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Titolo:
Guided medication dosing for inpatients with renal insufficiency
Autore:
Chertow, GM; Lee, J; Kuperman, GJ; Burdick, E; Horsky, J; Seger, DL; Lee, R; Mekala, A; Song, J; Komaroff, AL; Bates, DW;
Indirizzi:
Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Div Gen Internal Med, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 v Gen Internal Med, Boston, MA 02115 USA Harvard Univ, Brigham & Womens Hosp, Sch Med, Dept Med,Renal Div, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 Dept Med,Renal Div, Boston, MA 02115 USA Partners Healthcare Syst, Dept Informat Syst, Boston, MA USA Partners Healthcare Syst Boston MA USA ept Informat Syst, Boston, MA USA
Titolo Testata:
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
fascicolo: 22, volume: 286, anno: 2001,
pagine: 2839 - 2844
SICI:
0098-7484(200112)286:22<2839:GMDFIW>2.0.ZU;2-N
Fonte:
ISI
Lingua:
ENG
Soggetto:
ADVERSE DRUG EVENTS; FAILURE; INTERVENTION; PREVENTION; MORTALITY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
15
Recensione:
Indirizzi per estratti:
Indirizzo: Chertow, GM UCSF Laurel Hts, Dept Med Res, 3333 Calif St,Suite 430, San Francisco, CA 94118 USA UCSF Laurel Hts 3333 Calif St,Suite 430 San FranciscoCA USA 94118
Citazione:
G.M. Chertow et al., "Guided medication dosing for inpatients with renal insufficiency", J AM MED A, 286(22), 2001, pp. 2839-2844

Abstract

Context Usual drug-prescribing practices may not consider the effects of renal insufficiency on the disposition of certain drugs. Decision aids may help optimize prescribing behavior and reduce medical error. Objective To determine if a system application for adjusting drug close and frequency in patients with renal insufficiency, when merged with a computerized order entry system, improves drug prescribing and patient outcomes. Design, Setting, and Patients Four consecutive 2-month intervals consisting of control (usual computerized order entry) alternating with intervention(computerized order entry plus decision support system), conducted in September 1997-April 1998 with outcomes assessed among a consecutive sample of 17 828 adults admitted to an urban tertiary care teaching hospital. Intervention Real-time computerized decision support system for prescribing drugs in patients with renal insufficiency. During intervention periods, the adjusted dose list, default dose amount, and default frequency were displayed to the order-entry user and a notation was provided that adjustmentshad been made based on renal insufficiency. During control periods, these recommended adjustments were not revealed to the order-entry user, and the unadjusted parameters were displayed. Main Outcome Measures Rates of appropriate prescription by dose and frequency, length of stay, hospital and pharmacy costs, and changes in renal function, compared among patients with renal insufficiency who were hospitalized during the intervention vs control periods. Results A total of 7490 patients were found to have some degree of renal insufficiency. In this group, 97 151 orders were written on renally cleared or nephrotoxic medications, of which 14440 (15%) had at least 1 dosing parameter modified Ely the computer based on renal function. The fraction of prescriptions deemed appropriate during the intervention vs control periods by dose was 67% vs 54% (P<.001) and by frequency was 59% vs 35% (P<.001). Mean (SD) length of stay was 4.3 (4.5) days vs 4.5 (4.8) days in the intervention vs control periods, respectively (P=.009). There were no significant differences in estimated hospital and pharmacy costs or in the proportion ofpatients who experienced a decline in renal function during hospitalization. Conclusions Guided medication dosing for inpatients with renal insufficiency appears to result in improved dose and frequency choices. This intervention demonstrates a way in which computer-based decision support systems canimprove care.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 07/04/20 alle ore 22:28:00