Use of a computer-based reminder to improve sedative-hypnotic prescribing in older hospitalized patients

• HIT Description: Decision support More info...
  
• Purpose of Study: Develop computerized reminder to improve sedative-hypnotic prescribing in hospitalized elderly patients
  
• Years of study: 2002-2003
  
• Study Design: Pre-post
  
• Outcomes: Patient safety
  

• Settings: Academic medical center hospital
• Intervention: Computer generated reminder to MDs to first prescribe nonÐdrug sleep protocol. If drug needed, to minimize potential for harm with diphenydramine and diazepam, choose trazadone or lorazepam instead.
• Evaluation Method: Using medical charts, assessed frequency of prescription of the four drugs mentioned above during the 12 months before and after the intervention was instituted.
• Description: Clinical Care Support System (Eclipsys Corporation). Each time diphenhydramine or diazepam was selected, the MD was exposed to up to 3 sequential reminder screens that covered adverse effects and recommendations for alternatives. All patient orders, including prescriptions, are entered using a computerized order-entry system. Orders printed at the nurses stations.
• System Penetration: Entire hospital
• Facilitators: Hospital-wide computer system was already in use; reminders were an addition
• Barriers: MD may not have interacted directly with patient or offered the non-drug alternative in person.
• Healthcare Utilization: Combined prescription rates for all 4 drugs fell consistently throughout the post-intervention period.
• Quality of Care and Patient Safety Outcome: 95% of patients were successfully directed to a safer drug or non-drug sleep protocol.