Computer-based program for identifying medication orders requiring dosage modification based on renal function

A computer-based program that enables staff pharmacists to quickly review medication orders written for renally impaired patients is described. Medication orders requiring dosage modification based on the renal function of the patients for whom they were written were being identified by a medical staff-approved pharmacist intervention program. However, staff pharmacists were unable to assess the orders easily and rapidly because of a lack of readily available patient data. In response, a computer-based intervention program was developed. Specific dosage guidelines for renally eliminated drugs in patients with renal dysfunction were entered into the pharmacy computer. An interface with the laboratory computer enables the pharmacy computer to access creatinine concentration or clearance values, perform calculations if necessary, and alert pharmacists to specific drug orders that may require modification. Such medication orders are flagged by the pharmacy computer during order entry. When a staff pharmacist judges that intervention is needed, he or she telephones the ordering physician or sends a note to the patient's nursing station. Over a two-month period, 1485 orders were identified as being potentially inappropriate. Physicians were contacted about 191 of the flagged orders, and they accepted the pharmacist's recommendation for 141 (74%) of these orders. The interventions resulted in a drug acquisition cost saving of $7082 over the two-month period. A computer-based program enabled staff pharmacists to easily and rapidly identify orders for renally eliminated agents that required modification, reduced the risk of adverse reactions, trimmed costs, and promoted the clinical dimension of pharmacy practice.