|
|
| (2 intermediate revisions by 2 users not shown) |
| Line 1: |
Line 1: |
| − | '''''Back to'''''
| + | #REDIRECT [[CDS]] |
| − | | + | |
| − | [[:CDS|CDS]] | + | |
| − | | + | |
| − | [[:CDS#Medication-Based_Safety_Rules|Medication-Based Safety Rules]]
| + | |
| − | | + | |
| − | ----
| + | |
| − | A brief summary of several studies involving CDS for renally cleared medications
| + | |
| − | | + | |
| − | Many medications must be carefully monitored in the setting of compromised renal function. Clinical decision support has been shown in several studies to improve compliance with guidelines. A study by Chertow1 suggested that incorporation directly into CPOE led to significant compliance improvements. A study by Roberts2 showed that clinical decision support, even outside of CPOE can improve conformity, but continued education is required or levels of compliance will return to their pre-implementation levels. Oppenheim showed that a CDS system for renally dosing medications could be implemented without adversely affecting educational benefits by allowing a "first crack" by the housestaff.
| + | |
| − | | + | |
| − | 1 Chertow GM, Lee J, Kuperman GJ, Burdick E, Horsky J, Seger DL, Lee R, Mekala A, Song J, Komaroff AL, Bates DW. Guided medication dosing for inpatients with renal insufficiency. JAMA. 2001 Dec 12;286(22):2839-44.
| + | |
| − | | + | |
| − | 2 Roberts GW, Farmer CJ, Cheney PC, Govis SM, Belcher TW, Walsh SA, Adams RJ. Clinical decision support implemented with academic detailing improves prescribing of key renally cleared drugs in the hospital setting. J Am Med Inform Assoc. 2010 May 1;17(3):308-12.
| + | |
| − | | + | |
| − | 3 Oppenheim MI, Vidal C, Velasco FT, Boyer AG, Cooper MR, Hayes JG, Frayer WW. Impact of a computerized alert during physician order entry on medication dosing in patients with renal impairment. Proc AMIA Symp. 2002:577-81.
| + | |
| − | | + | |
| − | submitted by Bennett Burke
| + | |
| − | | + | |
| − | | + | |
| − | ==References==
| + | |
| − | KAISER PERMANENTE:SAFETY IN PRESCRIBING (SIP). Recommendations for dosing and drug alternatives. Dosing Recommendation in renal dysfunction. FEBRUARY 10, 2003 UPDATE.
| + | |
| − | ----
| + | |
| − | | + | |
| − | <table style="background-color: FFFFFF;" border="12">
| + | |
| − | | + | |
| − | ==<th>Examples of Medications Requiring Dosage Adjustments in Renal Insufficiency</th>== <tr>
| + | |
| − | | + | |
| − | <table style="background-color: FFFFFF;" border="4">
| + | |
| − | <th align=left>Drug</th><th align=left>GFR</th><th align=left>Dosing recommendation in alert</th><th align=left>Potential safety problem listed in alert</th>
| + | |
| − | | + | |
| − | | + | |
| − | <tr><td align=left>'''Allopurinol'''</td>
| + | |
| − | <td>51-60
| + | |
| − | | + | |
| − | 10-50
| + | |
| − | | + | |
| − | <10
| + | |
| − | </td>
| + | |
| − | <td>200mg per day maximum
| + | |
| − | | + | |
| − | 150mg per day maximum
| + | |
| − | | + | |
| − | Do not use
| + | |
| − | </td>
| + | |
| − | <td align=left> Liver and hematoligic toxicity.
| + | |
| − | | + | |
| − | | + | |
| − | <tr><td align=left>'''Co-trimoxazole'''</td>
| + | |
| − | <td>15-30
| + | |
| − | | + | |
| − | <15
| + | |
| − | </td>
| + | |
| − | | + | |
| − | | + | |
| − | <td> 80/400mg twice per day maximum
| + | |
| − | | + | |
| − | Do not use
| + | |
| − | </td>
| + | |
| − | <td align=left> Crystalluria and kidney stone formation.
| + | |
| − | | + | |
| − | | + | |
| − | <tr><td align=left>'''Metformin'''</td>
| + | |
| − | <td><10
| + | |
| − | </td>
| + | |
| − | <td>Do not use
| + | |
| − | </td>
| + | |
| − | <td align=left> Lactic acidosis.
| + | |
