Clinical trial NCT01034761: Using Clinical Alerts to Decrease Inappropriate Medication Prescribing
Official title: Using Clinical Alerts in a Computerized Provider Order Entry System to Decrease Inappropriate Medication Prescribing Among Hospitalized Elders
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Elderly
Keywords: Electronic prescribing
Inappropriate medications
Patient safety
Elderly patients in the hospital
Lead sponsor: Baystate Medical Center
Sponsor class: OTHER
First posted: 2009-12-17
Enrollment: 719
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: PREVENTION

Brief summary: Introduction:

The Beers list identifies medications that should be avoided in persons 65 years or older because they are ineffective, pose an unnecessarily high risk, or a safer alternative is available. In a recent study, we found a high rate of prescribing of Beers list medications to hospitalized patients. At Baystate, 41% of medical patients received at least one Beers list drug classified as "high severity," meaning it carried a high risk for an adverse drug reaction, while 5% received 3 or more. Some Beers drugs have been associated with delirium and falls. When compared to Baystate patients who did not receive a high severity medication, those who did had an increased risk of mortality (7.8% vs. 5.2%), longer length of stay (5.5 days vs. 3.9 days) and higher costs ($11,240 vs. 6243).

Specific Aims:

1. Quantify the impact of synchronous electronic alerts on physician prescribing of high-severity Beers' list drugs to hospitalized patients over the age of 65 years.
2. Compare physician reactions to each drug-specific alert

Project Description:

We will develop a series of clinical alerts in CIS, Baystate's computerized provider order entry system, to reduce the use of potentially inappropriate medications among hospitalized elders. We will randomize providers to electronic alerts or usual care. Whenever a provider randomized to alerts attempts to place an order for a high-risk medication on the Beers list and the intended recipient is over 65 years of age, a synchronous alert (i.e. a "pop-up") will inform the physician about the risks associated with the medication and will propose safer alternatives.

We will collect data on physician ordering and patient outcomes comparing the number of Beers list prescriptions from providers receiving electronic alerts to those not receiving alerts. Our anticipated outcome is a decrease in inappropriate prescribing during the period when the electronic alerts are activated. Other potential outcomes include decrease in length of stay and a decrease in falls.


Eligibility criteria: Inclusion Criteria:

* Hospitalized patients with Age \> 65

Exclusion Criteria:

* None

Primary outcomes:
measure: The percentage of elderly patients who receive a specified high-risk medication from the Beer's list.
timeFrame: Earlier of hospital stay or end of study
Secondary outcomes:
measure: The average number of specified high risk medications prescribed per patient.
timeFrame: Earlier of hospital stay or end of study
measure: Restraint use
timeFrame: Earlier of hospital stay or end of study
measure: Falls
timeFrame: Earlier of hospital stay or end of study
measure: Length of stay
timeFrame: Earlier of hospital stay or end of study
measure: Total Cost
timeFrame: Earlier of hospital stay or end of study
measure: Discharge status
timeFrame: 6 months
Other outcomes:
Locations:
city: Springfield
country: United States
facility: Baystate Medical Center
state: Massachusetts
Study officials:
affiliation: Baystate Medical Center
name: Linda J Canty, MD
role: PRINCIPAL_INVESTIGATOR
References: