Évaluation de l’impact d’un pharmacien clinicien dans l’adaptation de dose du médicament à la fonction rénale d’une population de patients hospitalisés : Étude prospective interventionnelle

Details

Supervisors

Dalleur, Olivia ; Vandamme, Charlotte

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

Background. – Patients with renal impairment are at risk of drug related adverse events if the dose is not adjusted to the estimated glomerular filtration rate. Therefore, the systematic verification by the pharmacist of drug dose adaptation to renal function is potentially an important asset for the patients. Objective. – The objective of this study is to evaluate the impact of the clinical pharmacist verification in a population of hospitalized patients with renal impairment. Firstly, by describing its pharmaceutical interventions (PIs) on the drug dose adaptation and measuring their acceptance rate by medical doctors. Secondly, through the evaluation of these PIs in terms of clinical impact for the patient by a committee of two experts in the field. Methodology. – A prospective interventional study was carried out in a 300-bed hospital at the CHRSM in Auvelais over a period of 20 days. Patients with glomerular filtration rate (GFR) less than 60 ml/min were included in the study. The pharmacist made recommendations to doctors about adjusting the dose of the drug to kidney function. Characteristics of the drug interventions were collected and evaluated by a committee of two renal function experts, a nephrologist, and a hospital pharmacist, using an adapted evaluation grid from the Society of Hospital Pharmacists of Australia (SHPA). Results. - A total of 69 PIs were formulated for 45 patients with GFR less than 60 ml/min. The acceptance rate among clinicians was 84,1 %. The pharmacist’s most frequently formulated type of intervention was increased dosing interval (39,1%). The class of painkillers received the most PI (29 %). 47,8 % of PIs were considered high or very high risk by the nephrologist while 94,2 % by the pharmacist. Conclusion. - This study shows the positive impact of the clinical pharmacist in the systematic verification of the drug dose adaptations to the renal function.