Evaluation of a Dose Optimization Tool for Patients with Impaired Renal Function Admitted to Inpatient Wards at Sirindhorn Khon Kaen Hospital

Abstract

Chronic kidney disease is an increasingly common problem among hospitalized patients, and many medications require dose adjustment according to renal function to ensure patient safety. This study aimed to develop a pharmacist-led workflow for caring for inpatients receiving medications requiring renal dose adjustment, and to evaluate outcomes before and after implementing a dose optimization tool at Sirindhorn Khon Kaen Hospital. A quasi-experimental design was used. The study sample consisted of inpatients at Sirindhorn Khon Kaen Hospital, excluding the pediatric and neonatal wards, comprising 690 patients before and 328 patients after tool implementation. The tool consisted of three components: (1) a case-finding report displaying automatically calculated eGFR and CrCl values in the HOSxP system, (2) medication label stickers showing patient eGFR and CrCl alongside the CrCl threshold for dose adjustment, and (3) a renal dose-adjustment handbook for adult patients at Sirindhorn Hospital. Appropriateness of drug dosing before and after tool implementation was analyzed using the Chi-square test or Fisher's exact test, and patient characteristics were analyzed using descriptive statistics, including frequency, percentage, mean, and standard deviation.

Of the total instances in which patients received medications requiring renal dose adjustment, 1,013 instances occurred before tool implementation and 616 instances occurred after. The proportion of appropriately dosed instances increased significantly, from 68.41% to 80.36% (p < 0.001). Physicians accepted pharmacists' dose-adjustment recommendations in 48.48% of cases, and users reported overall satisfaction with the workflow and tool at the highest level (mean score 4.50 out of 5). In conclusion, the developed tool and pharmacist-led workflow effectively improved the appropriateness of drug dosing in patients with impaired renal function, supported a proactive pharmacist role, and helped enhance medication safety for hospitalized patients.