Positive changes in prescribing of potentially inappropriate medications (PIM) for older adults were associated with the use of a passive clinical decision support (CDS) tool across a multihospital system, researchers report. “This study adds to the growing body of literature to support resources into developing robust clinical decision support systems in [computerized provider order entry (CPOE) system] for geriatric patient populations,” the authors conclude. “Moving forward, this passive CDS model utilized in our cohort of older adults can continue to be expanded with the addition of more medications and trials with other select populations.”
Medication usage patterns for older adults were compared before and after implementation of the CDS in a large academic tertiary care hospital, a long-term acute care hospital, and 6 community hospitals during two 9-month periods in 2019 and 2021. The primary endpoint was the percentage of each medication intervened with an ordered dose and frequency outside of alignment with recommended context parameters. Also examined were total daily dose (TDD) and average dose (AD) per patient of the individual PIMs and the frequency of active alerts fired by the CPOE and overridden by providers.
“A total of 62,738 older adult hospital admissions are included in the overall study period, with 32,969 pre-implementation and 29,769 post-implementation,” the authors report. “Haloperidol showed the greatest reduction in inappropriate doses from 41.5% to 21.4% (P < 0.001) of orders, followed by reduction in inappropriate frequencies in orders for diphenhydramine from 57.2% to 39.7% (P < 0.001). Secondary endpoints showed favorable reductions across 11 of the 16 medications in both TDD and AD administered. Exploratory analysis with select medications showed reductions in frequency of alerts fired and overridden.”