TY - JOUR
T1 - Dosing errors in prescribed antibiotics for older persons with CKD
T2 - A retrospective time series analysis
AU - Farag, Alexandra
AU - Garg, Amit X.
AU - Li, Lihua
AU - Jain, Arsh K.
N1 - Funding Information:
Support: Grant support was provided by the Kidney Foundation of Canada . Dr Garg was supported by a Clinician Scientist Award from the Canadian Institutes of Health Research . Dr Jain was supported by a salary award from the Academic Medical Association of Southwestern Ontario . The Institute for Clinical Evaluative Sciences is a nonprofit research corporation funded by the Ontario Ministry of Health and Long-Term Care. The opinions, results, and conclusions reported in this report are those of the authors and are independent from the funding sources. No endorsement from the funding sources is intended or should be inferred.
PY - 2014/3
Y1 - 2014/3
N2 - Background Prescribing excessive doses of oral antibiotics is common in chronic kidney disease (CKD) and in this population is implicated in more than one-third of preventable adverse drug events. To improve the care of patients with CKD, many ambulatory laboratories now report estimated glomerular filtration rate (eGFR). We sought to describe the rate of ambulatory antibiotic dosing errors in CKD and examine the impact of eGFR reporting on these errors. Study Design Population-based retrospective time series analysis. Setting & Participants Southwestern Ontario, Canada, from January 2003 to April 2010. Participants were ambulatory patients 66 years or older with CKD stages 4 or 5 (eGFR < 30 mL/min/1.73 m2) who were not receiving dialysis. Predictor Introduction of eGFR reporting in ambulatory laboratories (January 2006). Outcome Antibiotic dosing errors. Measurements Using linked health care databases, we assessed the monthly rate of excess dosing of orally prescribed antibiotics that require dose adjustment in CKD. We compared this rate before and after implementation of eGFR reporting. Results 1,464 prescriptions were filled for study antibiotics throughout the study period. Prior to eGFR reporting, the average rate of antibiotic prescriptions dosed in excess of guidelines was 64 per 100 antibiotic prescriptions. The introduction of eGFR reporting had no impact on this rate (68 per 100 antibiotic prescriptions; P = 0.9). Nitrofurantoin, which is contraindicated in patients with CKD, was prescribed 169 times throughout the study period. Limitations Although we attribute the dosing errors to poor awareness of dosing guidelines, we did not assess physician knowledge to confirm this. Dosing errors lead to adverse drug events; however, the latter could not be assessed reliably in our data sources. Conclusions Ambulatory antibiotic dosing errors are exceedingly common in CKD care. Strategies other than eGFR reporting are needed to prevent this medical error.
AB - Background Prescribing excessive doses of oral antibiotics is common in chronic kidney disease (CKD) and in this population is implicated in more than one-third of preventable adverse drug events. To improve the care of patients with CKD, many ambulatory laboratories now report estimated glomerular filtration rate (eGFR). We sought to describe the rate of ambulatory antibiotic dosing errors in CKD and examine the impact of eGFR reporting on these errors. Study Design Population-based retrospective time series analysis. Setting & Participants Southwestern Ontario, Canada, from January 2003 to April 2010. Participants were ambulatory patients 66 years or older with CKD stages 4 or 5 (eGFR < 30 mL/min/1.73 m2) who were not receiving dialysis. Predictor Introduction of eGFR reporting in ambulatory laboratories (January 2006). Outcome Antibiotic dosing errors. Measurements Using linked health care databases, we assessed the monthly rate of excess dosing of orally prescribed antibiotics that require dose adjustment in CKD. We compared this rate before and after implementation of eGFR reporting. Results 1,464 prescriptions were filled for study antibiotics throughout the study period. Prior to eGFR reporting, the average rate of antibiotic prescriptions dosed in excess of guidelines was 64 per 100 antibiotic prescriptions. The introduction of eGFR reporting had no impact on this rate (68 per 100 antibiotic prescriptions; P = 0.9). Nitrofurantoin, which is contraindicated in patients with CKD, was prescribed 169 times throughout the study period. Limitations Although we attribute the dosing errors to poor awareness of dosing guidelines, we did not assess physician knowledge to confirm this. Dosing errors lead to adverse drug events; however, the latter could not be assessed reliably in our data sources. Conclusions Ambulatory antibiotic dosing errors are exceedingly common in CKD care. Strategies other than eGFR reporting are needed to prevent this medical error.
KW - Orally prescribed antibiotics
KW - adverse drug event
KW - antibiotic dosing errors
KW - chronic kidney disease (CKD)
KW - drug dosing adjustment
KW - drug safety
KW - estimated glomerular filtration rate (eGFR) reporting
KW - medical error
KW - nitrofurantoin
KW - quality of care
KW - renal disease
UR - http://www.scopus.com/inward/record.url?scp=84894471380&partnerID=8YFLogxK
U2 - 10.1053/j.ajkd.2013.09.009
DO - 10.1053/j.ajkd.2013.09.009
M3 - Article
C2 - 24189475
AN - SCOPUS:84894471380
SN - 0272-6386
VL - 63
SP - 422
EP - 428
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -