Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients.
OBJECTIVE
To develop a feasible, inexpensive, point-of-care computerized reminder to improve sedative-hypnotic prescribing in hospitalized older people.


METHODS
Pre-postintervention with a computer-based reminder.


METHODS
Academic medical center.


METHODS
Hospitalized patients aged 65 and older.


METHODS
Computer-based reminder directing clinicians to prescribe a nonpharmacological sleep protocol, to minimize the potential for harm with diphenhydramine and diazepam use by choosing an alternative medication (trazodone or lorazepam), or both.


METHODS
Frequency of prescription of four sedative-hypnotic drugs (diphenhydramine, diazepam, lorazepam, and trazodone) during the 12 months before (n=12,356 patients) and after (n=12,153) the reminder was instituted.


RESULTS
Prescribing of sedative-hypnotics decreased from 2,208 per 12,356 (18%) patients preintervention to 1,832 per 12,153 (15%) postintervention (odds ratio for the intervention=0.82, 95% confidence interval=0.76-0.87), an 18% risk reduction. Combined prescription rates for all four drugs fell consistently throughout the postintervention period. Diphenhydramine, diazepam, and lorazepam orders declined overall, with lorazepam prescriptions decreasing 39% during the intervention. Ninety-five percent of patients were successfully directed to a safer sedative-hypnotic drug or a nonpharmacological sleep protocol.


CONCLUSIONS
Using real-time computer-based reminders could lead to improved sedative-hypnotic prescribing for older persons in acute care. This study highlights the potential to address patient safety concerns, and the quality of medication prescribing in particular, in vulnerable hospitalized patients.
Agostini
Joseph V
JV
Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, CT 06516, USA. joseph.agostini@yale.edu
Zhang
Ying
Y
Inouye
Sharon K
SK
D000046:Academic Medical Centers; D000368:Aged; D003199:Computer Systems; D004360:Drug Therapy, Computer-Assisted; D017723:Drug Utilization Review; D015577:Geriatric Assessment; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D050316:Medical Order Entry Systems; D019095:Point-of-Care Systems; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D017010:Reminder Systems; D007319:Sleep Initiation and Maintenance Disorders / Q000628:therapy*
D006993:Hypnotics and Sedatives