Knowledge and attitudes of healthcare professionals on prescribing errors

Objectives This study aimed to evaluate the knowledge and attitudes of healthcare professionals on prescribing errors. Methods This was a cross-sectional study employing a questionnaire that consisted of 12 items on knowledge and 10 items on healthcare professionals’ attitudes toward errors in prescribing process. The participants responded to the questionnaire with a 5-Likert scale of agreement. The domains assessed in the questionnaire were respondents’ knowledge and attitudes on prescribing errors, professionals responsible for the errors, and professionals’ competence on drug dose adjustment. Additionally, the questionnaire had two case scenarios to further assess the healthcare professionals’ knowledge of prescribing errors. There were 300 questionnaires administered to physicians, nurses, and pharmacists who attended conferences in Denpasar from July to October 2019. Results There were 30 physicians, 58 nurses, and 69 pharmacists who responded to the survey. A response rate of 52.3% (157/300) was obtained. All healthcare professionals agreed that errors may occur in prescribing, dispensing, and administration process. All healthcare professionals understood that physician is responsible for ensuring drug safety in prescribing process and also supported a standardized form on drugs which may need drug dose personalization. Concerning item on the importance of collaboration in drug dose adjustment, although the healthcare professionals agreed on the statement, they had significant differences on the level agreement on the statement (p=0.029). The healthcare professionals also supported having regular training on drug dose adjustment based on individual patients’ regimentation. The healthcare professionals’ responses showed that the significant differences found on the statement of healthcare professionals should have competency on personalized dose calculation (p<0.001). All healthcare professionals agreed that physicians should have competency on drug dose adjustment, yet physicians showed less agreement that other health professionals should have the competency. Conclusions All healthcare professionals understood that medication errors may occur during the prescribing process but showed different attitudes on professionals who had competence in drug dose calculation. They emphasize the need to have a standardized prescription format for medication with dose changes. The respondents also recommend having regular training on medication safety for healthcare professionals.

Accuracy of freely available online GFR calculators using the CKD-EPI equation

Purpose Estimated glomerular filtration rate (eGFR) as calculated by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is used for detection of chronic kidney disease and drug dose adjustment. The purpose of the present study was to investigate the accuracy of freely available eGFR online calculators. Methods All identified CKD-EPI online calculators were run with five reference cases differing in age, sex, serum creatinine, and ethnicity. Conversion from eGFRindexed (unit ml/min per 1.73 m2) to eGFRnon-indexed (unit ml/min) and creatinine unit from milligramme/decilitre to micromole/litre was checked, if available. Results Only 36 of 47 calculators (76.6%) produced accurate eGFR results for all reference cases. Eight of 47 (17.0%) calculators were considered as faulty because of errors relating to ethnicity (4 calculators), to conversion of the eGFR unit (2 calculators), to erroneous eGFR values without obvious explanation (2 calculators), to conversion of the creatinine unit (1 calculator), and to an error in the eGFR unit displayed (1 calculator). Overall, 28 errors were found (range 59 to 147% of the correct eGFR value), the majority concerning calculation of eGFRindexed and the conversion to eGFRnon-indexed. Only 7 of 47 (14.9%) calculators offered conversion of the eGFR unit. Conclusions Erroneous calculations that might lead to inappropriate clinical decision-making were found in 8 of 47 calculators. Thus, online calculators should be evaluated more thoroughly after implementation. Conversion of eGFR units that might be needed for drug dose adjustments should be implemented more often.

Position statement from the Brazilian Society of Nephrology regarding chloroquine and hydroxychloroquine drug dose adjustment according to renal function

ABSTRACT Chloroquine and hydroxychloroquine have shown promising preliminary results and have been discussed as therapeutic options for patients with Covid-19. Despite the lack of robust evidence demonstrating the benefits and justifying the use of one of these drugs, the final decision is the responsibility of the attending physician and should be individualized and shared, whenever possible. This position statement recommends dosage adjustment for these drugs in the context of renal impairment.