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Table 3 Detailed characteristics for four pharmacotherapeutic categories for which notes vs. notes plus phone calls were performedc

From: Development and implementation of “Check of Medication Appropriateness” (CMA): advanced pharmacotherapy-related clinical rules to support medication surveillance

 

Electronic note

Electronic note + phone call

Category

Patient’s age in years (mean ± SD)

Top 5 patients’ wards (% of actions)

Top 5 drugs (% of actions)

Patient’s age in years (mean ± SD)

Top 5 patients’ wards (% of actions)

Top 5 drugs (% of actions)

Drug use in renal insufficiency

74 ± 15

1. ED (33%)

2. Nephrology (9%)

3. Vascular sg (8%)

4. Cardiac sg (6%)

5. Pneumology (5%)

1. Enoxaparin (43%)

2. Spironolactone (13%)

3. Metformin (13%)

4. Allopurinol (9%)

5. Vancomycin (5%)

72 ± 15

1. ED (38%)

2. Nephrology (9%)

3. Abdominal Tx (9%)

4. Vascular sg (9%)

5. Cardiac sg (9%)

1. Enoxaparin (48%)

2. Spironolactone (14%)

3. Rivaroxaban (14%)

4. Vancomycin (6%)

5. Tinzaparin (6%)

Drugs with high potential of QTc prolongation

70 ± 16

1. ED (19%)

2. Vascular sg (4%)

3. Hematology Tx (4%)

4. Cardiac sg (4%)

5. Hematology (4%)

1. Levofloxacin (36%)

2. Ondansetron (14%)

3. Fluconazol (12%)

4. Haloperidol (10%)

5. Sotalol (9%)

74 ± 15

1. ED (19%)

2. Cardiology (10%)

3. Geriatrics (6%)

4. Thoracic sg (6%)

5. Internal medicine (5%)

1. Levofloxacin (40%)

2. Fluconazol (12%)

3. Moxifloxacin (12%)

4. Ondansetron (9%)

5. Sotalol (9%)

Drugs with restricted indication or dosing

47 ± 27

1. Pediatric hematology-oncology (13%)

2. Pneumology (11%)

3. ED (9%)

4. Daycare ward pediatrics (4%)

5. Trauma sg (4%)

1. Meropenem high dose (36%)

2. Linezolid indication (17%)

3. Colistin dose (17%)

4. Temocillin indication (14%)

5. Rifampin indication (10%)

50 ± 24

1. Pneumology (16%)

2. ED (10%)

3. Pediatric hematology-oncology (8%)

4. Septic orthopedic sg (4%)

5. Trauma sg (4%)

1. Meropenem high dose (32%)

2. Colistin dose (20%)

3. Linezolid indication (14%)

4. Temocillin indication (14%)

5. Rifampin indication (9%)

Overruled very severe DDIs

70 ± 16

1. Thoracic sg (11%)

2. ED (8%)

3. Trauma sg (5%)

4. Urology (5%)

5. Vascular sg (4%)

1. QTc prolonging drugsd & antiarrhythmic drugs (29%)

2. Factor Xa inhibitors & anticoagulants (15%)

3. Antiarrhythmic drugs & antipsychotics (12%)

4. Antiarrhythmic drugs & non-selective antidepressants (10%)

5. Metformin & contrast agents (5%)

72 ± 14

1. Trauma sg (10%)

2. Vascular sg (8%)

3. ED (8%)

4. Internal medicine (7%)

5. Urology (7%)

1. Factor Xa inhibitors & anticoagulants (37%)

2. QTc prolonging drugsd & antiarrhythmic drugs (17%)

3. Antiarrhythmic drugs & antipsychotics (11%)

4. CYP3A4 substrates & CYP3A4 inhibitors (8%)

5. Antiarrhythmic drugs & non-selective antidepressants (5%)

  1. cSD standard deviation, DDI drug-drug interaction, ED emergency department, sg surgery, Tx transplantation, CYP3A4 cytochrome P450 3A4.
  2. dQTc prolonging drugs: e.g. selective serotonin reuptake inhibitors, anticancer agents (e.g. sodium arsenite, anagrelide, eribulin), anti-emetics (e.g. 5-HT3-antagonists, domperidone), fluconazole, hydroxyzine, indapamide, ivabradine, vardenafil, bedaquilline