Prevalence and factors associated with medication errors in patients with chronic kidney disease at Moi Teaching and Referral Hospital

Gatutha, Rhoda Marion Mutundu

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dc.contributor.author	Gatutha, Rhoda Marion Mutundu
dc.date.accessioned	2021-12-07T06:52:17Z
dc.date.available	2021-12-07T06:52:17Z
dc.date.issued	2021
dc.identifier.uri	http://ir.mu.ac.ke:8080/jspui/handle/123456789/5563
dc.description.sponsorship	Background: Medication errors (MEs) refer to preventable events that may cause inappropriate medication use or patient harm. MEs are a global patient safety issue that cause morbidity, mortality and increase health care costs. A study in Kenya had a 100% prevalence of MEs in Chronic Kidney Disease (CKD) patients (Njeri et al., 2018). CKD is a complex illness requiring frequent contact with various prescribers and several medications which predispose patients to MEs. To avoid medication errors in CKD patients, medication should be prescribed based on estimated glomerular filtration rate (eGFR) and evidence-based recommendation. UpToDate® and Micromedex® are evidence based online medical and drug references which are accepted and used widely by health care professionals. Objectives: The study determined the prevalence and factors associated with medication over dosage, under dosage, and inappropriate medication based on GFR, concomitant comorbidities and potential drug-drug interactions (DDI) in adult CKD patients at Moi Teaching and Referral Hospital (MTRH). Methods: A cross-sectional census study was carried on 132 eligible adult patients with CKD stage 3 to 5 for six months. MEs were determined based on Kidney Disease Improving Global Outcomes (KDIGO) guidelines, UpToDate® and Micromedex. Statistical software STATA version 13 SE was used to analyze the data collected on MEs. Association between MEs and demographic, clinical as well as medication variables was assessed using logistic regression models. Odds ratios and the corresponding 95% confidence intervals were reported and P-values < 0.05 considered statistically significant. Results: The median age was 53.5 (IQR: 39.0, 65.0) years and 55.3% of the population were males. There were 94 (71.2%) patients in CKD stage 5; hypertension was the most common comorbidity at 72.7% and 63.6% of the patients had more than five medications at the time data was collected. Prevalence of MEs included: over dosage 47 (35.6%), under dosage 36 (27.3%), inappropriate medication combination with major DDIs 19 (14.4%) and inappropriate medication prescription 16 (12.1%). Multivariate logistic regression showed that being on more than 5 medications (adjusted odds ratio (AOR)=2.93; 95% confidence interval (CI):1.28-6.71) and hematinic drugs (AOR=2.58; 95% CI: 1.06- 6.28) were independently associated with a higher probability of medication dosage errors. CKD stage 5 (AOR=5.26; 95% CI:1.70-16.29), being on an anti-infective (AOR=4.93; 95% CI:1.29-18.81) and hematinic drugs (AOR= 2.85; 95% CI:1.28-9.54) were independently associated with a higher probability of inappropriate medication. Conclusions: Medication dosing errors and inappropriate medication were prevalent in CKD adult patients at MTRH. There was higher prevalence of medication dosing errors as compared to inappropriate medication errors. Polypharmacy, hematinic, anti-infectives and severity of CKD were associated with medication errors in general. Recommendations: To prevent MEs in CKD patients, prescribers should; ensure appropriate medication and dosage prescription by estimation of eGFR, routinely use evidence-based reference tools such as UpToDate in prescribing medication and observe caution when prescribing to patients with more severe CKD, more than five medications, hematinics and anti-infective agents.	en_US
dc.language.iso	en	en_US
dc.publisher	Moi University	en_US
dc.subject	Prevalence	en_US
dc.subject	Medication errors	en_US
dc.subject	Chronic kidney disease	en_US
dc.subject	Polypharmacy	en_US
dc.title	Prevalence and factors associated with medication errors in patients with chronic kidney disease at Moi Teaching and Referral Hospital	en_US
dc.type	Thesis	en_US