Abstract
Background
Angiotensin converting enzyme (ACE) inhibitors reduce mortality and morbidity in heart failure, post-myocardial infarction and in those at high cardiovascular risk. However, recognised adverse effects contribute to hospital admissions.
Aim
To determine the feasibility of pharmacists collecting clinical data for ACE inhibitor prescribing and to inform the development of a hospital prescribing indicator set to measure the quality of monitoring for ACE inhibitors.
Method
A paper-based survey was conducted over 8 weeks. All patients admitted to a medical ward who were admitted on or started on ACE inhibitors were included. Data were collected prospectively and included serum creatinine, urea and potassium, and blood pressure measurements. These data were reviewed and compared against the parameter set for the indicator prepared.
Results
29 patients were included in the analysis and cilazapril was most frequently prescribed (17, 57%). Blood pressure was recorded less frequently in new patients (7.7 vs 17.8). Creatinine was above normal on 47 (52%) occasions and 13 patients had an elevated level on at least one occasion. Creatinine was measured on average 3.1 times during the admission. Urea was measured for 15 (52%) patients, not measured for 14 patients and was measured for only one patient before prescribing an ACE inhibitor for the first time. Potassium was checked less frequently in new patients (average 2.5 vs 3.6 times per admission).
Conclusion
This study confirmed that it is possible for pharmacists to collect and collate clinical and prescribing data as part of a routine monitoring program for inclusion in a hospital prescribing indicator set. Data can be collected, analysed and reported back to clinical teams in a short time. The results suggest that inpatients receiving ACE inhibitors are adequately monitored for adverse biochemical effects.