Guided prescription of psychotropic medications for geriatric inpatients.
BACKGROUND
Inappropriate use or excessive dosing of psychotropic medications in the elderly is common and can lead to a variety of adverse drug events including falls, oversedation, and cognitive impairment.


METHODS
We developed a database of psychotropic medication dosing and selection guidelines for elderly inpatients. We displayed these recommendations to physicians through a computerized order entry system at a tertiary care academic hospital. The system was activated for 2 of 4 six-week study periods in an off-on-off-on pattern. Main outcome measures were agreement with the recommended daily dose for the initial drug order, incidence of dosing at least 10-fold greater than the recommended daily dose, prescription of nonrecommended drugs, inpatient falls, altered mental status as measured by a brief nursing assessment, and hospital length of stay.


RESULTS
A total of 7456 initial orders for psychotropic medications were prescribed for 3718 hospitalized elderly patients with a mean +/- SD age of 74.7 +/- 6.7 years. The intervention increased the prescription of the recommended daily dose (29% vs 19%; P<.001), reduced the incidence of 10-fold dosing (2.8% vs 5.0%; P<.001), and reduced the prescription of nonrecommended drugs (10.8% vs 7.6% of total orders; P<.001). Patients in the intervention cohort had a lower in-hospital fall rate (0.28 vs 0.64 falls per 100 patient-days; P = .001). No effect on hospital length of stay or days of altered mental status was found.


CONCLUSIONS
A geriatric decision support system for psychotropic medications increased the prescription of recommended doses, reduced the prescription of nonrecommended drugs, and was associated with fewer inpatient falls.
Peterson
Josh F
JF
Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. josh.peterson@vanderbilt.edu
Kuperman
Gilad J
GJ
Shek
Caroline
C
Patel
Minalkumar
M
Avorn
Jerry
J
Bates
David W
DW
D000058:Accidental Falls / Q000517:prevention & control; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000517:prevention & control; D020000:Decision Support Systems, Clinical; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008510:Medication Systems, Hospital; D011619:Psychotropic Drugs / Q000008:administration & dosage*
D011619:Psychotropic Drugs