A SADMAN With No Plan; Medication Management and Adherence To SADMAN Guidelines In Ambulatory Geriatric Care

Abstract

Abstract Background Medication side effects are common causes of ill health, with ‘SADMAN’ medications identified as frequent offenders- sulphonylureas, angiotensin-converting enzyme inhibitors (ACEi), diuretics, metformin, angiotensin-receptor blockers, nonsteroidal anti-inflammatories and sodium/glucose cotransporter-2 inhibitors. Recent consensus recommendation published in the American Journal of Kidney Diseases is that patients on these should omit them if unwell1. We examined SADMAN usage within our Day Hospital, knowledge of this guidance and patients’ confidence in managing their medications. Methods All patients presenting for review in one week in our Day Hospital were included. Data collected included age, gender and number of medications including SADMAN. Patients were asked had they been advised to stop SADMAN medications if unwell, whether medications were blister packed and if they would be confident identifying and stopping a particular medication. Results 27 patients were included. 56% male, mean age 80 years old and mean number of medications 9 (range 0-22). 67% had medications blister-packed. 48% were prescribed one or more SADMAN medications and 15% more than one. Most commonly prescribed were ACEi (30%) and diuretics (19%). No patients had been advised to stop taking a SADMAN medication if they became unwell. Only 19% of patients (31% on SADMAN medications) were confident they could identify/stop a particular medication. Conclusion Despite clear guidelines to stop SADMAN medications if unwell, we found that no patients attending our Day Hospital were aware of this. Even if patients were appropriately educated, there was a lack of confidence in medication management. Polypharmacy and blister packing of medications pose significant barriers, leading us to question the feasibility of SADMAN guideline implementation in an Ambulatory Geriatric Care setting. Reference 1. Watson KE et al. Consensus Recommendations for Sick Day Medication Guidance for People With Diabetes, Kidney, or Cardiovascular Disease: A Modified Delphi Process. Am J Kidney Dis. 2023 May;81(5): 564-574.doi: 10.1053/j.ajkd.2022.10.012.