Summary of Recent Literature 2011 Dr. Alexandra Papaioannou

Piloting a Renal Drug Alert System for Prescribing to Residents in LTC 1 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 1.Kennedy CC et al. JAGS Garg AX et al. Kidney Int. 2004

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

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

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

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

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

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. High rate 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