Study: CPOE with targeted alerts cuts inappropriate drug ordering for seniors

A properly implemented CPOE system with specific, appropriate alerts can "dramatically yet selectively" reduce the ordering of potentially inappropriate medications for hospitalized senior citizens, according to a new study in the Archives of Internal Medicine.

Researchers at Beth Israel Deaconess Medical Center in Boston studied ordering patterns for three groups drugs commonly prescribed for patients 65 and older who were admitted to the hospital in June through November 2004--prior to the addition of a drug warning system--and from March 2005 through August 2008, when CPOE alerts were in use. Right away, they found a sustained reduction in order rates for drugs flagged by the system, from 11.56 times per day to 9.94 daily orders. They also observed a small decline in ordering of unflagged medications, while the rate of prescriptions was unchanged for drugs the system recommended to be given in smaller dosages.

The research team noticed a particular reduction in orders of the antihistamine diphenhydramine--commonly sold as Benadryl--which made up about one-third of all prescriptions studied in the pre-alert period. "Both its use and the use of other targeted medications dropped markedly after implementation of the warning system, although we had insufficient power to examine other medications individually," they write, according to Medscape Medical News.

Adverse drug events occur in as many as 40 percent of all hospital admissions of patients 65 and older, the study says. The researchers say that CPOE with straightforward, targeted alerts "can dramatically yet selectively reduce the prescriptions of [potentially inappropriate medications] in vulnerable hospitalized older patients," and say that a properly implemented system can be an effective means of improving patient safety.

For further details:
- take a look at this Medscape Medical News story
- view the study abstract

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