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Overdose Rate of Drugs Requiring Renal Dose Adjustment: Data Analysis of 4 Years Prescriptions at a Tertiary Teaching Hospital

Journal of General Internal Medicine volume 23, pages 423–428 (2008)Cite this article

Abstract

OBJECTIVE

To determine the overdose rate of drugs that require renal dose adjustment and factors related with overdose.

SUBJECTS

Total of 23,635,210 records of prescriptions and laboratory data of inpatients at a tertiary teaching hospital for the period from January 2002 to December 2005.

METHODS

A clinical data mart was constructed. A knowledge base containing dose adjusting information about 56 drugs was built. One day dose was compared to the reference dose adjusted to the patient’s renal function.

RESULTS

Considering the patient’s renal function, 5.3% of drug doses were excessive. The overdose rate in the patients with moderate to severe renal insufficiency was 28.2%. Only 25% of physicians were responsible for 50.6% of the overdoses. Of 56 drugs studied, 10 drugs, including ranitidine, amoxicillin, and piperacillin/tazobactam, were involved in 85.4% of the overdoses. The physicians with high overdose rate had patients with more impaired renal function (correlation coefficient = 0.192, P < .001). There were negative correlation between clinical experiences of physician and overdose rate (correlation coefficient = −0.221, P < .001) and workload of prescription (correlation coefficient = −0.446, P < .001), when excluding interns from the analyses. There was positive correlation between workload of prescription and overdose rate (correlation coefficient = 0.361, P < .001).

CONCLUSION

A clinical data mart was useful to analyze the vast amount of electronic hospital data. Drug overdose is quite common among inpatients with renal insufficiency. Only a few drugs are responsible for most of drug overdoses. The physicians’ clinical experience, workload of prescriptions, and patients’ renal function are correlated with drug overdose.

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Acknowledgements

The authors would like to acknowledge Dr. Hyuck Joon Chung for his assistance in the reference knowledge base review. This study was supported by a grant from the Korea Health 21 R&D project, Ministry of Health &Welfare, Republic of Korea (A050571); by a grant from the Korea Research Foundation, Republic of Korea (KRF-2006-332-E00093); and by a grant from the Department of Medical Sciences, The Graduate School, Ajou University.

Conflicts of Interest

None disclosed.

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Authors and Affiliations

  1. Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea

    Seung Soo Sheen MD

  2. Regional Clinical Trial Center, Ajou University Hospital, Suwon, South Korea

    Ji Eun Choi MPH

  3. Department of Medical Informatics, Ajou University School of Medicine, Wonchun-dong, Suwon, South Korea

    Rae Woong Park MD, PhD & Eun Yub Kim MPH

  4. Gachun University of Medicine and Science, Inchon, South Korea

    Young Ho Lee PhD & Un Gu Kang PhD

Authors
  1. Seung Soo Sheen MD
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  2. Ji Eun Choi MPH
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  3. Rae Woong Park MD, PhD
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  4. Eun Yub Kim MPH
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  5. Young Ho Lee PhD
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Corresponding author

Correspondence to Rae Woong Park MD, PhD.

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First two authors are equally contributed to this work.

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Sheen, S.S., Choi, J.E., Park, R.W. et al. Overdose Rate of Drugs Requiring Renal Dose Adjustment: Data Analysis of 4 Years Prescriptions at a Tertiary Teaching Hospital. J GEN INTERN MED 23, 423–428 (2008). https://doi.org/10.1007/s11606-007-0336-8

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  • DOI: https://doi.org/10.1007/s11606-007-0336-8

KEY WORDS

  • adverse drug events
  • overdose
  • renal insufficiency
  • safety
  • knowledge base
  • data mart