364 Artificial Turf Versus Grass in NCAA Football: Increased Knee Injuries Traded for Cost Savings to Schools

Abstract

Study Objectives: Elderly patients represent a population at elevated risk for adverse drug events due not only to polypharmacy, but also to physiological changes that decrease metabolism and clearance of individual drugs. This risk is especially pronounced with regard to renally-cleared medications. Studies suggest emergency physicians inappropriately dose 24-46% of renally-cleared prescriptions, often requiring guidance from automated decision support tools or in-department pharmacists to adjust dosages appropriately. The purpose of this study was to analyze our prescribing patterns in an elderly emergency department (ED) population and to determine our accuracy in adjustment for renal impairment.Methods: This is a retrospective observational study conducted at 2 tertiary care EDs between April 15, 2017 -April 30, 2018. Inclusion criteria included all patients age 65 years or older who were discharged with a new prescription. Each new medication counted as one encounter. We sought to determine how many new discharge medications required adjustment for renal function. We then looked at a subset of anti-infective medications (oseltamivir, sulfamethoxazole-trimethoprim, and nitrofurantoin) to determine if ED physicians appropriately adjusted the medication dosage for renal function. Age, weight, serum creatinine and sex were used to calculate the estimated creatinine clearance (CrCl) in milliliters/minute (mL/min). Patients were excluded from final analysis if data was incomplete.Results: During the study period, there were 6674 prescriptions dispensed upon ED discharge, 1256 (19%) of these were for medications in which dosing for renal impairment is recommended. Among these, the majority were anti-infectives (920, 73.2%). The next most common were analgesics (152, 12.1%), anti-hypertensives (104, 8.2%), and anticoagulants (81, 6.4%). For the subset analysis, oseltamivir was dispensed 85 times. 25 prescriptions were given to patients with a CrCl > 30 to 60mL/min. 11/25 (44%) of these prescriptions were not adjusted for renal function. In all cases, the standard treatment dose was prescribed for those with normal CrCl. There were 3 prescriptions given to patients with a CrCl > 10 to 30 mL/min. All 3 prescriptions were appropriately adjusted for CrCl. Sulfamethoxazole-trimethoprim (800-160mg or 400-80mg) was dispensed 148 times. 13 prescriptions were given to patients with a CrCl 15-30ml/min. In 7/13 cases (54%), the dose was not adjusted for renal function. Only one prescription was inappropriately given to a patient with CrCl < 15 mL/min. Nitrofurantoin was prescribed 36 times; only on 1 occasion inappropriately to a patient with a CrCl < 30 mL/min.Conclusions: Medications that necessitate adjustment for renal impairment are commonly prescribed to geriatric patients upon discharge. In our subset analysis, nearly half the prescriptions dispensed to patients with a CrCl < 30mL/min were not appropriately adjusted for renal impairment. Ongoing ED physician education and further endeavors to improve medication safety i...