gms | German Medical Science

Background: Following our previous study that demonstrated a higher risk of medication errors for patients with kidney insufficiency and polymedication [1] we aimed at developing an efficient medication monitoring that can easily be integrated in the daily routines of the pharmacists in a public general hospital without the facilities of a university medical center.

Materials and methods: GFRs (glomerular filtration rates) were daily recorded by the clinic’s own laboratory. Medications of 425 patients with GFR <40 ml/min were evaluated between March and June 2017 regarding firstly (A), adaptions to renal insufficiency (e.g. false dosing, unconsidered contraindications) and secondly (B), important drug interactions (according to ABDAMED category “necessary substitution”). Notably, the implementation to our recommendations through the physicians was checked by the electronic patient record and furthermore registered in ADKA-DokuPIK (https://www.adka-dokupik.de/).

Results: In about one third of cases (154 patients, about 6 per day) the medication was corrected or jointly discussed with physicians or staff nurses. More than half of the recommendations were immediately applied and another quarter was subjected to further cost-benefit analysis. Therapeutic interventions (type A or B) were required for 51% of patients with GFRs of 10–30 ml/min, by contrast, only for 17% with GFRs of 30–40 ml/min. Furthermore, we developed a spreadsheet for our routine use (with link to http://www.dosing.de/) and provided physicians with a leaflet as a permanent note on substantial drugs used in our hospital therapy.

Conclusion: We achieved an increasing patient safety in 114 of 154 cases by limiting to GFRs of 10–30 ml/min (according KDIGO classification 4). This also corresponds to a work efficient intervention quote of 51% (about 7 drug failures per day). After successfully presenting our results in the board of management and conference of chief physicians we sustain this everyday clinical service despite of limited human resources.