Contraindicated medications administered to inpatients with renal insufficiency in a Saudi Arabian hospital that has a computerized clinical decision support system

ABSTRACT

The aim of this study was to determine various types of contraindicated medications that are administered to patients with renal insufficiency by physicians who override alerts provided by the Computerized Decision Support Systems [CDSS]. This retrospective study incorporated all admitted patients during the period from January 1st through December 31st, 2010, with serum creatinine levels >1.7 mg/dL in a major tertiary hospital in the Eastern Province of the Kingdom of Saudi Arabia [KSA]. Chi-square and multivariate logistic regression tests were used to evaluate the factors associated with the increased likelihood of patients receiving contraindicated medication due to physicians overriding the CDSS alert. A total of 314 patients received at least one medication that was renally cleared and/or potentially nephrotoxic. Fourteen percent of these medications were contraindicated and resulted in a system alert and yet were administered to the patients. The administered contraindicated medications were limited to 4 drugs aspirin, gliclazide, nitrofurantoin, and spironolactone, with aspirin accounting for approximately 60% of all of the medications received by patients. Multivariate logistic regression showed that the odds of receiving these four contraindicated drugs increased in those with severe renal insufficiency [OR = 23.4, 95% CI 9.9-54.9, p < 0.001] after adjusting for confounding factors. Physicians override the CDSS alerts and prescribe medications that are contraindicated for patients with renal impairment. These medications are limited in number. This study also emphasizes that the medication database system might need to be updated with input from the physicians using the system