Retrospective Evaluation of the Outcomes of Applying the Renal Dosing Monitoring System in a Medical Center

BackgroundThe administration interval and dosage of the drugs must be adjusted properly according to patients’ renal functions to diminish adverse effects. The computerized monitoring system was established to modify drug dosing for patients with impaired renal function. The Renal Dosing Monitoring (RDM) system was officially operated in April 2007. Only one pharmacist was assigned to assess the reports and to offer the appropriate recommendations in the beginning of operation. The duties have been taken up by the individual pharmacist in each ward since January 2008.PurposeA retrospective analysis of the annual outcomes of applying the RDM system was conducted in March 2008. The goal of the study was to assess the outcome of the application of the RDM system.MethodThe computerized RDM system was established and applied for screening patients with renal dysfunction. Recommendations for frequency and dosage adjustments were made according to the renal function evaluated. Ranks of the drugs, physicians’ acceptance rates, and time to modify prescriptions were assessed by reviewing the documentation of pharmacy interventions. The savings of medication cost was also calculated.ResultsThe physicians accepted 173 (86%) of the 202 recommendations provided by the pharmacists. Most of the recommendations were related to antibiotics, and gentamicin was the most frequently involved drug. The durations for the physicians to modify their prescriptions were as follows: 142 cases were accomplished within 0–1 day (82%), 26 cases were modified within 2–3 days (15%), and five cases were done after more than 3 days (3%). The total saving was US$5377. The physicians declined the pharmacists’ recommendations in 29 cases because of serious infectious conditions in 14 cases (48%), the advice of infection specialists was followed in six cases (21%), and the rest of the cases (31%) had other reasons, such as unwilling to change patients’ long-term medications.ConclusionThe study showed that the RDM system could be an aid for pharmacists to evaluate the appropriateness and safety of medication more precisely and effectively.