Niedrig David, Krattinger Regina, Jödicke Annika, Gött Carmen, Bucklar Guido, Russmann Stefan
Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland.
Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland.
Pharmacoepidemiol Drug Saf. 2016 Oct;25(10):1204-1209. doi: 10.1002/pds.4062. Epub 2016 Jul 14.
Overdosing of the oral antidiabetic metformin in impaired renal function is an important contributory cause to life-threatening lactic acidosis. The presented project aimed to quantify and prevent this avoidable medication error in clinical practice.
We developed and implemented an algorithm into a hospital's clinical information system that prospectively identifies metformin prescriptions if the estimated glomerular filtration rate is below 60 mL/min. Resulting real-time electronic alerts are sent to clinical pharmacologists and pharmacists, who validate cases in electronic medical records and contact prescribing physicians with recommendations if necessary.
The screening algorithm has been used in routine clinical practice for 3 years and generated 2145 automated alerts (about 2 per day). Validated expert recommendations regarding metformin therapy, i.e., dose reduction or stop, were issued for 381 patients (about 3 per week). Follow-up was available for 257 cases, and prescribers' compliance with recommendations was 79%. Furthermore, during 3 years, we identified eight local cases of lactic acidosis associated with metformin therapy in renal impairment that could not be prevented, e.g., because metformin overdosing had occurred before hospitalization.
Automated sensitive screening followed by specific expert evaluation and personal recommendations can prevent metformin overdosing in renal impairment with high efficiency and efficacy. Repeated cases of metformin-associated lactic acidosis in renal impairment underline the clinical relevance of this medication error. Our locally developed and customized alert system is a successful proof of concept for a proactive clinical drug safety program that is now expanded to other clinically and economically relevant medication errors. Copyright © 2016 John Wiley & Sons, Ltd.
在肾功能受损的情况下，口服抗糖尿病药物二甲双胍过量是导致危及生命的乳酸性酸中毒的一个重要原因。本项目旨在量化并预防临床实践中这种可避免的用药错误。
我们在一家医院的临床信息系统中开发并实施了一种算法，该算法可在估算肾小球滤过率低于60 mL/分钟时前瞻性地识别二甲双胍处方。由此产生的实时电子警报会发送给临床药理学家和药剂师，他们会在电子病历中验证病例，并在必要时与开处方的医生联系并给出建议。
该筛查算法已在常规临床实践中使用了3年，产生了2145次自动警报（约每天2次）。针对381名患者（约每周3名）发布了关于二甲双胍治疗的经过验证的专家建议，即减少剂量或停药。对257例病例进行了随访，开处方者对建议的依从率为79%。此外，在3年期间，我们识别出8例与肾功能损害患者二甲双胍治疗相关的本地乳酸性酸中毒病例，这些病例无法预防，例如因为二甲双胍过量在住院前就已发生。
通过自动化的敏感筛查，随后进行特定的专家评估和个性化建议，可以高效且有效地预防肾功能损害患者的二甲双胍过量。肾功能损害患者中反复出现的二甲双胍相关性乳酸性酸中毒病例突显了这种用药错误的临床相关性。我们本地开发并定制的警报系统是一个主动临床药物安全计划的成功概念验证，该计划现已扩展到其他具有临床和经济相关性的用药错误。版权所有© 2016约翰威立父子有限公司。
