Objectives: To assess the risk of medication errors in subjects with renal impairment (defined as an estimated glomerular filtration rate (eGFR)
Design: Clinical survey.
Setting: The city of Zwolle, The Netherlands, in a primary care setting including 22 community pharmacists and 65 general practitioners.
Participants: All adults who underwent ambulatory creatine measurements which triggered an eGFR
Primary and secondary outcome measures: The total number of ambulatory subjects with an eGFR
Results: Creatine measurements were performed in 25 929 adults. An eGFR = 5 drugs) was present. In 15% (n=211) of these subjects, a medication error was detected. The proportion of errors increased with age. Pharmacists recommended 342 medication adjustments, mainly concerning diuretics (22%) and antibiotics (21%). The physicians' acceptance rate was 66%. Of all the medication errors, 88% were regarded as potential ADEs, with most classified as significant or serious. At follow-up, the ADE risk (n=40) appeared highest when the proposed medication adjustments were not implemented (38% vs 6%).
Conclusions: The introduction of automatic eGFR-alerts identified a considerable number of subjects who are at risk for ADEs due to renal impairment in an ambulatory setting. The nationwide implementation of this simple protocol could identify many potential ADEs, thereby substantially reducing iatrogenic complications in subjects with impaired renal function.