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Computerized guidelines for psychotropic drug use can improve prescribing and reduce falls among hospitalized elderly patients

Psychotropic medications are typically used to treat anxiety, depression, and other mental health problems. Their use among elderly hospital patients has been implicated in falls, hip fractures, cognitive impairment, and oversedation. Efforts to reduce adverse drug events in the elderly due to psychotropic medications have focused on reducing drug doses (due to age-related slower metabolic clearance of drugs) and improving drug selection. A new study, supported in part by the Agency for Healthcare Research and Quality (HS11169), found that adding psychotropic medication dosing and selection guidelines to a computerized order entry system at one hospital improved prescribing and reduced falls among elderly inpatients.

The investigators developed a database of dosing and selection guidelines that were displayed on the screen when physicians ordered psychotropic medications through the hospital's computerized order entry system. After a 6-week study period, they examined use of the guided prescription system and agreement with the recommended dosing and drugs, as well as inpatient falls, altered mental status, and hospital length of stay.

The researchers found that use of computerized guidelines increased adherence to recommended daily doses from 19 to 29 percent. It also reduced the incidence of daily dosing that was 10 times higher than the average recommended daily dosing from 5 to 2.8 percent. In addition, using computerized guidelines reduced prescribing of nonrecommended drugs from 10.8 percent to 7.6 percent of total orders. Patients whose doctors used the guidelines also had a lower in-hospital fall rate (0.28 vs. 0.64 falls per 100 patient days). There was no difference in length of stay or days of altered mental status.

More details are in "Guided prescription of psychotropic medications for geriatric inpatients," by Josh F. Peterson, M.D., M.P.H., Gilad J. Kuperman, M.D., Ph.D., Caroline Shek, R.Ph., and others, in the April 11, 2005, Archives of Internal Medicine 165, pp. 802-807.

Editor's Note: A related article examines the epidemiology of and solutions to inappropriate medication use in the elderly in nursing homes, hospitals, and other health care sites. For more details, see Zhan, C. (2005, May). "Inappropriate medication use in the elderly." Journal of the Pharmacy Society of Wisconsin, pp. 29-33. Reprints (AHRQ Publication No. 05-R058) are available from the AHRQ Publications Clearinghouse.

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