Observations of Polypharmacy and Interactions on Varying COVID-19 Medication Regimens in Nursing Home Residents

Abstract

Around 800,000 preventable medication-related errors occur yearly in nursing homes (NHs). With NHs susceptible to medication errors, COVID-19 can potentially increase their occurrence. No evidence-based regimen exists for COVID-19, yet different “cocktails” are prescribed at NHs as prophylaxis or treatment for COVID-19. Little is known regarding long-term consequences of such regimens, including increased pill burden, stable disease exacerbation, or adverse drug reactions. While preventing COVID-19 spread and decreasing mortality are important, doing so safely and effectively should be a priority. Pharmacists can play a pivotal role even with little information available regarding this issue. Student pharmacists performed a retrospective review of medication profiles of individuals living in a single nursing home chain who had an ICD-10 code for COVID-19 (U07.1) contained within their electronic health record from March 1to September 20, 2020. Medications started specifically for COVID-19 were collected, as were the number of scheduled medications +/-14 and +/-30 days from the COVID-19 diagnosis date. Drug interactions were screened via Lexi-Comp if new medications were started for COVID-19 and significant drug-disease interactions were based on clinical skills of the candidate and a review by the geriatrics-focused preceptor. Across 31 facilities, 759 patients were diagnosed with COVID-19. Out of 759 patients, 322 (42.4%) were treated pharmacologically following diagnosis. Interventions included antibiotics, antiplatelets, anticoagulants, nutritional supplements, and other medications. There were 164 patients (21.6%) prescribed antibiotics, 64 (8.4%) anticoagulants, 36 (4.7%) aspirin, 1 (0.1%) clopidogrel, 21 (2.8%) hydroxychloroquine, 124 (16.3%) corticosteroids, and 312 (41.4%) supplements. Nearly 1 in 5 individuals (n=148) were exposed to dangerous drug-drug interactions, with potential for increased bleeding risk and QTc prolongation the most common possible outcomes. Important drug-disease interactions were found in 221 patients with the most common being use of dexamethasone in diabetic patients. The average number of medications added for COVID-19 was 2.8 (range 1-10). The average increase in medications 30 days post-infection was 2.15 (range 1-13); however, 135 patients had fewer medications post-COVID-19, and 214 had no change. While anticoagulants and antibiotics typically did not persist long past infection resolution largely due to stop dates, supplements continued on profiles 30 days after diagnosis. Pharmacists have a vital role in recommendations of evidence-based medication regimens, as well as ensuring proper monitoring parameters are employed. Making certain stop dates are used can also greatly improve patient care and avoid unnecessary polypharmacy. Pharmacists should ensure when medications are being used for a COVID-19 infection, the indication is properly stated, as this will assist with classification of these individuals in other large database studies.