The Usage of Dosing GAMA Application to Evaluate the Appropriateness of Drug Doses in Hospitalized Patients with Renal Impairment

https://doi.org/10.22146/jmpf.58534

Vidiya Gunarsih(1), Fita Rahmawati(2*), Djoko Wahyono(3)

(1) Magister Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(2) Fakultas Farmasi, Universitas Gadjah Mada
(3) Fakultas Farmasi, Universitas Gadjah Mada
(*) Corresponding Author

Abstract


An application named ‘Dosing GAMA’ has developed for drug doses adjustment in patients with renal and hepar impairment. Dosing GAMA is targeted for clinical Pharmacists to calculate and make dose recommendations for patients, based on renal and hepatic conditions. This study aims to identify the appropriateness of drug dosage adjustment by using Dosing GAMA application in hospitalized patients with renal impairment and to determine the risk factors for the drug dose inappropriateness. This study was a retrospective observational descriptive study, cross-sectional design, used a consecutive sampling technique. The source of the data was Medical Record of hospitalized patients with renal impairment (creatinine clearance ≤50 mL/min) from 2018 of February till 2020 of March in the Academic Hospital of UGM. The names and the doses of the drugs were filled to Dosing GAMA application, and it would evaluate the appropriateness of drug doses. There were 570 drugs of 73 medical records included in this study. This study revealed Dosing GAMA could assess 144 drugs (25,6%) need to adjust, and 82 drugs (56,9%) were inappropriate doses. There were significant correlations of the age characteristic (p=0,000) and the creatinine clearance value (p=0,012) to the drugs dose appropriateness. There were inappropriate doses need to adjust in the hospital. So, the use of health-based technology expected for pharmacists to improve the use of drugs rationally.

Keywords


Aplikasi Dosing GAMA; penurunan fungsi ginjal; penyesuaian dosis obat

Full Text:

PDF


References

  1. Kementerian Kesehatan. Riset Kesehatan Dasar 2013. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan; 2013. http://www.academia.edu/download/36235491/Laporan_riskesdas_2010.pdf.
  2. Kementerian Kesehatan. Hasil Utama Riskesdas 2018. Jakarta; 2018.
  3. Shargel L, Yu ABC. Applied Biopharmacetical. 7th ed. United State: Mc Graw-Hill Education; 2016.
  4. Kementerian Kesehatan. Peraturan Menteri Kesehatan RI Nomor 72 Tahun 2016, Tentang Standar Pelayanan Kefarmasian Di Rumah Sakit. Jakarta, Indonesia: Kementerian Kesehatan Republik Indonesia; 2016:5-34.
  5. Nielsen AL, Henriksen DP, Marinakis C, et al. Drug Dosing in Patients with Renal Insufficiency in a Hospital Setting using Electronic Prescribing and Automated Reporting of Estimated Glomerular Filtration Rate. Basic Clin Pharmacol Toxicol. 2014;114(5):407-413. doi:10.1111/bcpt.12185
  6. Tesfaye WH, Castelino RL, Wimmer BC, Zaidi STR. Inappropriate prescribing in chronic kidney disease: A systematic review of prevalence, associated clinical outcomes and impact of interventions. Int J Clin Pract. 2017;71(7):e12960. doi:10.1111/ijcp.12960
  7. Breton G, Froissart M, Janus N, et al. Inappropriate drug use and mortality in community-dwelling elderly with impaired kidney function--the Three-City population-based study. Nephrol Dial Transplant. 2011;26(9):2852-2859. doi:10.1093/ndt/gfq827
  8. Getachew H, Tadesse Y, Shibeshi W. Drug dosage adjustment in hospitalized patients with renal impairment at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. BMC Nephrol. 2015;16(1):158. doi:10.1186/s12882-015-0155-9
  9. Saad R. Evaluation of renal drug dosing adjustment in chronic kidney disease patients at two university hospitals in Lebanon. Pharm pra. 2019;17(1):1-6.
  10. Boussadi A, Caruba T, Karras A, et al. Validity of a clinical decision rule-based alert system for drug dose adjustment in patients with renal failure intended to improve pharmacists’ analysis of medication orders in hospitals. Int J Med Inform. 2013;82(10):964-972. doi:10.1016/j.ijmedinf.2013.06.006
  11. Rahmawati F, Wahyono D, Andayani TM, Ihsan M, Hakim AR. Kementerian Hukum dan Hak Asasi Manusia. 2018.
  12. Hajma LPA. Pengaruh Penggunaan Perangkat Lunak Dosing Gama Terhadap Waktu Evaluasi Adjustment Dosis pada Pelayanan Kefarmasian serta Studi Kebermanfaatannya. 2020.
  13. Harlan J, Sutjiati R. Metodologi Penelitian Kesehatan. 2nd ed. Jakarta: Gunadarma; 2018.
  14. Salomon L, Deray G, Jaudon MC, et al. Medication misuse in hospitalized patients with renal impairment. Int J Qual Heal Care. 2003;15(4):331-335. doi:10.1093/intqhc/mzg046
  15. Prajapati A, Ganguly B. Appropriateness of drug dose and frequency in patients with renal dysfunction in a tertiary care hospital: A cross-sectional study. J Pharm Bioallied Sci. 2013;5(2):136-140. doi:10.4103/0975-7406.111829
  16. Chang P, Chien L-N, Lin Y-F, Wu M, Chiu W, Chiou H. Risk factors of gender for renal progression in patients with early chronic kidney disease. Medicine (Baltimore). 2016;95(30):e4203. doi:10.1097/MD.0000000000004203
  17. Kementerian Kesehatan. Peraturan Menteri Kesehatan RI Nomor 82 Tentang Sistem Manajeman Rumah Sakit. Jakarta, Indonesia: Kementerian Hukum dan Hak Asasi Manusia RI; 2013.
  18. Presiden RI. Undang-Undang No 13 Tahun 1998 tentang Kesejahteraan Lansia. Keputusan Pres. 1998. hhtp://bphn.go.id.
  19. White W, Cove-Smith A. Chronic Kidney Disease: Kidney disease in the elderly. Medicine (Baltimore). 2015;43(8):489-492. doi:10.1016/j.mpmed.2015.05.002
  20. O’Sullivan ED, Hughes J, Ferenbach DA. Renal Aging: Causes and Consequences. J Am Soc Nephrol. 2017;28(2):407-420. doi:10.1681/asn.2015121308
  21. Frisse S, Röhrig G, Franklin J, Polidori MC, Schulz R-J. Prescription errors in geriatric patients can be avoided by means of a computerized physician order entry (CPOE). Z Gerontol Geriatr. 2016;49(3):227-231. doi:10.1007/s00391-015-0911-2
  22. Sakr Y, Sponholz C, Reinhart K. Organ Dysfunction in the ICU: A Clinical Perspective. In: Intensive Care Medicine. New York, NY: Springer New York; 2007:238-245. doi:10.1007/978-0-387-49518-7_22
  23. Bauer LA. Clinical Pharmacokinetic and Pharmacodynamic Concept. In: Applied Clinical Pharmacokinetics. 2nd ed. United State: Mc Graw-Hill Medical; 2008:3. doi:10.1036/0071476288
  24. Evans PD, Taal MW. Chronic Kidney Disease: Epidemiology and Causes. In: Medicine. Vol 43. London: Springer London; 2015:537-545. doi:10.1007/978-1-4471-5547-8_47
  25. Mahmoodi BK, Matsushita K, Woodward M, et al. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet. 2012;380(9854):1649-1661. doi:10.1016/S0140-6736(12)61272-0
  26. Holm H, Bjerke K, Holst L, Mathiesen L. Use of renal risk drugs in patients with renal impairment. Int J Clin Pharm. 2015;37(6):1136-1142. doi:10.1007/s11096-015-0175-3
  27. Yang P, Chen N, Wang R-R, Li L, Jiang S-P. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital. Dove Press J. 2016:1517-1524.
  28. Emami S, Esfahani HR, Farokhi FR, Fahimi F. Assessment of drug dose adjustment in patients with kidney disease: Opportunities for pharmacist involvement. Int J Pharm Pharm Sci. 2012;4(SUPPL.3):178-181.
  29. Hassan Y, Al-Ramahi RJ, Aziz NA, Ghazali R. Impact of a Renal Drug Dosing Service on Dose Adjustment in Hospitalized Patients with Chronic Kidney Disease. Ann Pharmacother. 2009;43(10):1598-1605. doi:10.1345/aph.1M187
  30. Saleem A, Masood I. Pattern and Predictors of Medication Dosing Errors in Chronic Kidney Disease Patients in Pakistan : A Single Center Retrospective Analysis. PLoS One. 2016:1-12. doi:10.1371/journal.pone.0158677
  31. Soetikno V, Effendi I, Setiabudy R. A survey on the appropriateness of drug therapy in patients with renal dysfunction at the Internal Medicine Ward FMUI / Dr . Cipto Mangunkusumo Hospital. Med J Indones. 2009;18(2):108-113.
  32. Desmedt S, Spinewine A, Jadoul M, Henrard S, Wouters D, Dalleur O. Impact of a clinical decision support system for drug dosage in patients with renal failure. Int J Clin Pharm. 2018;40(5):1225-1233. doi:10.1007/s11096-018-0612-1
  33. Cabello-Muriel A, Gascón–Cánovas JJ, Urbieta-Sanz E, Iniesta-Navalón C. Effectiveness of pharmacist intervention in patients with chronic kidney disease. Int J Clin Pharm. 2014;36(5):896-903. doi:10.1007/s11096-014-0001-3
  34. Joosten H, Drion I, Boogerd KJ, et al. Optimising drug prescribing and dispensing in subjects at risk for drug errors due To renal impairment: Improving drug safety in primary healthcare by low eGFR alerts. BMJ Open. 2013;3(1):1-9. doi:10.1136/bmjopen-2012-002068
  35. Lexi-comp I. Drug Information Handbook : A Clinically Relevant Resource for All Healthcare Professionals. 26th ed. (American Pharmacists Association, ed.). United State: Wolters Kluwer; 2017.
  36. Munar MY, Singh H. Drug Dosing Adjustments in Patients with Chronic Kidney Disease. Am Fam Physician. 2007;75(10):1487-1496. www.aafp.org/afp.



DOI: https://doi.org/10.22146/jmpf.58534

Article Metrics

Abstract views : 1550 | views : 1759

Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice)

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

©Jurnal Manajemen dan Pelayanan Farmasi
Faculty of Pharmacy
Universitas Gadjah Mada
Creative Commons License
View My Stats