The Use of Renally-Dosed Medications on Beers List in Elderly Living in a SNF
Poster Winner - 3rd Place
by Meline Toutikian, Pharm.D. Candidate 1,2, Mariam Khachatryan, Pharm.D.1,2, Robert Shmaeff, RPh2,Rick Smith, MD2, Janice Hoffman, Pharm.D., CGP, FASCP1

Background: In long-term care facilities, there is often inappropriate dosing of renally-dosed medications (Sönnerstam, 2017). The Beers Criteria highlights potentially dangerous medications that require reduced dosing in renal impairment to reduce the risk of toxicities. The goal of this project was to identify residents on renally-dosed medications with doses higher than recommended in the elderly living within a Skilled Nursing Facility (SNF) and raise awareness to prescribers. Secondary outcomes include whether a dose reduction was attempted and whether medications were discontinued.

Methods: A retrospective cohort at a 239-bed SNF was performed, and investigated medications listed on Beers Criteria requiring renal dosing in patients 65 years of age and older, from January to December 2016. Data was collected regarding pharmacist recommendations and any dose reductions or discontinuations by the prescriber. Results were analyzed using descriptive statistics including chi-squared test. IRB approval with exempt status was granted for this study.

Results: The primary outcome resulted in 60.7% (65/107) residents needing dose reductions due to renal impairment. From this group, 50.8% of residents had an actual dose-reduction or a discontinuation medication order. Drug class groups cardiovascular/hemostasis, central nervous system (CNS)/analgesics, and gastrointestional (GI) agent recommendations and acceptances showed no statistical significance (p>0.05). Chi-squared tests between drug class groups cardiovascular/hemostasis and CNS/analgesics (OR 1.049; 95% CI 0.32 to 3.27) CNS/analgesics and GI agents (OR 0.82; 95% CI 0.30 to 2.17), and cardiovascular/hemostasis and GI agents (OR 0.86; 95% CI 0.26 to 2.66) indicated no statistically significant outcomes.

Conclusions: In this study, we found that the majority of participants needed renal dose reduction. No statistical significance (p>0.05) was found between the different drug classes regarding the two outcomes: pharmacist recommendations and discontinuation of medications. The lack of compliance to Beers Criteria recommendations suggests that prescribers and pharmacists must pay closer attention to renal dose requirements. Further studies may  look at a more diverse population and include common renally-dosed medications and not just from the Beers Criteria alone.

1. Western University of Health Sciences, College of Pharmacy, Pomona, CA
2. Los Angeles Jewish Home for the Aging (LAJHA), Reseda, CA