Decreasing Inappropriate Prescribing in Elderly Patients

Purpose: The geriatric population are well known to be more susceptible to adverse drug events (ADEs) than younger patients. These ADEs are associated with increased hospitalizations, morbidity and mortality, and increased health care costs. We previously conducted a retrospective analysis to determine how many geriatric patients were prescribed “high severity” Beers medications. In our follow-up study, we sought to evaluate whether the implementation of a Best Practice Alert (BPA) will reduce the prescribing of Beers medications in our geriatric patients.

Methods: The BPA was developed and incorporated into the electronic health record (EHR) which appears when a “high severity” Beers medication is ordered by a provider to an IFH patient greater than 65 years old. A smartest was then linked which included a recommended alternative that was labeled a “positive” Beers Medications. A follow-up internal report on prescribing patterns was generated 6 months after implementation.

Results: Eighteen high severity medications were prescribed by various providers within the institution. The most commonly prescribed medications were amitriptyline, cyclobenzaprine, diazepam, and fluoxetine. There were no changes in prescribing patterns pre and post intervention of the BPA.

Conclusion: The use of a BPA alert in the EHR did not appear to decrease prescribing of the high severity Beer’s medications. More work needs to be done in this area to assess reasoning for no change physician’s prescribing in this patient population.