empower science for patient care
Renal Pharmacist Consultant Service
Pharmaceutical care for patients with impaired kidney function on the surgical wards of the LMU Clinic in the setting of the digital patient file
Postdoc-scholarship 2020-2021
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Patients with renal impairment (RI) show a higher rate of drug-related problems (DRP), like e.g. overdosage or contraindications, which increase the risk for adverse drug reactions. Thus, it is important to screen inpatients for decreased renal function and, consequently, their medication for DRP. Pharmacists as part of the multiprofessional team can support physicians on ward by identifying and solving DRP.
In a previous study with urological patients it was shown that a ‘renal pharmacist consultant service’ (RPCS) reviewing patients with RI for DRP can foster patient safety. Here, written patient charts were still used (no electronic order entry, electronic chart or ward pharmacists) and the consultations in paper form seemed to be superior to a digital PDF document. In this way, the consultations were directly available at the point of prescribing. However, the prescription process of the physician has totally changed since the implementation of a computerized physician order entry (CPOE)-system with a clinical decision support system (CDSS). The benefit of the RPCS in this new setting is unknown.
The aim of the study is to evaluate a RPCS on wards with CPOE-CDSS, its need in general and its effectiveness on prescription changes. During weekdays, surgical and orthopedic patients with eGFRabsolute/KreaCl < 60 ml/min receive a medication review for DRP by a renal pharmacist for all medication presented in the CPOE-CDSS. Written consultations explaining DRP and recommending interventions to solve them, e.g. dose or drug adaptation, are presented to physicians directly in the drug chart tab of the CPOE-system. The overall goal of this project is to increase patient safety of patients with renal impairment on wards working with CPOE-CDSS and to foster the interprofessional collaboration between pharmacist, physicians and nursing staff at the LMU hospital Munich.
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