Lester Paula E, Rios-Rojas Liliana, Islam Shahidul, Fazzari Melissa J, Gomolin Irving H
Division of Geriatric Medicine, Winthrop University Hospital, 222 Station Plaza North, Suite 518, Mineola, NY, 11501, USA,
Drugs Aging. 2015 Mar;32(3):227-33. doi: 10.1007/s40266-015-0244-2.
A computerized physician order entry (CPOE) system provides opportunity for real-time alerts to prescribers. Winthrop University Hospital began using CPOE in 2009.
We sought to improve prescribing among older hospitalized patients by adding alerts to the CPOE system for potentially inappropriate medications.
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.
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.
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.
计算机化医师医嘱录入（CPOE）系统为开处方者提供了实时提醒的机会。温斯洛普大学医院于2009年开始使用CPOE。
我们试图通过在CPOE系统中添加针对潜在不适当药物的提醒，来改善老年住院患者的处方开具情况。
2011年1月，针对选定的高风险药物（苯海拉明、甲氧氯普胺和所有抗精神病药物），将信息提醒整合到CPOE系统中。我们通过比较2010年第二季度（“提醒前”）与2011年至2013年第二季度（“提醒后”）的处方数量，评估了这些提醒对处方开具频率的影响。通过药物医嘱的药房数据库评估处方模式。根据总出院人数调整处方开具频率。与18至64岁年龄组进行比较，并比较“按需”医嘱与长期医嘱。
在65岁及以上年龄组中，苯海拉明（p < 0.001）和甲氧氯普胺（p < 0.001）提醒前与提醒后的处方率显著降低。老年患者抗精神病药物的处方率没有下降（p = 0.80）。在较年轻的对照组中，未观察到这些药物的处方率下降。我们的分析基于书面处方数量，而非实际给药剂量；因此，无法确定这些提醒对这些药物的风险/益处沟通或记录的影响。
数据表明，CPOE提醒可以改变老年患者中疗效最差、危害可能性最大且有替代药物（即苯海拉明和甲氧氯普胺）的药物的处方率。
