Evaluation of Triple Whammy Prescriptions After the Implementation of a Drug Safety Algorithm

Overview

Journal Drugs Real World Outcomes

Date 2024 Jan 6

PMID 38183571

Authors

Hendrike Dahmke

Jana Schelshorn

Rico Fiumefreddo

Philipp Schuetz

Ali Reza Salili

Francisco Cabrera-Diaz

Carla Meyer-Massetti

Claudia Zaugg

Affiliations

Soon will be listed here.

Abstract

Background And Objective: The term triple whammy (TW) refers to the concomitant use of non-steroidal anti-inflammatory drugs, diuretics, and angiotensin system inhibitors; this combination significantly increases the risk of acute kidney injury (AKI). To prevent this serious complication, we developed an electronic algorithm that detects TW prescriptions in patients with additional risk factors such as old age and impaired kidney function. The algorithm alerts a clinical pharmacist who then evaluates and forwards the alert to the prescribing physician.

Methods: We evaluated the performance of this algorithm in a retrospective observational study of clinical data from all adult patients admitted to the Cantonal Hospital of Aarau in Switzerland in 2021. We identified all patients who received a TW prescription, had a TW alert, or developed AKI during TW therapy. Algorithm performance was evaluated by calculating the sensitivity and specificity as a primary endpoint and determining the acceptance rate among clinical pharmacists and physicians as a secondary endpoint.

Results: Among 21,332 hospitalized patients, 290 patients had a TW prescription, of which 12 patients experienced AKI. Overall, 216 patients were detected by the alert algorithm, including 11 of 12 patients with AKI; the algorithm sensitivity is 88.3% with a specificity of 99.7%. Physician acceptance was high (77.7%), but clinical pharmacists were reluctant to forward the alerts to prescribers in some cases.

Conclusion: The TW algorithm is highly sensitive and specific in identifying patients with TW therapy at risk for AKI. The algorithm may help to prevent AKI in TW patients in the future.

Citing Articles

Treatment of chronic kidney disease in older populations.

Kishi S, Kadoya H, Kashihara N Nat Rev Nephrol. 2024; 20(9):586-602.

PMID: 38977884 DOI: 10.1038/s41581-024-00854-w.

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