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Renal Function in Elderly Long-Term Care Home Residents

Renal Function in Elderly Long-Term Care Home Residents. Summary of Recent Literature 2011 Dr. Alexandra Papaioannou. Piloting a Renal Drug Alert System for Prescribing to Residents in LTC 1.

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Renal Function in Elderly Long-Term Care Home Residents

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  1. Renal Function in Elderly Long-Term Care Home Residents Summary of Recent Literature 2011 Dr. Alexandra Papaioannou

  2. Piloting a Renal Drug Alert System for Prescribing to Residents in LTC1 • Due to age-related declines in kidney function, 40% of LTC residents have some degree of renal impairment.2 • Renally excreted drugs require dose and frequency adjustments • A computerized clinical decision support system (CDSS) is recommended to assist with prescribing • A literature review determined the top renally excreted medications that required frequent dose adjustments. • They were all reviewed by an expert panel • Kennedy CC et al. JAGS 2011 • Garg AX et al. Kidney Int. 2004

  3. Flow-Chart of the Computerized Clinical Decision Support System for Renal Prescribing Kennedy CC et al. JAGS 2011

  4. Study Results • The ALERT computer program conducted an initial review of all medications; new orders were also tracked over a 3 month time-period • 7 LTC homes (Total Residents, N=1196) • Mean age = 87 years (SD= 7.4) • Female = 81% • Mean CrCl = 34.6 mL/min (SD = 12.3) Kennedy CC et al. JAGS 2011

  5. Results • 446 ALERTS were generated in 321 patients • 27% of all LTC residents had at least one ALERT • 30% had 2 or more ALERTS • The pharmacists sent 63% of ALERTS to the physician • The physician responded to 96% of the recommendations • The physician’s response agreed with the pharmacist’s recommendation 80% of the time • 45% of all Alerts were for Digoxin, Ranitidine, Metformin Kennedy CC et al. JAGS 2011

  6. ALL RESIDENTS (7 Homes) n=1196 ALERTS NO ALERTS n=321 (27%) n=875 (73%) 1 ALERT 2 ALERTS 3 ALERTS 4 - 5 ALERTS n=226 (70%) n=73 (23%) n=16 (5%) n=6 (2%) Residents with Renal Prescribing Alerts During a-month Period* *Includes a review of all standing medication orders at baseline and any new orders over 3-months Kennedy CC et al. JAGS 2011

  7. Results Physician Response • Physician responded to 96% of the ALERTS requiring a response by the Pharmacist • The physician’s response agreed with the pharmacist’s recommendation 80% of the time Kennedy CC et al. JAGS 2011

  8. Conclusions • The ALERT system was well accepted by all stake-holders • This system is being implemented with the pharmacy provider across many Ontario LTC homes. • Highrate of acceptance by physicians, WHY? • Clinician feedback was incorporated e.g. how to receive the ALERTS; medications that are most challenging • Existing relationship between pharmacist and physicians • ALERT guidelines were created by Local Opinion Leaders Kennedy CC et al. JAGS 2011

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