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Use of a Computer-Based Reminder to Improve Sedative–Hypnotic Prescribing in Older Hospitalized Patients

Authors

  • Joseph V. Agostini MD,

    1. From the *Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, ConnecticutDepartment of Internal Medicine, Yale University School of Medicine, New Haven, ConnecticutInstitute for Aging Research, Hebrew Rehabilitation Center/Hebrew Senior Life, Boston, Massachusetts§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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  • Ying Zhang MD, MPH,

    1. From the *Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, ConnecticutDepartment of Internal Medicine, Yale University School of Medicine, New Haven, ConnecticutInstitute for Aging Research, Hebrew Rehabilitation Center/Hebrew Senior Life, Boston, Massachusetts§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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  • Sharon K. Inouye MD, MPH

    1. From the *Clinical Epidemiology Research Center, VA Connecticut Healthcare Center, West Haven, ConnecticutDepartment of Internal Medicine, Yale University School of Medicine, New Haven, ConnecticutInstitute for Aging Research, Hebrew Rehabilitation Center/Hebrew Senior Life, Boston, Massachusetts§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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  • Presented in part as a poster at the annual meeting of the American Geriatrics Society, Orlando, Florida, May 13, 2005.

Address correspondence to Joseph V. Agostini, MD, Clinical Epidemiology Research Center 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: joseph.agostini@yale.edu

Abstract

OBJECTIVES: To develop a feasible, inexpensive, point-of-care computerized reminder to improve sedative-hypnotic prescribing in hospitalized older people.

DESIGN: Pre-postintervention with a computer-based reminder.

SETTING: Academic medical center.

PARTICIPANTS: Hospitalized patients aged 65 and older.

INTERVENTION: Computer-based reminder directing clinicians to prescribe a nonpharmacological sleep protocol, to minimize the potential for harm with diphenhydramine and diazepam use by choosing an alternative medication (trazodone or lorazepam), or both.

MEASUREMENTS: Frequency of prescription of four sedative-hypnotic drugs (diphenhydramine, diazepam, lorazepam, and trazodone) during the 12 months before (n=12,356 patients) and after (n=12,153) the reminder was instituted.

RESULTS: Prescribing of sedative-hypnotics decreased from 2,208 per 12,356 (18%) patients preintervention to 1,832 per 12,153 (15%) postintervention (odds ratio for the intervention=0.82, 95% confidence interval=0.76–0.87), an 18% risk reduction. Combined prescription rates for all four drugs fell consistently throughout the postintervention period. Diphenhydramine, diazepam, and lorazepam orders declined overall, with lorazepam prescriptions decreasing 39% during the intervention. Ninety-five percent of patients were successfully directed to a safer sedative-hypnotic drug or a nonpharmacological sleep protocol.

CONCLUSION: Using real-time computer-based reminders could lead to improved sedative-hypnotic prescribing for older persons in acute care. This study highlights the potential to address patient safety concerns, and the quality of medication prescribing in particular, in vulnerable hospitalized patients.

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