AIMS
This project aims to understand the risks linked to medicine doses for hospital patients whose kidneys are not working properly. Researchers will look at how often prescribed doses do not match recommended guidelines, which medicines are most often involved, and what happens to patients. The findings will help the team develop and test a computer tool to flag doses that may need review. Any benefits for patient safety would depend on further development and testing before the tool could be considered for use in patient care.
The project will:
- Look at how medicines are prescribed for patients with kidney problems.
- Check whether prescribed doses follow recommended guidelines for how well a patient’s kidneys are working.
- Find out which medicines most often have doses that do not match these guidelines and explore the risks linked to these doses.
- Develop and test a computer tool to flag potentially incorrect doses for healthcare staff to review.
BACKGROUND
The kidneys remove waste products and many medicines from the body. If the kidneys are not working properly, some medicines can build up in the body and cause harm. Healthcare staff may need to change the dose to keep treatment safe.
Kidney problems are common. Around three million people in England are estimated to have chronic kidney disease, a long-term condition in which the kidneys do not work as well as they should. Around one in five hospital admissions involves acute kidney injury, when kidney function gets worse over a short time.
Choosing the right medicine dose can be difficult, especially in busy hospital departments where patients need urgent care. Studies suggest that, when patients first come into hospital, fewer than half of medicines that need a dose change are correctly adjusted. Kidney function can also change quickly during illness, so doses may need to be checked and changed regularly.
Computer tools can flag information for healthcare staff to review while caring for patients. These are known as clinical decision support tools. In this project, researchers will explore how a tool could flag potentially incorrect medicine doses for patients with kidney problems. Developing and testing an early version will help the team understand how it might support staff in the future; it will not establish whether the tool makes patient care safer.
THE RESEARCH
Researchers will use information already collected during routine healthcare to study prescribing for patients with kidney problems. They will compare prescribed doses with recommended guidelines and explore the risks linked to doses that do not match those guidelines.
The study will look at:
- How well patients’ kidneys are working and how this changes during their hospital stay.
- Which medicines patients are prescribed and whether the doses are adjusted when needed.
- Which medicines most often have doses that do not match recommended guidelines.
- What happens to patients, including whether their kidney function gets worse, whether they have side effects, how long they stay in hospital and whether they survive.
The team will use the findings to design an early version of a computer tool to flag potentially incorrect doses for healthcare staff to review. The tool will be tested in a simulated setting, not used to guide care for real patients as part of this project. Healthcare staff and patients will review the early designs. Further development and testing would be needed before the tool could be considered for use in patient care or its effect on patient safety could be assessed.
PATIENT AND PUBLIC INVOLVEMENT
People with kidney disease and people receiving urgent hospital care have helped shape this project from an early stage. Many were concerned about medicine-related risks and supported research into computer tools that could help healthcare staff identify doses needing review.
Patient groups will continue to work with the research team throughout the project. They will help review the findings, develop materials that explain how these computer tools work, and give feedback on early designs.
APPROVAL
All members of the PIONEER Data Trust Committee supported this project.
The project is led by Dr Tanya Pankhurst, a consultant kidney specialist and Director of Digital Health at University Hospitals Birmingham NHS Foundation Trust.
