Using Clinical Alerts to Decrease Inappropriate Medication Prescribing

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
Linda Canty, MD, Baystate Medical Center
ClinicalTrials.gov Identifier:
NCT01034761
First received: December 15, 2009
Last updated: August 13, 2013
Last verified: August 2013
  Purpose

Introduction:

The Beers list identifies medications that should be avoided in persons 65 years or older because they are ineffective, pose an unnecessarily high risk, or a safer alternative is available. In a recent study, we found a high rate of prescribing of Beers list medications to hospitalized patients. At Baystate, 41% of medical patients received at least one Beers list drug classified as "high severity," meaning it carried a high risk for an adverse drug reaction, while 5% received 3 or more. Some Beers drugs have been associated with delirium and falls. When compared to Baystate patients who did not receive a high severity medication, those who did had an increased risk of mortality (7.8% vs. 5.2%), longer length of stay (5.5 days vs. 3.9 days) and higher costs ($11,240 vs. 6243).

Specific Aims:

  1. Quantify the impact of synchronous electronic alerts on physician prescribing of high-severity Beers' list drugs to hospitalized patients over the age of 65 years.
  2. Compare physician reactions to each drug-specific alert

Project Description:

We will develop a series of clinical alerts in CIS, Baystate's computerized provider order entry system, to reduce the use of potentially inappropriate medications among hospitalized elders. We will randomize providers to electronic alerts or usual care. Whenever a provider randomized to alerts attempts to place an order for a high-risk medication on the Beers list and the intended recipient is over 65 years of age, a synchronous alert (i.e. a "pop-up") will inform the physician about the risks associated with the medication and will propose safer alternatives.

We will collect data on physician ordering and patient outcomes comparing the number of Beers list prescriptions from providers receiving electronic alerts to those not receiving alerts. Our anticipated outcome is a decrease in inappropriate prescribing during the period when the electronic alerts are activated. Other potential outcomes include decrease in length of stay and a decrease in falls.


Condition Intervention
Elderly
Inappropriate Medication Prescribing
Behavioral: Pop-up alert

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Prevention
Official Title: Using Clinical Alerts in a Computerized Provider Order Entry System to Decrease Inappropriate Medication Prescribing Among Hospitalized Elders

Further study details as provided by Baystate Medical Center:

Primary Outcome Measures:
  • The percentage of elderly patients who receive a specified high-risk medication from the Beer's list. [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:
  • The average number of specified high risk medications prescribed per patient. [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: Yes ]
  • Restraint use [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: Yes ]
  • Falls [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: Yes ]
  • Length of stay [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: No ]
  • Total Cost [ Time Frame: Earlier of hospital stay or end of study ] [ Designated as safety issue: No ]
  • Discharge status [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 7500
Study Start Date: April 2013
Estimated Study Completion Date: September 2013
Primary Completion Date: June 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Pop-up alerts
Providers will receive pop-up alerts in the electronic medical record when prescribing one of the specified medications from the Beers list.
Behavioral: Pop-up alert
Pop-up alert in the electronic medical record whenever the provider enters an order for a specified high risk medication from the Beers list.
No Intervention: Usual care

  Eligibility

Ages Eligible for Study:   65 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Hospitalized patients with Age > 65

Exclusion Criteria:

  • None
  Contacts and Locations
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Please refer to this study by its ClinicalTrials.gov identifier: NCT01034761

Locations
United States, Massachusetts
Baystate Medical Center
Springfield, Massachusetts, United States, 01199
Sponsors and Collaborators
Baystate Medical Center
Investigators
Principal Investigator: Linda J Canty, MD Baystate Medical Center
  More Information

No publications provided

Responsible Party: Linda Canty, MD, Assistant Clinical Professor of Medine, Baystate Medical Center
ClinicalTrials.gov Identifier: NCT01034761     History of Changes
Other Study ID Numbers: 132454
Study First Received: December 15, 2009
Last Updated: August 13, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Baystate Medical Center:
Electronic prescribing
Inappropriate medications
Patient safety
Elderly patients in the hospital

ClinicalTrials.gov processed this record on October 19, 2014