Guided prescription of psychotropic medications for geriatric inpatients.

Full Abstract

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. CONCLUSION: 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.

Author information

Author/s: Peterson, Josh F (JF); Kuperman, Gilad J (GJ); Shek, Caroline (C); Patel, Minalkumar (M); Avorn, Jerry (J); Bates, David W (DW);

Affiliation: Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. josh.peterson(-atsign-)vanderbilt.edu

Grants: U18HS11169 (Agency:AHRQ HHS)

Journal and publication information

Publication Type: Evaluation Studies; Journal Article; Research Support, U.S. Gov't, P.H.S.

Journal: Archives of internal medicine (Arch Intern Med), published in United States. (Language: eng)

Reference: 2005-Apr; vol 165 (issue 7) : pp 802-7

Dates: Created 2005/04/12; Completed 2005/05/05; Revised 2008/11/21;

PMID: 15824302, status: MEDLINE (last retrieved date: 2/18/2009)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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