Appropriateness evaluation
Appropriateness of prescriptions was assessed by a multidisciplinary
committee; a consultant nephrologist, a consultant cardiologist, and a
senior clinical pharmacist. The main investigator (DAN) arranged three
online meetings (April 5-20, 2020) using Zoom©Software, 2 hours for each one with the experts to discuss the
appropriateness of prescriptions. Their purpose was to judge the
prescription appropriateness of QTcP-inducing drugs among the included
patients. They reviewed all prescriptions and clinical information
(Prescribed medications’ name, dosage, frequency, route of
administration, diagnosis, lab results and clinical history of patients)
provided by the investigator against the British National Formulary
(BNF), version 79, and Wilcock et al., guideline for prescribing drugs
in ESRD (34). The committee divided the prescriptions to two major
categories; 1) appropriate decision which was subcategorised to
completely appropriate (Correct decision with correct choice of drug and
correct application), inappropriate choice (the drug is needed, but can
be replaced with a safer one), and incorrect application (correct
decision and choice, but incorrect dose, frequency, or route of
administration), and 2) inappropriate decision (the drug is not needed).
Prescriptions with insufficient clinical information were dropped.To
ensure the reliability of this approach, the Kappa statistic was used to
test interrater reliability of the committee members. Value of kappa
Below 0.5 was considered as bad reliability, above 0.5 and below 0.7
moderate reliability, Above 0.7 good, and above 0.8 great reliability
(35).