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1/27/22 jh Updates to make Creatinine Clearance (CrCl) more accessible in Cerner
February 7, 2022
From: "Joseph Ho" <joseph.ho@hhsys.org>
To: "grp allpharm" <grp_allpharm@hhsys.org>
Cc: "Aaron Atkins" <aaron.atkins@hhsys.org>, "Travis Ball" <travis.ball@hhsys.org>, "Brittney Hale" <brittney.shippee@hhsys.org>, "Allison Guyton" <allison.guyton@hhsys.org>, "Patrick Newman" <patrick.newman@hhsys.org>, "Adam Sawyer" <adam.sawyer@hhsys.org>, "Cara Bujanowski" <cara.bujanowski@hhsys.org>, "Gregg Knowles" <gregg.knowles@hhsys.org>, "Katie Varner" <katie.varner@hhsys.org>, "Christopher Squires" <chris.squires@hhsys.org>, "lynsi collins" <lynsi.collins@hhsys.org>, "Michele Durda" <michele.durda@hhsys.org>, "Christopher Strickland" <christopher.strickland@hhsys.org>, "Katie Vandiver" <katie.vandiver@hhsys.org>, "Lauren Whitt" <lauren.whitt@hhsys.org>, "Jonathan Edwards" <jonathan.edwards@hhsys.org>, "april williams" <april.williams@hhsys.org>, "Cassi Gibbs" <cassi.gibbs@hhsys.org>, "amy pope" <amy.pope@hhsys.org>, "David Collette" <david.collette@hhsys.org>
Sent: Thursday, January 27, 2022 1:41:36 PM
Subject: RE: Updates to make Creatinine Clearance (CrCl) more accessible in Cerner
We are pleased to announce significant progress toward standardization of CrCl/eGFR calculations within our system. Below are the standards agreed upon by the CrCl standardization workgroup.
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CrCl standardization: Pediatrics (neonates (term and pre-term), children, adolescents, all ages < 18 years) Bedside Schwartz equation for estimating GFR (2009): Estimated GFR (mL/min/1.73 m2) = [k × height (cm)] / SCr (mg/dL) where k = 0.413
Adults (age ≥ 18 years) Cockcroft-Gault CrCl (mL/min) = [(140 – age) × (weight (kg) × (0.85 if female)] / [72 × SCr (mg/dL)] Weight to use: · If underweight (actual weight < ideal body weight (IBW)), use Actual body weight · If normal weight (actual weight <30% over IBW), use IBW · If overweight/obese (actual weight ≥30% over IBW), use Adjusted Body Weight (AdjBW) where · Ideal body weight (IBW) [Devine equation]: · IBW (kg) male = 50 + [2.3 × (height in inches – 60)] · IBW(kg) female = 45.5 + 2.3 × (height in inches – 60)] · Adjusted body weight (AdjBW): · AdjBW (kg) = IBW (kg) + 0.4 × [Actual Body Weight (kg) – IBW (kg)] SCr to use: · If SCr <0.7, use SCr of 0.7 o For Carboplatin, also cap CrCl at 125 mL/min and use Adjusted body weight if BMI ≥25
Links: SBAR with references, updated Renal Dosing Adjustments policy |
Previously there was inconsistency within Cerner when calculating CrCl:
- In MedManager, Cerner only used Dosing Weight or Ideal Body Weight for CrCl.
o Never used Adjusted Body Weight (may underestimate clearance for obese)
o Never rounded SCr regardless of age (may overestimate clearance for elderly)
- In the Dose Calculator, Cerner always used Adjusted Body weight for CrCl
Starting this Tuesday, February 1st:
- Cerner for both the Dose Calculator and MedManager Demographics:
- For Pediatrics (<18 years), Cerner will default to display eGFR as “Schwartz (Bedside)” and calculate per the new standards.
- For Adults (≥18 years), Cerner will default to display CrCl as “Cockroft-Gault (HHSYS)”. Cerner will use the respective weights (Actual, Ideal, Adjusted) and minimum SCr of 0.7 per the new standards. Clicking on MedManager demographics and swapping between the dropdown options for CrCl will allow you to see which weight Cerner is defaulting to for HHSYS. We also made adjustments so that the CrCl value will be capped at <15 mL/min and >125 mL/min and will be less likely to be displayed as “Out of Range”
- Adult Vancomycin Excel calculator: will display CrCl calc. using the new standards. A message will display when the minimum SCr of 0.7 is being used. (Peds Vanco calculator doesn’t use eGFR/CrCl)
- We are actively working to update Sentri7 to the new standards.
- Lastly, please continue to send over any suggestions for additions to Related Results.
Thanks again to the many people that made these changes possible and please reach out if you have any questions or concerns.
Best,
- Joseph
From: Joseph Ho [mailto:joseph.ho@hhsys.org]
Sent: Monday, November 15, 2021 3:35 PM
To: 'grp_allpharm@hhsys.org'; 'amy pope'; 'cassandra gibbs'
Subject: Updates to make Creatinine Clearance (CrCl) more accessible in Cerner
Hey all,
A number of our pharmacists have been involved in a project to standardize CrCl/eGFR calculation within Cerner and Sentri7, the goal being so CrCl is calculated the same across as many platforms as possible. As part of this project, we recently implemented a rule so that estimated CrCl appears in both Cerner Related Results and under the Pharmacist View flowsheet. You will now be able to see CrCl as a related result for all QRG-identified renally adjusted medications, with the exception of Carboplatin.
No changes have been made to the way Cerner currently calculates CrCl. We plan to distribute more information on how we are standardizing the calculations after P&T approval and future Cerner updates and adjustments are made. Feel free to reach out to me (joseph.ho@hhsys.org) if you have questions about the current, existing behavior.
Also, please let us know (grp_pharmit@hhsys.org) if you have additional suggestions for medications to add CrCl to as a Related Result, and if you encounter any issues with these additions.
Example of CrCl in Pharmacist View from Recent Results
As a Related Result under PowerChart Orders/Medication List/Reconciliation when selecting a medication or when ordering one:
As a Related Result from the orange button in MedManager order detail screen when Verifying, Copying, Modifying, or Inquiring:
Many thanks to you and to everyone that has been helping with this initiative!