Assessment of Adherence to Renal Dosing Guidelines in Long‐Term Care Facilities
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OBJECTIVE: We determined whether dosing guidelines based on creatinine clearance (Ccr) for renally excreted drugs are being applied when prescribing to long‐term care residentsDESIGN: A cross sectional chart review for the month of May 1999.PARTICIPANTS: 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.
