Warning System May Reduce Orders for Inappropriate Meds

Computerized system results in fewer orders for potentially inappropriate drugs in older patients
By Beth Gilbert
HealthDay Reporter

TUESDAY, Aug. 10 (HealthDay News) -- The implementation of a computerized provider order entry (CPOE) drug warning system can reduce orders for potentially inappropriate medications (PIMs) in hospitalized older patients, according to a study published in the Aug. 9/23 issue of the Archives of Internal Medicine.

Melissa L.P. Mattison, M.D., of the Beth Israel Deaconess Medical Center in Boston, and colleagues evaluated patients aged 65 years and older, admitted to a large, urban academic medical center from June 1, 2004, through Nov. 29, 2004, prior to implementation of a warning system, and from March 17, 2005, through Aug. 30, 2008, after implementation of the warning system. They added a warning system within the CPOE that specifically alerted health care providers when they ordered a PIM and recommended an alternative drug or reduced dose.

After implementation of the CPOE warning system, the investigators found that the mean rate of ordering medications that were not recommended declined from 11.56 to 9.94 orders per day, with the effect not waning over time. The researchers did not find any appreciable changes in the rate of ordering drugs for which dose reduction only was recommended or those that were not targeted by the warning system.

"In summary, we found that a CPOE system with specific, targeted, and straightforward warnings can dramatically yet selectively reduce the prescription of PIMs in vulnerable hospitalized older patients," the authors write. "Such systems can produce rapid and clinically significant change while leaving unchanged the rate of prescribing unflagged medications. This may represent a tool for improving the safety of hospitalized older adults."

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