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The Effect of Computerized Physician Order Entry Template Modifications on the Administration of High-Risk Medications in Older Adults in the Emergency Department

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Abstract

Background

Older adults are more susceptible to adverse events when administered certain medications at doses appropriate for younger adults.

Objective

The aim of this study was to investigate the effect of default geriatric dosing on computerized physician order entry (CPOE) templates on the subsequent administration of recommended starting doses of opioids, benzodiazepines (BZDs) and non-steroidal anti-inflammatory drugs (NSAIDs) to older adults in the emergency department (ED).

Methods

This was a before–after comparison of the frequency of the recommended starting doses of high-risk medications to adults aged 65 years and older. Computerized records were queried for the administration of the above medication classes in two academic EDs over two similar 4-month periods in 2015 and 2016. Between study periods, the doses of high-risk medications on ED CPOE templates were adjusted for older adults based on established pharmacy guidelines and expert consensus.

Results

There was a significant improvement in the rate of recommended dose administration of all medications of interest (27.3 vs. 32.5%, p < 0.001). Not surprisingly, the medications that were maximally impacted were also those most frequently prescribed, with a significant increase in the recommended dosing of opioids (29.0 vs. 35.2%, p < 0.001) accounting for the majority of the change. Although there were no differences in BZDs as a group, there were significant differences in selected BZDs such as midazolam and diazepam. Changes in the recommended dosing of NSAIDs could not be determined due to low numbers of administered doses in both phases of the study.

Conclusion

Simple changes in the CPOE template resulted in increased administration of the recommended starting doses of high-risk medications to older adults in the ED.

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Acknowledgements

The authors wish to thank Robert Anthony Black, Christine Fong and the support of the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1 TR002319 for assistance with data collection.

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Authors and Affiliations

  1. Department of Emergency Medicine, University of Washington, Box 359702, 325 Ninth Avenue, Seattle, WA, USA

    Mitchell Kim, Steven H. Mitchell & Medley Gatewood

  2. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA

    Stephen J. Kaplan, Katherine A. Bennett, Mamatha Damodarasamy & May J. Reed

  3. Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA

    Itay Bentov

  4. School of Pharmacy, University of Washington, Seattle, WA, USA

    Carol A. Crawford & Diane Matsuwaka

  5. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA

    Paul R. Sutton

  6. Section of General, Thoracic, and Vascular Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Stephen J. Kaplan

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  1. Mitchell Kim
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Corresponding author

Correspondence to Mitchell Kim.

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Funding

This work was supported by the John A. Hartford Foundation (to MJR).

Conflicts of interest

Mitchell Kim, Stephen Kaplan, Steven H. Mitchell, Medley Gatewood, Itay Bentov, Katherine A. Bennett, Carol A. Crawford, Paul R. Sutton, Diane Matsuwaka, Mamatha Damodarasamy and May Reed declare that they have no conflicts of interest relevant to the content of this study.

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Kim, M., Kaplan, S.J., Mitchell, S.H. et al. The Effect of Computerized Physician Order Entry Template Modifications on the Administration of High-Risk Medications in Older Adults in the Emergency Department. Drugs Aging 34, 793–801 (2017). https://doi.org/10.1007/s40266-017-0489-z

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  • DOI: https://doi.org/10.1007/s40266-017-0489-z

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