| Guided medication dosing for elderly emergency patients using real-time, computerized decision support. | |
| | |
MedLine Citation:
|
PMID: 22052899 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
ObjectiveTo evaluate the impact of a real-time computerized decision support tool in the emergency department that guides medication dosing for the elderly on physician ordering behavior and on adverse drug events (ADEs).DesignA prospective controlled trial was conducted over 26 weeks. The status of the decision support tool alternated OFF (7/17/06-8/29/06), ON (8/29/06-10/10/06), OFF (10/10/06-11/28/06), and ON (11/28/06-1/16/07) in consecutive blocks during the study period. In patients ≥65 who were ordered certain benzodiazepines, opiates, non-steroidals, or sedative-hypnotics, the computer application either adjusted the dosing or suggested a different medication. Physicians could accept or reject recommendations.MeasurementsThe primary outcome compared medication ordering consistent with recommendations during ON versus OFF periods. Secondary outcomes included the admission rate, emergency department length of stay for discharged patients, 10-fold dosing orders, use of a second drug to reverse the original medication, and rate of ADEs using previously validated explicit chart review.Results2398 orders were placed for 1407 patients over 1548 visits. The majority (49/53; 92.5%) of recommendations for alternate medications were declined. More orders were consistent with dosing recommendations during ON (403/1283; 31.4%) than OFF (256/1115; 23%) periods (p≤0.0001). 673 (43%) visits were reviewed for ADEs. The rate of ADEs was lower during ON (8/237; 3.4%) compared with OFF (31/436; 7.1%) periods (p=0.02). The remaining secondary outcomes showed no difference.LimitationsSingle institution study, retrospective chart review for ADEs.ConclusionThough overall agreement with recommendations was low, real-time computerized decision support resulted in greater acceptance of medication recommendations. Fewer ADEs were observed when computerized decision support was active. |
| | |
Authors:
|
Richard T Griffey; Helen G Lo; Elisabeth Burdick; Carol Keohane; David W Bates |
Related Documents
:
|
11616309 - The photographic collection of charles john bond (1856-1939. 10160719 - Compensating hospital medical staff leaders for organizational duties. 2734709 - Lobbyists on guard in midst of chaos. 15877489 - Value of hospital-employed medical officers in rural australia. 15828689 - Medical management of iraqi enemy prisoners of war during operation telic. 1739059 - Alternatives to physical and pharmacologic restraints in long-term care. 2764329 - Emergency department revisits. 18354529 - Real-time fringe pattern demodulation with a second-order digital phase-locked loop. 9887849 - Patient-physician communication assessment instruments: 1986 to 1996 in review. |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-11-3 |
Journal Detail:
|
Title: Journal of the American Medical Informatics Association : JAMIA Volume: - ISSN: 1527-974X ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
|
Created Date: 2011-11-4 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9430800 Medline TA: J Am Med Inform Assoc Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
|
Division of Emergency Medicine, Washington University Institute for Public Health, St. Louis, Missouri, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: A multi-layered framework for disseminating knowledge for computer-based decision support.
Next Document: Cost-effectiveness of a shared computerized decision support system for diabetes linked to electroni...