46th ESCP symposium on clinical pharmacy "Science meets practice: towards evidence-based clinical pharmacy services", Heidelberg, Germany, October 9th–11th, 2017

2017 International Journal of Clinical Pharmacy  
and Objective: An impaired renal function, which is common in the elderly, is an important risk factor for medication related hospital admissions. We aimed to investigate the management of drug therapy alerts on safe use of antibiotics in elderly patients with (potential) renal impairment in combination with the option of creatinine point of care testing (PoCT) in community pharmacy practice. Setting and Method: Community pharmacists used a clinical decision support system (CDSS) for seven
more » ... iotics. Alerts were generated during prescription processing in case of previously registered renal impairment, and when no information on renal function was available for patients aged 70 and over. Pharmacists could perform PoCT when renal function could not be retrieved from other health care providers. Actions were registered in the CDSS. A retrospective descriptive analysis of alert management and medication dispensing histories was performed. Logistic regression was performed on PoCT cases to analyse determinants of identifying patients with renal impairment. Main outcome measures: Nature and frequency of CDSS alerts, interventions, and performed PoCT; determinants for identifying patients with impaired renal function by PoCT in community pharmacy. Results: 351 pharmacists registered the management of 88,391 alerts for 64,763 patients. For 49,178 patients (75.9%) renal function was registered in the CDSS. 1.8% of the alerts (n = 1532) led to dose adjustment or drug replacement. Pharmacists performed 1988 PoCTs (2.2%). In 9.2% of these PoCTs, the renal function was impaired (estimated glomerular filtration rate ≤ 50 ml/min/1.73 m 2 ). Determinants for finding renal impairment were higher age and higher number of medicines in use. Conclusion: Implementation of a CDSS and possibility to perform PoCT in community pharmacies prevented potential inappropriate (dosing of) antibiotics in elderly patients with renal impairment. Pharmacists retrieved renal functions mostly from other health care providers. Creatinine PoCT was of added value in a limited number of cases, especially in the very elderly. CP-PC002: Novel technology-enabled pharmacist and patient education program enhances adherence to stroke prevention medications
doi:10.1007/s11096-017-0565-9 pmid:29222732 fatcat:baa6gmxbqrdg7bwwfgdozshmly