Using Clinical Alerts to Decrease Inappropriate Medication Prescribing

Elderly Clinical Trial

Official title:

Using Clinical Alerts in a Computerized Provider Order Entry System to Decrease Inappropriate Medication Prescribing Among Hospitalized Elders

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01034761
• Other study ID #: 132454
• Status: Completed
• Phase: N/A
• First received: December 15, 2009
• Last updated: March 7, 2015
• Start date: April 2013
• Est. completion date: June 2013

Study information

• Verified date: March 2015
• Source: Baystate Medical Center
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Interventional

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 719
• Est. completion date: June 2013
• Est. primary completion date: June 2013
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 65 Years and older

Eligibility

Inclusion Criteria:

• Hospitalized patients with Age > 65

Exclusion Criteria:

Study Design

Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention

Related Conditions & MeSH terms

• Elderly

Intervention

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

Locations

Country	Name	City	State
United States	Baystate Medical Center	Springfield	Massachusetts

Sponsors (1)

Lead Sponsor	Collaborator
Baystate Medical Center

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	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	Yes
Secondary	The average number of specified high risk medications prescribed per patient.		Earlier of hospital stay or end of study	Yes
Secondary	Restraint use		Earlier of hospital stay or end of study	Yes
Secondary	Falls		Earlier of hospital stay or end of study	Yes
Secondary	Length of stay		Earlier of hospital stay or end of study	No
Secondary	Total Cost		Earlier of hospital stay or end of study	No
Secondary	Discharge status		6 months	No