Using serum creatinine concentrations to screen for inappropriate dosage of renally eliminated drugs

J. P. Peterson, V. J. Colucci, S. E. Schiff

Research output: Contribution to journalArticlepeer-review

32 Scopus citations


The impact on drug therapy and costs of a program to identify and correct unadjusted dosage in renally impaired patients is described. The program was instituted in May 1988 by the clinical pharmacy staff at a 272-bed hospital. Each day the clinical pharmacist uses laboratory data to list patients with serum creatinine concentrations greater than 1.5 mg/dL. The pharmacist screens the pharmacy profiles of listed patients and calculates creatinine clearance for patients receiving renally eliminated drugs. If, after reviewing the patient's medical record, the pharmacist judges that a dosage adjustment may be appropriate, he writes a confidential note to the physician. From May 1988 through June 1989, 2341 patients with elevated serum creatinine were monitored. During that period, 162 notes were left; recommendations from 142 (88%) of the notes were accepted by physicians. Most of the notes were written for patients receiving antimicrobials or histamine H2-receptor antagonists. The program, which requires 20-30 minutes of pharmacist time per day, avoided $5003 in drug acquisition costs and cost $2700 to administer during the one-year period. When the costs associated with drug preparation and administration are considered, net cost avoidance was $5040. An intervention program in which notes to physicians are written when patients with abnormal serum creatinine values are receiving drugs for which a dosage adjustment appears indicated (1) has medical staff acceptance, (2) helps to satisfy standards of the Joint Commission on Accreditation of Healthcare Organizations, and (3) saves money.

Original languageEnglish
Pages (from-to)1962-1964
Number of pages3
JournalAmerican Journal of Hospital Pharmacy
Issue number9
StatePublished - 1991


  • Administration
  • Clinical pharmacists
  • Costs
  • Creatinine
  • Dosage
  • Economics
  • Joint Commission on Accreditation of Healthcare Organizations
  • Kidney failure
  • Pharmaceutical services
  • Pharmacy, institutional, hospital
  • Physicians
  • Standards


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