Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm.

Autor: Dahmke H; Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland. hendrike.dahmke@ksa.ch.; Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. hendrike.dahmke@ksa.ch., Schelshorn J; Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland.; Faculty of Medicine, University of Bern, Bern, Switzerland., Fiumefreddo R; Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland., Schuetz P; Medical University Clinic, General Internal and Emergency Medicine, Kantonsspital Aarau AG, Aarau, Switzerland., Salili AR; Pinmed Gemeinschaftspraxis, Wallisellen, Switzerland., Cabrera-Diaz F; Hospital Pharmacy, General University Hospital of Ciudad Real, Ciudad Real, Spain., Meyer-Massetti C; Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital-University Hospital Bern, Bern, Switzerland.; Institute of Primary Health Care BIHAM, University of Bern, Bern, Switzerland., Zaugg C; Hospital Pharmacy, Kantonsspital Aarau AG, Aarau, Switzerland.
Jazyk: angličtina
Zdroj: Drugs - real world outcomes [Drugs Real World Outcomes] 2024 Mar; Vol. 11 (1), pp. 125-135. Date of Electronic Publication: 2024 Jan 06.
DOI: 10.1007/s40801-023-00405-y
Abstrakt: Background and Objective: The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician.
Methods: We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint.
Results: Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases.
Conclusion: The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
(© 2024. The Author(s).)
Databáze: MEDLINE
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