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Computerized order system cuts drug errors for seniors by 16 percent: study

by Brendon Nafziger, DOTmed News Associate Editor | August 10, 2010
CPOE can warn
of drug dangers
A computerized system that flagged drugs not recommended for seniors cut drug ordering errors by around 16 percent, according to a new study.

In a paper published Monday in Archives of Internal Medicine, researchers found the rate of inappropriate drugs prescribed per day to the elderly fell from 11.56 to 9.94 after doctors at Beth Israel Deaconess Hospital in Boston, Mass. installed a custom-made computerized provider order entry (CPOE) drug warning system.

What's more, the system showed no signs of "alert fatigue," the authors wrote - that is, doctors didn't get bored by warnings and then ignore them. Nor did rates of prescription for other medications get changed, the authors said. The research was led by Dr. Melissa L. P. Mattison, who works in geriatrics and general medicine at Beth Israel.

Adverse drug reactions occur in about 40 percent of hospital admissions with old people, and nearly two-thirds are caused by mistakes in the ordering process, the authors wrote.

Fewer than one in 10 U.S. hospitals use CPOEs, according to the study, despite recommendations from the Institute of Medicine calling for universal adoption.

The study tracked drug prescription data for patients 65 years old and up at Beth Israel, comparing results from June 1, 2004 to Nov. 29, 2004, before the warning system was set up, to those from March 17, 2005 to Aug. 30, 2008, after it was installed.

The CPOE system, created especially for the study, would alert doctors if drugs prescribed fell on the so-called "Beers medications" list - a list of drugs geriatric medical specialists consider too risky to be prescribed to older patients, including diazepam, naproxen, clorazepate dipotassium and fluoxetine hydrochloride. The system would then recommend an alternative drug or a dose reduction.

"It is not yet clear whether any differences in patient outcomes can be attributed to this change in behavior," the authors caution, "but our results provide optimism that this important research question can be addressed in the near future."

As the researchers worked with a bespoke CPOE system, tailored for the specific needs of the study, the authors also warn that a commercial CPOE system might not be flexible enough for the "fine-tuned and circumscribed" intervention described in the study. In light of their findings, they advise commercial CPOE developers to "minimize generalized warnings" and "use focused alerts to target specific patient populations" for best results.