Dahmke, Hendrike; Schelshorn, Jana; Fiumefreddo, Rico; Schuetz, Philipp; Salili, Ali Reza; Cabrera-Diaz, Francisco; Meyer-Massetti, Carla; Zaugg, Claudia (2024). Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm. Drugs - real world outcomes, 11(1), pp. 125-135. Springer 10.1007/s40801-023-00405-y
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BACKGROUND AND OBJECTIVE
The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician.
METHODS
We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint.
RESULTS
Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases.
CONCLUSION
The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM) 04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine |
UniBE Contributor: |
Schelshorn, Jana Sophie, Meyer-Massetti, Carla Verena |
Subjects: |
300 Social sciences, sociology & anthropology > 360 Social problems & social services 600 Technology > 610 Medicine & health |
ISSN: |
2199-1154 |
Publisher: |
Springer |
Funders: |
[253] Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA) |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
08 Jan 2024 09:27 |
Last Modified: |
02 Apr 2024 15:33 |
Publisher DOI: |
10.1007/s40801-023-00405-y |
PubMed ID: |
38183571 |
Additional Information: |
Dahmke and Schelshorn contributed equally to this work. |
BORIS DOI: |
10.48350/191333 |
URI: |
https://boris.unibe.ch/id/eprint/191333 |
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