title: Electronic surveillance and pharmacist intervention for vulnerable older inpatients on high-risk medication regimens.
abstract: OBJECTIVE
  To develop and evaluate an electronic tool to assist clinical pharmacists with reviewing potentially inappropriate medications (PIMs) in hospitalized elderly adults.
  
  
  METHODS
  Pilot intervention.
  
  
  METHODS
  Academic tertiary care hospital.
  
  
  METHODS
  Hospitalized adults aged 65 and older admitted to the general medicine, orthopedics, and urology services during a 3-week period in 2011 who were administered at least one medication from a list of 240 PIMs.
  
  
  METHODS
  A computerized PIMS dashboard flagged individuals with at least one administered PIM or a high calculated anticholinergic score. The dashboard also displayed 48-hour cumulative narcotic and benzodiazepine administration. Participants were ranked to reflect the estimated risk of an adverse event using logical combinations of data (e.g., use of multiple sedatives in a nonmonitored location). In a pilot implementation, a clinical pharmacist reviewed the flagged records and delivered an immediate point-of-care intervention for the treating physician.
  
  
  METHODS
  Clinician response to pharmacist intervention.
  
  
  RESULTS
  The PIMS dashboard flagged 179 of 797 individuals (22%) admitted over a 3-week period and 485 participant-medication pairs for review by the clinical pharmacist. Seventy-one participant records with 139 participant-medication pairs required additional manual review of the electronic medical record. Twenty-two participants receiving 40 inappropriate medication orders were judged to warrant an intervention, which was delivered by personal communication over the telephone or text message. Clinicians enacted 31 of 40 (78%) pharmacist recommendations.
  
  
  CONCLUSIONS
  An electronic PIM dashboard provided an efficient mechanism for clinical pharmacists to rapidly screen the medication regimens of hospitalized elderly adults and deliver a timely point-of-care intervention when indicated.
authors.affiliation: Department of Biomedical Informatics, School of Medicine, Vanderbilt University, Nashville, Tennessee; Department of Medicine, School of Medicine, Vanderbilt University, Nashville, Tennessee.
authors.forename: Josh F
authors.initials: JF
authors.lastname: Peterson
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
authors.forename: Ioana
authors.initials: I
authors.lastname: Danciu
authors.forename: Debbie
authors.initials: D
authors.lastname: Harrell
authors.forename: Marketa
authors.initials: M
authors.lastname: Marvanova
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.forename: Carmen
authors.initials: C
authors.lastname: Rodriguez
authors.forename: James S
authors.initials: JS
authors.lastname: Powers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D016330:Frail Elderly; D006785:Hospitals, University; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D007297:Inpatients; D008297:Male; D050316:Medical Order Entry Systems; D059065:Medication Reconciliation / Q000379:methods*; D008510:Medication Systems, Hospital / Q000458:organization & administration*; D054539:Medication Therapy Management / Q000458:organization & administration*; D010343:Patient Admission; D010595:Pharmacists; D010865:Pilot Projects; D013714:Tennessee
keywords: acute care; clinical informatics; geriatrics; medication safety; pharmacy intervention; vulnerable elderly