Clinical Pharmacist Intervention in Cardiac Patients With Renal Impairment

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Clinical Pharmacist Intervention in Cardiac
Patients With Renal Impairment
Elham Al-Shammari, B.Sc. Pharm.
Supervised by
Hisham Abou-Auda, Ph. D.
Meshal Al-Mutairi, Pharm. D.
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Introduction
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Introduction
Having clinical pharmacist during physician
rounds will decrease preventable adverse drug
events especially in intensive care unit.
Adverse drug events were the sixth leading
cause of death in USA in 1994 with 10.9 of all
hospital patients.
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Introduction
Pharmacists working beside the dispensing windows
miss the opportunity to assist physicians in
rational prescribing. Addressing medical errors
is one strategy to improve safety of
medication For every 1 invested in clinical
pharmacy services, 4 in benefit is expected
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Introduction
45.6 billion in direct health care costs would
be avoided even when this kind of service led to
4-fold increase in fee association.
A review of the economic benefit of clinical
pharmacy services through 59 articles published
between 1996 to 2000 performed by Center for
Pharmacoeconomics Research and Department of
Pharmacy Practice, University of Illinois at
Chicago, USA
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Objectives
Through clinical observation, patients with
cardiac problems were in high risk to develop
renal impairment. Therefore, this study was
conducted to
Evaluate the role of clinical pharmacist in
dosage adjustment in patients with renal
impairment
Assess the cost impact of clinical pharmacists
intervention.
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Methodology
Study Setting

• Prince Sultan Cardiac Center in Riyadh.
• 160 full-capacity beds
• 5,304 admissions / year.
• Patients with cardiac problems.
• Scheduled procedures and also serves outpatient
  and emergency clinics.

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Study Design
Methodology

• Prospective, observational and interventional
  study.
• Five days a week for four weeks during July
  2004.
• Approved by the PT Committee to be provided by
  PSCC Pharmacy Department.

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Institutional Board Review was obtained.
The study was also approved by the Ethical
Committee in PSCC.
The study was conducted according to Helsinki
Declaration and the safety of all patients was
insured.
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Methodology
Drugs to be Monitored

• Ceftazidime,
• Cefuroxime,
• Ciprofloxacin,
• Digoxin,
• Piperacillin/tazobactam (tazosin),
• Ranitidine.
• (extensive use high acquisition cost).

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Methodology
Intervention Protocol
Identify patients receiving these drugs on daily
basis, Review their demographic data and assess
laboratory findings. Recommended appropriate
dosing adjustment according to renal function.
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Inclusion and Exclusion Criteria
Methodology

• All hospitalized cardiac patients 18 years of
  age or older.
• Receiving one or more of the study medications.

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Outcome Measures
Methodology
Ethical considerations. Clinical outcome. Cost
avoidance will be determined by calculating the
difference between the costs of the original and
adjusted regimens.
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Data Collection
Methodology

• Demographic data.
• Lab findings
• Scr, drug levels, BUN, etc.
• Diagnosis and underlying disease (e.g. CHF).

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Methodology
Data Collection, cont
Cockcroft and Gault equation
Female 85
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Methodology
Data Collection, cont
Jellife method
Female 90
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Methodology
Data Collection, cont
Appropriate dose adjustment when
needed. Calculation of cost avoidance and
extrapolation of the results to one year.
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Statistical Analysis
Methodology
SPSS version 13.0 Frequencies Condescriptives Para
metric or Nonparametric tests.
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Results
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Demographics
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42.5
CHF
57.5
72.4
ICU
27.6
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r 0.374, p 0.002
120
100
80
60
CL Cr (ml/min)
40
20
0
0
40
20
60
80
10
30
50
70
Ejection fraction ()
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CLCr35.23 0.605 (Ejection Fraction)
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Renal Impairment Categories
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Renal Impairment Categories
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Dose Adjustment
13.8
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Drugs Involved
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Annual saving
During study
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Digoxin CL CLcr 20 Without CHF Digoxin CL
CLcr 40 With CHF
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Discussion Conclusion
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Discussion conclusion
Equations for predicting Digoxin CL cannot be
applied to our population ? Future investigation
? Saving lives, reducing adverse
events Pharmacist intervention can save between
SR 287,609 and SR 384,358
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Discussion conclusion

• Role of pharmacist
• prescription monitoring, reduction in length of
  hospital stays,
• incidence of adverse drug reactions
• total cost.