Development of renal dosing system in hospitalized patients with Renal Impairment at Wapipathum Hospital, Mahasarakham Province

Abstract

Objective : This study aimed to develop a more effective renal dosing system in hospitalized patients with Renal Impairment at Wapipathum Hospital and to evaluate its outcomes.

Methods : This action research utilized a PAOR cycle, conducted in four rounds from January 2022 to December 2023. The sample consisted of: 1) 20 individuals involved in system development, 2) 764 inpatients with an eGFR < 60 mL/min/1.73 m² receiving medications requiring dose adjustments, and 3) 30 users of the developed system. Data were collected using observation forms, focus group recordings form, case record form, and satisfaction surveys. Quantitative data were analyzed using descriptive statistics, independent sample
t-test, and Chi-square tests, while qualitative data were analyzed using content analysis.

Result : The developed system included: 1) practitioners having correct knowledge and understanding, 2) standardizing dosage guidelines, 3) automatic display of CrCl values,
4) renaming medications for clarity, 5) showing renal function at all points, 6) providing dosage information in HOSxP, and 7) regular monitoring of renal function for nephrotoxic drugs. The implementation led to a significant increase in appropriately dosed medications from 43.04% to 90.23% (P<0.01). Adverse drug events decreased from 3 cases to none, and the cost of wasted medications was reduced from 291,340.00 THB to 31,868.50 THB. User satisfaction with the system was high.

Conclusion : The developed system significantly improved the appropriateness of medication dosing within the context of Wapipathum Hospital, demonstrating its effectiveness in managing medications for patients with renal impairment.