Transcript Hip Protectors in Long

Summary of Recent Literature
2011
Dr. Alexandra Papaioannou
Piloting a Renal Drug Alert System for
Prescribing to Residents in LTC1
 Due to age-related declines in kidney function, 40% of
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1.
2.
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
Flow-Chart of the Computerized Clinical Decision Support System for
Renal Prescribing
Long-Term Care Home (annually) sends data
(serum creatinine, age, weight)
Computer Medication Review*
(Target list of 25 medications)
Alerts Generated at Pharmacy†
Kennedy CC et al. JAGS 2011
Yes
On-duty Pharmacist reviews and
contacts Physician immediately
Time
Sensitive?
No
Placed in Consultant Pharmacist
mailbox
Consultant Pharmacist reviews Alert
and Patient Chart (at facility)
Responses to recommendations
tracked by Consultant Pharmacist
Writes recommendation for Physician
(& attaches Alert)
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 amonth Period*
ALL RESIDENTS
(7 Homes)
n=1196
ALERTS
n=321 (27%)
1 ALERT
n=226 (70%)
2 ALERTS
n=73 (23%)
NO ALERTS
n=875 (73%)
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