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Reducing Preventable Medication Safety Events by Recognizing Renal Risk

FIELDS, WILLA DNSc, RN; TEDESCHI, CHRISTINE MS, RN; FOLTZ, JUSTINE BA, RN; MYERS, TERRY BSN, RN; HEANEY, KAREN RN; BOSAK, KELLY PhD, APRN; RIZOS, ALBERT PharmD; SNYDER, RITA PhD, RN

doi: 10.1097/01.NUR.0000311795.69476.2f
Continuing Education: CE Feature Article

Evidence suggests that medication safety may be improved through more accurate assessment of renal function and appropriate dosing of renally cleared medications. The purpose of this article is to describe patient renal risk groups, associated medication errors, and ways that nurses can improve renal assessment.

Methods: Medication safety data were collected through voluntary reporting, computerized triggers, pharmacist surveillance, and retrospective chart review. Data were analyzed across 3 renal risk groups.

Results: Findings indicated that regarding the detected medication errors, elderly women were more likely to have hidden renal risk and that prescribing errors involving a wrong dose occurred more often in patients with high and hidden renal risk. Antibiotic and diabetic medications were the primary drug categories involved in these medication errors.

Recommendations: Results indicated that identification of patients with hidden renal risk can be improved by routinely assessing serum creatinine and estimated creatinine clearance levels during renal assessments. Clinical nurse specialists can use this evidence to promote safer nursing care of renal patients.

Author Affiliations: School of Nursing, San Diego State University, California (Dr Fields); Sharp HealthCare, San Diego, California (Ms Tedeschi); Sharp Memorial Hospital, San Diego, California (Ms Foltz); Sharp HealthCare, San Diego, California (Ms Myers); Sharp Chula Vista Medical Center, Chula Vista, California (Ms Heaney); College of Nursing, University of Nebraska Medical Center, Omaha (Dr Bosak); Sharp HealthCare, San Diego, California (Dr Rizos); and College of Nursing, University of Nebraska Medical Center, Omaha (Dr Snyder).

This research was supported by Agency Healthcare Research and Quality grant RO1 HSO013131.

This research was supported by Agency for Healthcare Research and Quality grant RO1 HSO013131

Corresponding author: Willa Fields, DNSc, RN, School of Nursing, San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4158 (Willa.fields@sbcglobal.net).

© 2008 Lippincott Williams & Wilkins, Inc.