Appropriate dosing in patients with impaired renal function on medical wards before and after an educational intervention

Context: Whereas in larger hospitals individualized dose adjustment in renal insufficiency can be provided by expert systems and pharmacists, these options are often not available in smaller hospitals. Aims: We evaluated whether one short educational session for the medical staff of internal wards of a community hospital, focusing oil creatinine clearance and dosing in renal insufficiency, and providing a list of frequently used drugs and their dosing schedule does reduce the rate of patients With unadjusted doses. Material and methods: In patients with a creatinine clearance < 60 ml/min, dosing schedules for 92 drugs were determined. After a 6-month observation period (Cohort 1), all educational intervention and the above-mentioned list were delivered to the medical staff. This intervention was followed by a further 6-months observation period (Cohort 2). Results: In Cohort 1, 55/85 patients (median age 79 y) had at least one initially inappropriately adjusted medication, and 47/85 remained so at discharge, whereas in Cohort 2 (median age 77 y): 28/85 patients had at least one initially inappropriately adjusted medication (p = 0.014 compared to Cohort 1) and 27/85 remained so at discharge (p = 0.05). In Cohort 1, 46.0% of all prescriptions with drugs which need dose adjustment (n = 220) were not adjusted. After the intervention (Cohort 2), 25.6% of all prescriptions (n = 176) followed all unadjusted dosage (p < 0.001). Conclusion: This intervention was oil a "low key"-level, and no further support e.g. academic detailing was effected. Despite this, we found a considerable reduction in the number of inappropriate doses in patients with impaired renal function.