Improving sedative-hypnotic prescribing in older hospitalized patients: provider-perceived benefits and barriers of a computer-based reminder.
BACKGROUND
Older adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium.


OBJECTIVE
To identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications.


METHODS
Qualitative study using semi-structured interviews.


METHODS
Thirty-six house staff physicians at a university hospital.


METHODS
Information was collected regarding the experiences of prescribing an SH using a computer order entry system with a reminder intervention. Clinicians were asked about their perceptions of the reminder and what they found most and least useful about it. Responses were analyzed using grounded theory methodology.


RESULTS
The 36 participants (including 29 interns) had prescribed an SH medication for a hospitalized patient over age 65 years. Three themes associated with benefits of a computer reminder were identified: increasing awareness of safety, including risk of delirium, falls, and general patient safety risks; usefulness of information technology; and the value of the educational content, including geriatric pharmacology review and nonpharmacologic treatment options. Barriers included the demands of the reminder with regard to time needed to read the reminder, the role of clinician experience with regard to preserving clinical autonomy, and the information content of the reminder, including its being too basic or not relevant for a particular patient. The mean satisfaction rating for the reminder was 8.5 (+/-0.9 SD), with 10 indicating high satisfaction.


CONCLUSIONS
Improving decision support systems involves an understanding of how clinicians respond to real-time strategies encouraging better prescribing.
Agostini
Joseph V
JV
Clinical Epidemiology Research Center 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA. joseph.agostini@yale.edu
Concato
John
J
Inouye
Sharon K
SK
D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D003693:Delirium / Q000139:chemically induced; D004360:Drug Therapy, Computer-Assisted; D004363:Drug Utilization; D005260:Female; D005544:Forecasting; D015577:Geriatric Assessment; D019538:Health Care Surveys; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008508:Medication Errors / Q000517:prevention & control; D019095:Point-of-Care Systems; D011787:Quality of Health Care; D017010:Reminder Systems; D018570:Risk Assessment
D006993:Hypnotics and Sedatives