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Pro-active provision of drug information as a technique to address overdosing in intensive-care patients with renal insufficiency

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

To correct overdosing of drugs requiring adjustment based on renal function in intensive-care patients.

Methods

In a prospective intervention study, we estimated individual glomerular filtration rate and assessed whether medication required dose adjustment based on renal function. Senior clinicians received a structured report containing recommendations as to whether and how to adjust dosage in the individual patient (intervention). Prevalence of overdosed drugs (primary outcome), extent of overdoses, and reasons for nonacceptance of recommendations (secondary outcomes) were assessed.

Results

Of 138 screened intensive-care patients, 68 (49%) had renal impairment, and 110 (14%) of the 805 prescribed drugs required consideration of renal function. A potential overdose was found in 53/110 drugs (48%) and this rate decreased to 26/110 (24%, P < 0.001) after the intervention. The average extent of overdose was reduced from 54% before to 31% after the intervention (P < 0.001). The main reasons expressed by the physicians for nonacceptance of recommendations were a large therapeutic index or minor overdoses of the involved drugs.

Conclusions

In intensive-care patients, overdosing of drugs requiring adjustment based on renal function is still very common. Drug information counselling significantly decreased the prevalence and extent of overdose.

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Acknowledgements

We would like to thank all physicians on the ward for their helpful support in data collection. This work was funded by the University of Heidelberg. No conflicts of interest were present.

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Authors and Affiliations

  1. Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Thilo Bertsche, David Czock & Walter E. Haefeli

  2. Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany

    Thilo Bertsche, Martina Fleischer, Johannes Pfaff & Walter E. Haefeli

  3. Department of Internal Medicine IV, Gastroenterology, University of Heidelberg, 69120, Heidelberg, Germany

    Johannes Pfaff & Jens Encke

Authors
  1. Thilo Bertsche
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  2. Martina Fleischer
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  3. Johannes Pfaff
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  4. Jens Encke
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  5. David Czock
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  6. Walter E. Haefeli
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Correspondence to Walter E. Haefeli.

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Bertsche, T., Fleischer, M., Pfaff, J. et al. Pro-active provision of drug information as a technique to address overdosing in intensive-care patients with renal insufficiency. Eur J Clin Pharmacol 65, 823–829 (2009). https://doi.org/10.1007/s00228-009-0643-6

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  • DOI: https://doi.org/10.1007/s00228-009-0643-6

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