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WARNING: Do You Really Want to Prescribe This?

A computerized order entry warning system prevented some potentially inappropriate medication use in hospitalized older patients.

Older patients are particularly vulnerable to adverse drug events (ADEs) because of the number of medications they receive, plus their lessened ability to metabolize drugs. ADEs occur in as many as 40% of hospitalized older patients and lead to substantial morbidity and mortality.

Researchers studied prescription orders for older patients (age, 65) who were admitted to an urban academic medical center in Boston during 6 months before or after implementation of a computerized provider order entry (CPOE) drug warning system. Ordering patterns for three groups of drugs were analyzed: The first group was flagged by the warning system as not to be used as per the Beers criteria. The second group of Beers medications was flagged to be used at reduced doses in elders, and a third group of Beers medications (controls) were not flagged. The mean rate of prescribing not-to-be-used medications dropped from 11.56 before CPOE warning implementation to 9.94 orders daily after implementation of the warning system. No significant change was noted in the rate of ordering medications in the dose-reduction or the unflagged group.

Comment: These researchers demonstrated that a CPOE warning system can lower use of potentially inappropriate medications in older adults; however, even with this system, 10 potentially inappropriate medications were ordered daily. This finding suggests that either clinical indications made the medications absolutely necessary or that more education is required for physicians about the appropriateness of prescribing Beers medications for older adults. Quality improvement studies are necessary to assess variations in prescribing practices for older patients (JW Hosp Med Jun 9 2008) and to determine whether fewer potentially inappropriate medications translate to better patient outcomes.

— Neil H. Winawer, MD, SFHM

Published in Journal Watch Hospital Medicine September 13, 2010

Citation(s):

Mattison MLP et al. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med 2010 Aug 9; 170:1331.

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Reader Remarks:

Review and add to remarks on this article

• Problem is Beers criteria
  JR Brittain, 14 Sep 2010 1:56 PM EST
  When the Beers criteria came out, they were touted as the absolute greatest guideline of prescribing in the elderly ever... [more]

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