Analysis on the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system
10.3760/cma.j.cn114015-20231204-00860
- VernacularTitle:前置审核系统对肾功能不全患者医嘱中禁用药物的预警情况分析
- Author:
Jia ZHOU
1
;
Lei JIN
1
;
Shuhong BU
1
;
Xiyue YUAN
1
Author Information
1. 上海交通大学医学院附属新华医院临床药学部，上海 200092
- Publication Type:Journal Article
- Keywords:
Renal insufficiency;
Contraindications;
Medication errors;
Pre-audit system;
Pre-warnings
- From:
Adverse Drug Reactions Journal
2024;26(5):268-274
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system.Methods:The pre-warnings of contraindicated drugs in medical advices in patients with renal insufficiency by the pre-audit system in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2021 to December 31, 2021 were collected. The drugs involved were analyzed and determined as drugs in the correct pre-warnings and drugs in the audit rules that needed to be corrected. The drugs involved in the correct pre-warnings and the acceptance of pre-warnings by clinicians were analyzed; drugs that can be used off-label according to the evidence-based information were recorded and the proposed suggestions on the revision of the audit rules were provided.Results:A total of 259 medical advices about pre-warnings related to contraindicated drugs in patients with renal insufficiency were included in the analysis, involving 47 drugs. Among the 259 pre-warnings, 169 were correct, with the correct rate of 65.25%, and 107 (63.31%) of them were accepted by clinicians. The rate of acceptance by surgeons was higher than that by physicians, and the difference was statistically significant [76.39% (55/72) vs. 53.61% (52/97), P<0.01]. The audit rules in the 90 pre-warnings that needed to be modified involved 12 drugs. Of them, one drug (dapagliflozin tablets) had updated instruction, thus the rules can be modified directly according to it. The other 11 drugs were recorded for off-label drug use in the system based on evidence-based information, and of them, pre-warning levels were adjusted for 6 drugs, and audit rules were adjusted for 5. Conclusions:The pre-audit system can effectively pre-warning the contraindicated drug prescriptions of CKD patients, and the correct rate of pre-warning and clinician acceptance rate are more than 60%. The audit rules of some pre-warnings need to be adjusted with the update of the instructions and additional evidence-based information for off-label drug use after recording.
