Hospital warning system changed prescribing for elderly patients

Elderly hospital patients are more vulnerable than younger people to certain medications. Drugs may linger longer in their bodies and have side effects that make them more likely to fall or become confused than someone younger and stronger. A new study in the Archives of Internal Medicine examines how well warnings built into a computerized prescribing system work to protect older patients.

Dr. Melissa Mattison and her colleagues at Beth Israel Deaconess Medical Center looked at what happened before and after alerts were added to the hospital’s system for ordering medications. Under the new system, if a physician ordered one of 16 drugs regarded as potentially inappropriate for people over 65, a warning would be displayed with an explanation and list of conditions that put patients at increased risk.

Prescribing diazepam (Valium), for example, would prompt a warning about how long it stays in the body and the risk of falls, especially in people with impaired liver, neurologic, or psychiatric function. All 16 drugs had reasonable alternatives, the authors said. They chose a small number of commonly used drugs to avoid the "alert fatigue" that can overwhelm prescribers.

Before the warning system was in place, the 16 potentially inappropriate drugs were ordered an average of about 12 times a day. After the warnings were added, that dropped to about 10 times a day, or about 14 percent. In general, drug alerts are overridden up to 90 percent of the time, according to research cited in the paper.

“We were happy to see it did have the intended effect,” Mattison said in an interview.