring renal dose adjustment that was established through consensus among multiple summaries of product characteristics and specialized literature. Alerts were triggered when an antibiotic was prescribed within the threshold of the patient’s eGFR. The impact of this CDSS was determined by comparing the percentage of inappropriate dosing between these periods. Results: Among 1012 total patients, 65.2% were over 65 years old, and 71.3% were male. The eGFR ranging from 60-90 mL/min was observed in 54.8% of patients during both periods. Of 1545 and 1730 antibiotic prescriptions in the pre- and post-period, 28.2% and 19.4% respectively, had inappropriate dosing (OR 0.61; 95% CI: 0.52-0.72; p<0.001). Inappropriate RCA dosing significantly decreased in the internal medicine department (OR 0.45; 95% CI: 0.36-0.57; p <0.001) and intensive care unit (OR: 0.57; 95% CI: 0.39-0.83; p=0.003), with marked reductions observed for cefoperazone/sulbactam, levofloxacin, and meropenem during the post-period (p <0.001). Conclusions: This study demonstrates the initial success of implementing a CDSS for antibiotic dosage prescriptions. Future research endeavors should focus on pharmacist interventions and integrate antibiotic indications into these recommendations to achieve optimal, personalized care.
Keyword:
Antibiotics; Renal Disease; Prescription Alerts; Clinical Decision Support Systems; Medication Safety
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