Impact of the inclusion of creatinine clearance on antibiotic order forms in a long-term care facility

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PURPOSE: Decreasing kidney function is a common occurrence with advancing age, and many medications require dose adjustments based on renal function (serum creatinine or creatinine clearance [ClCr]). This presents a challenge when dosing antibiotics in elderly patients, as it is critical to clear infections while avoiding an increased risk of side effects. Additionally, prescribers may be unaware of ClCr when ordering antibiotics. The objective of this study was to compare the percentage of inappropriately dosed antibiotics before and after the inclusion of ClCr on prescriber order forms at a long-term care facility (LTCF).

METHODS: A retrospective chart review of residents who were prescribed antibiotics over a 10 month period from August 2013 through May 2014 was conducted. In December 2014, protocol at the facility changed to include pharmacist-calculated ClCr on all prescriber order forms. The percentage of incorrectly dosed antibiotics before the protocol change was compared to that after initiation. A student’s t-test was used to compare results before and after the inclusion of ClCr.

RESULTS: Residents were prescribed a total of 66 antibiotics over the 10 month period; seven (10.6%) were incorrectly dosed.One antibiotic (3.1%) was incorrectly dosed after the inclusion of creatinine clearance on the order forms, whereas 6 (17.6%) were dosed incorrectly prior to the protocol change. The inclusion of ClCr on physician order forms resulted in a significant reduction(p<0.05) of incorrect antibiotic doses.

CONCLUSION: Assessing renal function in the geriatric population before initiating antibiotics is critical. Calculation of creatinine clearance by pharmacists and placement on physician order forms improved the number of antibiotic renal dose adjustments by prescribers.