Prevalence and Recognition of Chronic Kidney Disease (CKD) in Long Term Care (LTC) Residents in Hawaii

scope, lack of knowledge and clarity of NP role, workload demands) and perceived outcomes of the NP role (i.e., thorough assessments, consistent care, more time spent with residents, efficient ordering of pain medications and tests, timely follow-up with resident pain concerns) were also described. Areas that were suggested for future role development related to pain management included becoming more engaged with medication reviews and completing physical assessments. Conclusion/Discussion: The findings from this study contribute to our understanding of how the NP role is perceived by other health care professionals, particularly around pain management. Stronger interdisciplinary collaborative relationships need to be facilitated within a model of care that includes an NP, with the ultimate goal of improving pain management services in LTC. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract. Prevalence and Recognition of Chronic Kidney Disease (CKD) in Long Term Care (LTC) Residents in Hawaii Presenting Author: R. Bailey, MD, Centocor Ortho Biotech Services, LLC Author(s): J. Higa, PharmD, G. Reardon, RPh, PhD; and R. Bailey, MD Introduction/Objective: To estimate the prevalence of CKD in Hawaii’s LTC population based on laboratory data and the degree to which a corresponding diagnosis of CKD is identified in the resident’s chart. Design/Methodology: Data was obtained retrospectively through chart audit. During January-March 2009, all current residents of 7 LTC facilities with available chart and lab data were considered for inclusion. Residents were excluded if they were \18 years of age, receiving dialysis, or had missing values for hemoglobin, serum creatinine (sCR), age, gender or race. Lab-defined renal function was estimated from the most recent sCR value and converted to two estimates of kidney function: 1) estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) 4-variable equation, and 2) an adjusted eGFR (A-eGFR) for Asian/Pacific Islanders based on a correction for GFR by Matsuo et al. [Am J Kidney Dis 2009 53(6): 982-992]. Lab-defined CKD was identified if GFR \60 mL/min/1.73 m2 (stages 3-5 for both eGFR and A-eGFR, National Kidney Foundation Outcomes Quality Initiative definition). Recognized CKD was identified from any recorded diagnosis in the resident chart. Results: Chart reviews were performed for 791 residents. 614 were retained for analysis after applying exclusion criteria. Mean age was 84 years; 71% were female. Asian/Pacific-Islander ethnicity accounted for 72% of residents. Mean (SD) eGFR was 77.4 (47.1) and mean (SD) A-eGFR was 66.7 (41.8) mL/min/1.73 m2. Lab-defined CKD prevalence was 33% (eGFR) and 48% (A-eGFR). CKD prevalence was not associated with increasing age category when using eGFR (P 5 .244) but was significantly associated (P 5 .041) when using A-eGFR. Gender was not associated with CKD (P 5 .223 for eGFR and P 5 .185 for A-eGFR). Of residents with lab-defined CKD, 31% (eGFR) and 25% (A-eGFR) also had a recognized CKD diagnosis recorded in the chart. Diagnosed CKD recognition rates increased to 67% (eGFR) and 65% (A-eGFR) for those residents with stage 4-5 CKD (\30 mL/min/ 1.73 m2 for both eGFR and A-eGFR). Limitations: Lab-defined CKD was determined from a single sCR value. Recognized CKD was determined retrospectively from a single chart review. The method for A-eGFR estimation has not been validated for use in this specific population. Conclusion/Discussion: Based on retrospective chart review including examination of laboratory evidence, CKD was observed in this predominately Asian/Pacific-Islander population. CKD prevalence increased when A-eGFR was applied. In these LTC residents, CKD appeared to be documented in the chart at lower rates for those residents found to have CKD from lab estimates. Disclosures: J. Higa, PharmD and G. Reardon, RPh, PhD are consultants for Centocor Ortho Biotech Services, LLC. R. Bailey, MD is an employee at Centocor Ortho Biotech Services, LLC. Prevalence of Nursing Home Orders for Antipsychotic Medications without Indications or Diagnoses Entered By Prescribing Physician in the Nursing Medical Record: A Generalizable Quality Improvement Project Presenting Author: Bich-Thy Ngo, MD, Texas Tech University Health Science Center, Texas Tech University Health Science Center B18

Author(s): N. Ngo Bich-Thy, MD, Rebecca Sleeper, PharmD, Ohmar Win, MD, Missy Rosalez; and Andrew Dentino, MD Introduction/Objective: Antipsychotic drug prescription in most long term care (LTC) facilities is prevalent and common. However, specific indications for antipsychotic medications (APM) is oftentimes lacking when the APM order is written. The purpose of the study is to examine the prevalence of APM orders without documentation of specific target indication or diagnosis in the LTC medical record/chart. Design/Methodology: Retrospective study identifying new APM orders without supporting documentation among elderly LTC residents from April-October 2009. Patients’ charts were individually reviewed for documentation of specific target indications or diagnoses from the prescribing physician’s histories and physicals, progress notes and orders. Results: 158 charts were reviewed. The variables analyzed were: resident demographic variables (age, gender, race/ethnicity); diagnoses; APM by name and ‘category’ (e.g. typical or atypical); schedule of administration (e.g. single dose ‘‘one time order’’ vs. scheduled dosing vs. prn); other diagnoses; prescription of other psychoactive medications. The final results will be presented at AMDA in March 2010. Conclusion/Discussion: APM use has been associated with increased risk of mortality. The elderly are especially vulnerable to the adverse effects of psychoactive medications. Careful chart review helps to ensure proper documentation, which in turn ensures more appropriate use of APMs, improves LTC patient care and reduces iatrogenic effects seen with APMs in elderly patients. Considerations for this quality improvement project to be generalizable for other LTC facilities nationally are discussed. Disclosures: All authors have stated there are no disclosures to be made that are pertinent to this abstract. Prevalence of Painful Neuropathy and Use of Analgesic Medications in Residents with Diabetes Presenting Author: Dean Gianarkis, MS, PharmD, Pfizer Author(s): Dean Gianarkis, MS, PharmD; and Robert Fusco, BScPh Introduction/Objective: Diabetic peripheral neuropathy (DPN) is one of the most common long-term complications of diabetes. The primary objective of this research was to determine the prevalence of painful DPN (pDPN). The secondary objective was to evaluate medications used to treat other related comorbidities. Design/Methodology: A retrospective review using computerized pharmacy records was conducted on 17 randomly selected long-term care facilities in New Jersey. Residents were included in the analysis if they had at least one order for an antidiabetic agent between January 1, 2009 and June 30, 2009. Residents were assigned to the treatment group if they had one or more orders for any pain medication during the study period. Those not on pain medications served as controls. The prevalence of pDPN was estimated by identifying residents on medication frequently prescribed for neuropathic pain. Differences in medications used for sleep and mood disorders between groups were measured using Fisher’s exact test (p \ 0.05 was considered statistically significant). Results: There were 101 residents who met the inclusion criteria; 84 were included in the treatment group and 17 served as controls. The mean age was 80.3 years, 73% were female, and most (83%) had Type 2 diabetes. Since 43/ 101 residents were on an agent frequently used to treat neuropathic pain, the prevalence of pDPN is estimated to be 43%. However, only 2 residents had a diagnosis of neuropathy documented in their pharmacy records. Those treated for pDPN (51%) as compared to the control group (47%) were more likely to be on at least one medication for a sleep or mood-related comorbidity. Residents treated with medications for pDPN had more orders for antidepressants, anxiolytics and sleep medications but fewer for antipsychotic agents than those in the control group. However, these results were not statistically significant. Conclusion/Discussion: Using medications as a marker, the prevalence of pDPN in residents with diabetes is estimated to be 43%. This is similar to DPN, but higher than pDPN prevalence rates published in the literature. Residents with diabetes who are treated for pDPN are more likely to receive agents for depression, anxiety and sleep than diabetics not treated for pain. Therefore, it is important for pharmacists to obtain a specific pDPN diagnosis and maintain a comprehensive profile to optimize management of the disease. JAMDA – March 2010