Abstract: TH-PO0816
Evaluating Clinical Decision Support Tools for Renally Adjusted Medication Prescribing
Session Information
- Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
October 22, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 1900 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Diaz, Brianna, Hawaii Permanente Medical Group Inc, Honolulu, Hawaii, United States
- Tsuda, Crystal Tk, Kaiser Permanente LLC, Honolulu, Hawaii, United States
- Ching, Karen I., Hawaii Permanente Medical Group Inc, Honolulu, Hawaii, United States
Background
Inappropriate prescribing of renally cleared medications is a patient safety concern and contributes to adverse drug events, hospitalizations, and increased healthcare utilization. Clinical decision support (CDS) tools such as best practice alerts (BPAs) and standardized order sets (OSs) are routinely implemented in healthcare systems to improve prescribing accuracy. OSs are considered more difficult to implement but more effective at preventing inappropriate prescribing; however, comparative effectiveness data in chronic kidney disease (CKD) populations are limited. This study evaluates the impact of different CDS tools on prescribing practices.
Methods
We conducted a retrospective cohort study of adult outpatient prescriptions for five renally cleared medications (baclofen, ciprofloxacin, levofloxacin, enoxaparin, and oseltamivir). CDS tools compared were BPAs triggered in 2022 and OSs used in 2023. Renal function was defined by creatinine clearance or estimated glomerular filtration rate, depending on medication-specific dosing standards. Free text prescription instructions were parsed using rule-based natural language processing and classified as appropriate or inappropriate.
Results
Baclofen demonstrated significant improvement in prescribing safety following OS implementation. Overall inappropriate baclofen prescribing decreased from 55% in the BPA cohort to 39.5% in the OS cohort [ARR15.5%; p < 0.0001]. No statistically significant difference in inappropriate prescribing was observed in the other medications. Overall inappropriate prescribing changed from 47.4% to 51.7% for ciprofloxacin (p = 0.743), 66.7% to 55.3% for levofloxacin (p = 0.13), 46.7% to 24.6% for oseltamivir (p = 0.172), and 11.1% to 13.3% for enoxaparin (p = 0.876).
Conclusion
OSs were associated with a significant reduction in inappropriate baclofen prescribing. These findings suggest that OSs may improve prescribing safety for select medications, but inappropriate prescribing remains multi-factorial including complexity of indication-specific dosing and medication familiarity.