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Inpatient Z-drug use commonly exceeds safe dosing recommendations.

ABSTRACT: In 2016 recommendations for safer prescribing practices were circulated to all doctors in one of Canada's largest provinces, by the college of physicians, following a coroner's inquest into a vehicular death related to Z-drug use. We sought to determine how frequently Z-drug prescriptions in our institution were not adhering to these recommendations.Retrospective cohort study.McGill University Health Centre, an 832-bed tertiary care institution in Montréal, Canada.All adult non-obstetrical patients admitted between April 1, 2015 and March 31, 2016.The receipt of at least one dose of Z-drug as determined by pharmacy records.Adherence to four recommendations related to starting dose, maximal dose, concomitant drug administration, and duration of use were evaluated.1,409 unique patients received a Z-drug during 1,783 admissions representing use in 9.3% of non-obstetrical patients. Standing orders were seen in 42% (745/1783) of admissions. Non-conformity with the coroner's recommendations was common. Overall, 672/1783 (38%) admissions involved a patient receiving more than the recommended daily maximum dose (643/999 older patients, 64%). Of 607 admissions which were longer than 10 days, 257 (39%) involved a prescription which exceeded 10 days.A coroner's recommendation that doctors receive instructions about safe Z-drug prescribing is unprecedented, and was likely required given that use of Z-drugs occurs at doses and durations that often exceed best practice recommendations. Similar interventions may be required in other jurisdictions.

SUBMITTER: Lee TC

PROVIDER: S-EPMC5453707 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Inpatient Z-drug use commonly exceeds safe dosing recommendations.

Lee Todd C TC Bonnici André A Tamblyn Robyn R McDonald Emily G EG

PloS one 20170516 5

<h4>Importance</h4>In 2016 recommendations for safer prescribing practices were circulated to all doctors in one of Canada's largest provinces, by the college of physicians, following a coroner's inquest into a vehicular death related to Z-drug use. We sought to determine how frequently Z-drug prescriptions in our institution were not adhering to these recommendations.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>McGill University Health Centre, an 832-bed tertiary care institution i ...[more]

PMID: 28520804

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Project description:BackgroundDrug therapy in pediatric patients is a complex process. Children are subject to continuous growth and variation in drug-metabolizing enzyme activity, requiring continuous adaption of dosages. In Germany, currently no publicly available database exists that provides evidence-based information on drug dosages in pediatrics. For local drug dosing support, a prototype database has been developed within the Children's Hospital, Erlangen. A user-centered development process was initiated to establish an online platform for evidence-based dosing recommendations, as well as pharmacological and pharmaceutical drug information in pediatrics.ObjectivesThe objectives of the study were to survey the demand for such a platform and to assess the usability of the different versions of the developed system.MethodsThe developed prototype was evaluated in a pluralistic walkthrough with prospective end users. After a redesign, the second prototype of the online platform underwent an online usability testing based on a tailored questionnaire and the System Usability Scale (SUS) (n = 12).ResultsEleven of 12 participants expressed a demand for an online platform for pediatric dosing recommendations. The majority of the participants requested the integration of extended features, such as drug-drug interaction alerts, or information on adverse effects, pharmacokinetics, and pharmacodynamics. Particularly noteworthy is the demand for an online calculator; 5 of a total of 15 participants explicitly requested a calculator for dosages (based on age, weight, body surface) and glomerular filtration rate. The usability of the second prototype was rated "good to excellent" with a median SUS of 81.25.ConclusionLocal domain experts demand an online platform for pediatric dosing recommendations. The application of the user-centered design approach enabled the development of a prototype suitable for practical use. Multiple additional required functionalities have been identified, whereby the importance of an online calculator for patient-individual dosing recommendations was particularly emphasized.

Dataset Information

Inpatient Z-drug use commonly exceeds safe dosing recommendations.

Publications

Inpatient Z-drug use commonly exceeds safe dosing recommendations.

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