Impact of computerized physician order entry alerts on prescribing in older patients.
BACKGROUND
A computerized physician order entry (CPOE) system provides opportunity for real-time alerts to prescribers. Winthrop University Hospital began using CPOE in 2009.


OBJECTIVE
We sought to improve prescribing among older hospitalized patients by adding alerts to the CPOE system for potentially inappropriate medications.


METHODS
In January 2011, informational alerts were integrated into the CPOE system for selected high-risk medications: diphenhydramine, metoclopramide, and all antipsychotics. We evaluated the effect of these alerts on prescribing frequency by comparing the number of prescriptions during the second quarters of 2010 ("pre-alert") with the second quarters of 2011 through 2013 ("post-alert"). Prescribing patterns were evaluated through a pharmacy database of medication orders. Frequency of prescribing was adjusted for total discharges. A comparison was made to ages 18-64 years, and comparing "as needed" vs standing orders.


RESULTS
In the 65 years of age and older group, there were significant reductions in prescription rates pre-alert vs post-alert for diphenhydramine (p < 0.001) and metoclopramide (p < 0.001). There was no decrease in prescription rates for antipsychotics in older patients (p = 0.80). In the younger comparison group, no decreases in prescription rates for those drugs were observed. Our analysis is based on numbers of written prescriptions and not actual doses administered; therefore, no conclusions concerning the effect of these alerts on communication or documentation of risk/benefits of these medications can be ascertained.


CONCLUSIONS
The data suggest that prescribing rates for drugs with the least efficacy and potential for harm and with alternative agents (i.e., diphenhydramine and metoclopramide) can be modified by CPOE alerts for older patients.
Division of Geriatric Medicine, Winthrop University Hospital, 222 Station Plaza North, Suite 518, Mineola, NY, 11501, USA, plester@winthrop.org.
Paula E
PE
Lester
Liliana
L
Rios-Rojas
Shahidul
S
Islam
Melissa J
MJ
Fazzari
Irving H
IH
Gomolin
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D006801:Humans; D050316:Medical Order Entry Systems; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055815:Young Adult