Assessment of adherence to renal dosing guidelines in long-term care facilities.
OBJECTIVE
We determined whether dosing guidelines based on creatinine clearance (Ccr) for renally excreted drugs are being applied when prescribing to long-term care residents


METHODS
A cross sectional chart review for the month of May 1999.


METHODS
Long-term care residents more than 65 years of age from four long-term care facilities in Southern Ontario who were prescribed a medication from a list of renally excreted drugs commonly prescribed in long-term care facilities.


RESULTS
Approximately one in three prescriptions (34.1%) were considered inappropriate for the calculated Ccr of the residents. Overall, 42.3% of the residents who were prescribed a drug under review received at least one inappropriate prescription based on creatinine clearance. Logistic regression found that age (odds ratio (OR) = 1.06 per year; 95% confidence interval (CI) 1.03-1.09, P = .001), weight (OR = 0.96 per kg; 95% CI 0.94-0.98, P < .001), the total number of prescribed medications (OR = 1.10; 95% CI 1.04-1.17, P = .001), and the number of physicians prescribing in the facility (OR 1.02; 95% CI, 1.003-1.044, P = .03) were predictive for receiving an inappropriate prescription based on Ccr.


CONCLUSIONS
Renal function is often overlooked when prescribing renally excreted drugs to older long-term care residents. These findings emphasize the need for consideration of Ccr when prescribing such drugs in this population.
Papaioannou
A
A
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Clarke
J A
JA
Campbell
G
G
Bédard
M
M
D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000652:urine*; D003430:Cross-Sectional Studies; D017723:Drug Utilization Review; D005260:Female; D017408:Guidelines as Topic; D006707:Homes for the Aged; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000378:metabolism*; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D009864:Ontario; D004364:Pharmaceutical Preparations / Q000652:urine*
D004364:Pharmaceutical Preparations; D003404:Creatinine