Abstract: FR-PO961

Medication Dosing in Dialysis Dependent ESKD Patients: A Retrospective Single Center Review

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Nnani, Daryl U., Mount Sinai Hospital, New York, New York, United States
  • Nguyen, Timothy V., Long Island University - AMS College of Pharmacy and Health Sciences, Little Ferry, New Jersey, United States
  • Jariwala, Archna, Mount Sinai Hospital, New York, New York, United States
  • Lapsia, Vijay, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Patients with hemodialysis (HD) dependent end stage kidney disease (ESKD) are more prone adverse events and poor outcomes due to inappropriate medication dosing. A significant number of medications are converted into active metabolites and failure to adjust doses may result in toxicity. Medication errors account for a majority of adverse events within the inpatient setting. The purpose of this study was to assess the appropriateness of medication dosing in hospitalized HD dependent ESKD patients.

Methods

This was an IRB-approved, single-center, retrospective medication chart review of adult HD-dependent patients diagnosed with ESKD admitted between 1/2016 – 8/2016. Patients were excluded if they were on peritoneal dialysis, admitted for kidney transplantation, or had missing pertinent information. The appropriateness of medication dosing was assessed by evaluating inpatient medication orders on day one of admission and was compared to drug manufacturer and tertiary reference renal dose adjustment recommendations.

Results

A total of 509 patients were included in this study and 6,964 medication orders were reviewed for a mean of 13.7±8.32 medications per patient. A total of 221 inappropriate medications orders were identified and 32.4% (165 of 509) of patients included in this study had an inappropriate medication order on admission. A total of 20 medication classes were ordered inappropriately on day one of admission. The most frequently inappropriately ordered medication classes were anticonvulsants 26.1% (58 of 221), opioids 25.6% (57 of 221), antibiotics 16.2% (36 of 221), histamine-2 receptor antagonists 8.1% (18 of 221) and HMG-CoA reductase inhibitors 6.3% (14 of 221). Morphine sulfate accounted for 83% (47 of 57) of inappropriate opioid medication orders. Gabapentin accounted for 66% (38 of 58) and levetircetam accounted for 28% (16 of 58) of inappropriate anticonvulsants medication orders in this study.

Conclusion

Anticonvulsants and opioids accounted for greater than 50% of inappropriate medications orders. Mandatory pharmacist medication reconciliation in this patient population and implementation of a best practice alert integrated into the computerized physician order entry system may result in a reduction of inappropriate medication orders in this patient population.