A web-based system for determining drug dosing levels in kidney impairment

Abstract

University Hospital Galway, Ireland (UHG) uses a hybrid system to maintain patient records. Some wards have an electronic health record (EHR), while others are still dependent on paper records. The continued use of paper records represents a significant risk in relation to prescribing and managing certain drugs, as calculating the correct dosage involves error prone, multistep, algebraic calculations. This is a greater risk for patients more susceptible to drug toxicity such as premature babies, children and adults with kidney or cancer disease. Although drug dosage calculations have been automated for some time, the software solutions do not necessarily comply with local hospital guidelines, which undergo constant change. They are often stand-alone calculators that do not provide any additional feedback to clinicians. The quality of such calculators varies widely and transparency of the validation process is close to non-existent. In addition, changes in regulatory advice and the introduction of new drugs dictate that these systems must be constantly updated. This research is the result of a collaborative project with UHG and an effort to address the above issues. It involved a number of important UHG stakeholders, mainly the lead clinical pharmacist and members of the antimicrobial management team. This research resulted in the development of a tool that allows a trained clinical pharmacist to define and validate complex drug dosage regimes. These are then available to clinicians for drug dosage calculations, via a range of platforms such as a mobile phone or desktop PC. The system can be populated by a trained clinical pharmacist without requiring any changes in coding. The software can also report the data to doctors on their ward rounds, so that at-risk patients may be easily identified.