Using Clinical Alerts to Decrease Inappropriate Medication Prescribing

Not Applicable

Completed

• Conditions: Elderly
• Interventions: Behavioral: Pop-up alert

• Registration Number: NCT01034761
• Lead Sponsor: Baystate Medical Center

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.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2009-12-15
• Study First Submitted QC: 2009-12-16
• Study First Posted: 2009-12-17
• Study Start: 2013-04
• Primary Completion: 2013-06
• Study Completion: 2013-06
• Status Verified: 2015-03
• Last Update Submitted: 2015-03-07
• Last Update Posted: 2015-03-10

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 719

Inclusion Criteria

• Hospitalized patients with Age > 65

Exclusion Criteria

• None

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Pop-up alerts	Pop-up alert	Providers will receive pop-up alerts in the electronic medical record when prescribing one of the specified medications from the Beers list.

Primary Outcome Measures

Name	Time	Method
The percentage of elderly patients who receive a specified high-risk medication from the Beer's list.	Earlier of hospital stay or end of study

Secondary Outcome Measures

Name	Time	Method
Length of stay	Earlier of hospital stay or end of study
The average number of specified high risk medications prescribed per patient.	Earlier of hospital stay or end of study
Restraint use	Earlier of hospital stay or end of study
Discharge status	6 months
Falls	Earlier of hospital stay or end of study
Total Cost	Earlier of hospital stay or end of study

Trial Locations

Locations (1)

Baystate Medical Center; 🇺🇸 Springfield, Massachusetts, United States