The potential value on medication safety of a clinical decision support system in intensive care patients with renal insufficiency

• Published in: British journal of clinical pharmacology 2007-04, Vol.63 (4), p.504-504
• Main Authors: Helmons, P. J., Grouls, R. J. E., Roos, A. N., Bindels, A. J. G. H., De Clercq, P. A., Wessels‐Basten, S. J. W., Ackerman, E. W., Korsten, H. H. M.
• Format: Article
• Language: English
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/j.1365-2125.2007.02886_3.x

Introduction:  Clinical decision support systems (CDSS) are defined as electronic or non‐electronic systems designed to aid in clinical decision making, using characteristics of individual patients to generate patient‐specific assessments or recommendations that are then presented to clinicians for consideration (Garg et al., 2005). As the potential value of a CDSS is determined by the benefits on clinical practice of the clinical rules used in this system, it is essential to investigate the necessity and potential benefits on quality of care of these rules (Stiell et al., 1999; Helmons et al., 2006). Purpose  The aim of this study was to determine the potential value of a clinical rule designed to improve dosage adjustment of antibiotics in critically ill patients with renal dysfunction. Methods:  We developed a clinical rule assisting the physicians in selecting the appropriate dosage according to renal function of the ten most frequently prescribed antibiotics. We compared the actual number of dosage adjustments without the support of the CDSS with the theoretical number of dosage adjustments determined by the clinical rule in patients with moderate (creatinin clearance (Clcreat) 10–50 ml/min) and severe (Clcreat < 10 ml/min) renal dysfunction. If dosage adjustment was omitted, we determined the overexposure to the antibiotics in terms of duration and number of dosages administered and the extra drug costs involved. Results:  Seventeen hundred eighty‐eight patients were included in this retrospective study. In the moderate renal failure group, dosage adjustment was omitted in 163 patients (86%). In the severe renal failure group, dosage was not adjusted in 13 patients (54%). The duration of exposure was the most in patients receiving fluconazole and ciprofloxacin (median duration of 6 days). By adjusting the dosage of the ten most frequently prescribed antibiotics according to renal function, more than 116,000 can be saved annually on our ICU. Conclusion:  Dosage adjustment of antibiotics is often omitted in our ICU. We conclude that substantial savings and improvement in medication safety can be achieved by implementing this clinical rule in clinical practice. This technology has enormous potential to reduce medication errors. Further (prospective) research is needed to show that this system is clinically applicable.