Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support

• DOI: 10.1111/jcpt.13697
• Publication Date: 2022-07-23T01:54:20Z
• Authors: Sarah Seiberth; Hanna Mannell; Christof Birkenmaier; Carl Neuerburg; Vera Smolka; Monika Andraschko; Dorothea Strobach
• Keywords: Order entry

A 'renal pharmacist consultant service' (RPCS) reviewing patients' charts with renal impairment (RI) for drug-related problems (DRP) can foster patient safety. However, the benefit of this service in new setting a computerized physician order entry (CPOE)-system clinical decision support (CDS)-system is unknown. The aim our study was to evaluate general need an RPCS on wards CPOE-CDS-system already use and its effectiveness prescription changes ensure in-hospital safety.Over period 3 months (02-04/2021), elective orthopaedic trauma patients eGFRabsolute /CrCl <60 ml/min at German University Hospital received medication review by all entered into CPOE-system (Meona®) treating physicians. Written consultations explaining identified DRP recommending interventions solve them, example, dose or drug adaptation, were shared physicians directly chart tab Meona®. In complex cases, additionally discussed via phone. evaluated retrospectively.During 53 working days, 712 (30.5%) 2331 screened included eGFRnon-indexed pharmacist-led performed presented (Meona®). 79 (11.1%) patients, one more detected (median 1 (1-3) per patient) written recommendations concerning 106 1090 (9.7%) drugs total, 104 identified, mostly caused 'dosage too high' (n = 55, 52.9%), regime wrong' 13, 12.5%), 'contraindication' 9, 8.7%). Acceptance rate 74.0% 77/104). nine cases (8.7%), despite specific recommendations, no adjustment made because lack alternatives. 11 (10.6%) remained unchanged unknown reasons seven (6.7%) result due discharge.In prescribing CPOE-CDS-system, that provides advice adaption, reviews still RI. forwarding electronic medical record increased appropriate and, thus, may further improve