University of Groningen, University Medical Centre Groningen, Department of Internal Medicine, Groningen, The Netherlands.
BMJ Open. 2013 Jan 24;3(1):e002068. doi: 10.1136/bmjopen-2012-002068.
To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR) ≤40 ml/min/1.73 m(2)) and the effectiveness of automatic eGFR ≤40-alerts relayed to community pharmacists.
Clinical survey.
The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practitioners.
All adults who underwent ambulatory creatine measurements which triggered an eGFR ≤40-alert.
The total number of ambulatory subjects with an eGFR ≤40-alert during the study period of 1 year and the number of medication errors related to renal impairment. The type and number of proposed drug adjustments recommended by the community pharmacist and acceptance rate by the prescribing physicians. Classification of all medication errors on their potential to cause an adverse drug event (ADE) and the actual occurrence of ADEs (limited to those identified through hospital record reviews) 1 year after the introduction of the alerts.
Creatine measurements were performed in 25 929 adults. An eGFR ≤40-alert was indicated for 5.3% (n=1369). This group had a median (IQR) age of 78 (69, 84) years, and in 73% polypharmacy (≥5 drugs) was present. In 15% (n=211) of these subjects, a medication error was detected. The proportion of errors increased with age. Pharmacists recommended 342 medication adjustments, mainly concerning diuretics (22%) and antibiotics (21%). The physicians' acceptance rate was 66%. Of all the medication errors, 88% were regarded as potential ADEs, with most classified as significant or serious. At follow-up, the ADE risk (n=40) appeared highest when the proposed medication adjustments were not implemented (38% vs 6%).
The introduction of automatic eGFR-alerts identified a considerable number of subjects who are at risk for ADEs due to renal impairment in an ambulatory setting. The nationwide implementation of this simple protocol could identify many potential ADEs, thereby substantially reducing iatrogenic complications in subjects with impaired renal function.
评估肾功能损害患者（定义为估算肾小球滤过率（eGFR）≤40ml/min/1.73m²）发生药物错误的风险，以及自动 eGFR≤40 警报传递给社区药剂师的效果。
临床调查。
荷兰兹沃勒市，初级保健环境，包括 22 家社区药剂师和 65 名全科医生。
所有接受门诊肌酐检测的成年人，肌酐检测触发 eGFR≤40 警报。
在为期 1 年的研究期间，有 eGFR≤40 警报的门诊患者总数，以及与肾功能损害相关的药物错误数量。社区药剂师建议的药物调整类型和数量，以及开处方医生的接受率。根据潜在的药物不良事件（ADE）对所有药物错误进行分类，并在警报发布后 1 年评估实际发生的 ADEs（仅限于通过医院记录审查确定的 ADEs）。
对 25929 名成年人进行了肌酐检测。5.3%（n=1369）的患者 eGFR≤40 警报。该组的中位（IQR）年龄为 78（69，84）岁，73%（n=1369）的患者同时使用 5 种以上药物（即多药治疗）。在这些患者中，15%（n=211）检测到药物错误。错误的比例随年龄增加而增加。药剂师建议进行 342 次药物调整，主要涉及利尿剂（22%）和抗生素（21%）。医生的接受率为 66%。在所有药物错误中，88%被认为是潜在的 ADE，其中大多数被归类为重大或严重。在随访中，当未实施建议的药物调整时，ADE 风险（n=40）最高（38% vs 6%）。
自动 eGFR 警报的引入确定了相当数量的在门诊环境中因肾功能损害而面临 ADE 风险的患者。在全国范围内实施这一简单方案可以识别许多潜在的 ADE，从而大大减少肾功能受损患者的医源性并发症。
