Using Clinical Alerts to Decrease Inappropriate Medication Prescribing

NCT01034761 | Completed

• 1 other identifier: 132454
• Study Type: interventional
• Target: 719
• Locations: 1 country
• Sites: 1

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. 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. 2.Compare physician reactions to each drug-specific alert

Conditions

Elderly

Keywords

Electronic prescribing; Inappropriate medications; Patient safety; Elderly patients in the hospital

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (6)

• 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

• Falls

  Earlier of hospital stay or end of study

• Length of stay

  Earlier of hospital stay or end of study

• Total Cost

  Earlier of hospital stay or end of study

Study Arms (2)

Pop-up alerts

EXPERIMENTAL

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

Behavioral: Pop-up alert

Usual care

NO INTERVENTION

Interventions

Pop-up alert BEHAVIORAL

Pop-up alert in the electronic medical record whenever the provider enters an order for a specified high risk medication from the Beers list.

Pop-up alerts

Eligibility Criteria

• Age: 65 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Older Adult (65+)

You may qualify if:

• Hospitalized patients with Age \> 65

You may not qualify if:

• None

Sponsors & Collaborators

• Baystate Medical Center: lead

Study Sites (1)

Baystate Medical Center

Springfield, Massachusetts, 01199, United States

Location

Related Publications (1)

• Cole JA, Goncalves-Bradley DC, Alqahtani M, Barry HE, Cadogan C, Rankin A, Patterson SM, Kerse N, Cardwell CR, Ryan C, Hughes C. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2023 Oct 11;10(10):CD008165. doi: 10.1002/14651858.CD008165.pub5.

  PMID: 37818791 DERIVED

Study Officials

• Linda J Canty, MD

  Baystate Medical Center

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Clinical Professor of Medine

Study Record Dates

• First Submitted: December 15, 2009
• First Posted: December 17, 2009
• Study Start: April 1, 2013
• Primary Completion: June 1, 2013
• Study Completion: June 1, 2013
• Last Updated: March 10, 2015

Record last verified: 2015-03

Locations

US (1)