TCH-048 The Security of Pharmacokinetic Information in Electronic Health Records. (12th March 2013)

• Record Type: Journal Article
• Authors: Sendra García, A; Ruiz Millo, O; Fernández Álvarez, M; Moratalla, A; Jimenez Torres, NV; Climente Martí, M
• Is Part Of: European journal of hospital pharmacy. Volume 20(2013)Supplement 1
• Page Start: A85
• Page End: A86
• Publication Date: 2013-03-12
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2013-000276.239
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background: Accurate and complete electronic health record (EHR) information is essential for patient safety, especially when drugs with a narrow therapeutic range are involved. Purpose: To evaluate the quality and quantity of information recorded in EHRs concerning pharmaceutical interventions (PIs) generated by therapeutic drug monitoring (TDM). Materials and Methods: For 6 months, all onco-haematology in-patients were evaluated who were receiving vancomycin (≥3 doses). Renal function (RF) was classified into four categories: severe, moderate and mild renal impairment (RI) and normal RF for creatinine clearance (by Cockcroft-Gault equation) <10, 10–50, 50–90, >90 ml/min, respectively. PIs were classified into three categories of importance (high, moderate and low) according to the pharmacotherapy follow-up and the relation between plasma concentration and optimal therapeutic range. The completeness of EHRs regarding the RF and TDM process (ordering, result and PI-related parameters) was assessed. A binary logistic regression with odds ratio (OR) was performed using SPSS v.15.0. Results: TDM was performed for 39 (81%) of 48 patients receiving vancomycin. The median age was 57 years (95%CI: 52–62); 26 were male (68%); 21(54%) had mild to moderate RI. There were 76 PIs [median 2/patient (IQR: 2)], 51(67%), 4 (5%) and 21 (28%) of high, medium and low importance, respectively; 67(88%) were accepted. The EHRs did not record RF evolution, TDM requests and results or PIs in 53 (70%), 23 (30%), 39 (51%) and 61 (80%) cases respectively. OR for recorded TDM results related to highly important PIs compared to low-importance PIs, for recorded TDM ordering related to moderate RI compared to normal RF and records for RF evolution related to moderate RI compared to normal RF were 3 (95%CI: 1–9; p = 0.046), 0.3(95%CI: 0.8–0.9; p = 0.04) and 4(95%CI: 1–16; p = 0.029), respectively. A significant linear trend was observed. OR for all other variables was non-significant. Conclusions: The low percentage recording of TDM-related variables and pharmacist interventions in EHR potentially limits interprofessional communication and the decision-making process. This fact highlights the need for clinical pharmacists to safeguard the information they have discovered by recording their interventions in the EHR as a clinical episode in comprehensive patient care. This will increase the visibility of the pharmacist and the effect of his/her actions. No conflict of interest.