CPOE warning system may reduce orders for inappropriate meds

The implementation of a computerized provider order entry (CPOE) drug warning system can reduce orders for potentially inappropriate medications (PIMs) in hospitalized older patients, according to a study published in the Aug. 9 issue of the Archives of Internal Medicine, HealthDay News reported.

Melissa L.P. Mattison, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues evaluated patients 65 years of age and older who were admitted to a large urban academic medical center in Boston from June 1, 2004, to Nov. 29, 2004, prior to implementation of a warning system, and from March 17, 2005, to Aug. 30, 2008, after implementation of the warning system. The warning system that was added within the CPOE specifically alerted healthcare providers at the point of care if they ordered a PIM and recommended an alternative drug or reduced dose.

After implementation of the CPOE warning system, investigators found that the mean rate of medications ordered that were not recommended declined from 11.56 to 9.94 orders per day, with the effect not waning over time. The researchers found no appreciable changes in the order rate for drugs for which dose reduction only was recommended, or for those that were not targeted by the warning system.

“We found that a CPOE system with specific, targeted, and straightforward warnings can dramatically, yet selectively, reduce the prescription of PIMs in vulnerable hospitalized older patients,” the authors wrote. “Such systems can produce rapid and clinically significant change while leaving unchanged the rate of prescribing unflagged medications. This may represent a tool for improving the safety of hospitalized older adults.”