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International Journal of Clinical Pharmacy

, Volume 37, Issue 2, pp 387–394 | Cite as

Role of an electronic antimicrobial alert system in intensive care in dosing errors and pharmacist workload

  • Barbara O. M. Claus
  • Kirsten Colpaert
  • Kristof Steurbaut
  • Filip De Turck
  • Dirk P. Vogelaers
  • Hugo Robays
  • Johan Decruyenaere
Research Article

Abstract

Background Critically ill patients are vulnerable to dosing errors. We developed an electronic Antimicrobial Dose alert based upon Creatinine clearance (ADC-alert), which gives daily antimicrobial dosing advice based upon the 24-h creatinine clearance (CLcr). Objective Primary objective: to verify the correctness of the ADC-alert output and its benefit for the workload of the clinical pharmacist (CP). Secondary objective: to compare the ADC-alert output between patients with normal and impaired CLcr. Setting The 36-bed surgical and medical intensive care unit (ICU) of the Ghent University Hospital, Ghent, Belgium. Method In a single centre prospective observational 44-day study, prescriptions were reviewed by CP and compared with the ADC-alert output advice. CP workload was calculated with and without the use of the ADC-alert. Impaired renal function was defined as a CLcr < 50 mL/min for at least 1 day during antimicrobial treatment in the ICU or the need for renal replacement therapy (RRT). Main outcome measures Correct dosing recommendation by ADC-alert compared to CP review and time spent by CP with and without the ADC-alert. Results A total of 87 patients (554 daily antimicrobial prescriptions; 435 patient days) were both screened by CP and ADC-alert. Renal function impairment occurred in 39 patients (44.8 %) with 12 patients requiring RRT. The ADC-alert gave a correct dosage advice in 483 prescriptions (87.2 %). The overall sensitivity was 77.3 %; specificity was 89.9 %. Use of the ADC-alert reduces CP workload with 76.5 % (average time spent per patient: 17 vs. 4 min). Patients with a CLcr < 50 mL/min less frequently received a correct recommendation than patients with normal CLcr (P = 0.001). This was due to configuration problems in dialysis patients. Conclusion We developed and evaluated an electronic alert system to generate dynamic antimicrobial dose adaptation based on the daily calculation of the 24-h CLcr of ICU patients. Its use led to substantial time savings for clinical pharmacists. However, the alert advice suffered from some developmental and other flaws. Despite resolving some of these shortcomings, bedside interpretation of the results and clinical judgement remain necessary.

Keywords

Alert system Antibiotic dosing Belgium Clinical pharmacist Critically ill Intensive care unit Renal function Workload 

Notes

Funding

None.

Conflicts of interest

All authors express no conflict of interests.

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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Barbara O. M. Claus
    • 1
  • Kirsten Colpaert
    • 2
  • Kristof Steurbaut
    • 3
  • Filip De Turck
    • 3
  • Dirk P. Vogelaers
    • 4
  • Hugo Robays
    • 1
  • Johan Decruyenaere
    • 2
  1. 1.Pharmacy DepartmentGhent University HospitalGhentBelgium
  2. 2.Department of Critical Care MedicineGhent University HospitalGhentBelgium
  3. 3.Department of Information Technology (INTEC)Ghent UniversityGhentBelgium
  4. 4.Department of General Internal Medicine, Infectious Diseases and Psychosomatic MedicineGhent University HospitalGhentBelgium

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