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Josh F. Peterson, MD, MPH; Gilad J. Kuperman, MD, PhD; Caroline Shek, RPh; Minalkumar Patel, MD, MPH; Jerry Avorn, MD; David W. Bates, MD, MSc

Arch Intern Med. 2005;165:802-807.

Background  Inappropriate use or excessive dosing of psychotropic medications in the elderly is common and can lead to a variety of adverse drug events including falls, oversedation, and cognitive impairment.

Methods  We developed a database of psychotropic medication dosing and selection guidelines for elderly inpatients. We displayed these recommendations to physicians through a computerized order entry system at a tertiary care academic hospital. The system was activated for 2 of 4 six-week study periods in an off-on-off-on pattern. Main outcome measures were agreement with the recommended daily dose for the initial drug order, incidence of dosing at least 10-fold greater than the recommended daily dose, prescription of nonrecommended drugs, inpatient falls, altered mental status as measured by a brief nursing assessment, and hospital length of stay.

Results  A total of 7456 initial orders for psychotropic medications were prescribed for 3718 hospitalized elderly patients with a mean ± SD age of 74.7 ± 6.7 years. The intervention increased the prescription of the recommended daily dose (29% vs 19%; P<.001), reduced the incidence of 10-fold dosing (2.8% vs 5.0%; P<.001), and reduced the prescription of nonrecommended drugs (10.8% vs 7.6% of total orders; P<.001). Patients in the intervention cohort had a lower in-hospital fall rate (0.28 vs 0.64 falls per 100 patient-days; P = .001). No effect on hospital length of stay or days of altered mental status was found.

Conclusion  A geriatric decision support system for psychotropic medications increased the prescription of recommended doses, reduced the prescription of nonrecommended drugs, and was associated with fewer inpatient falls.

Author Affiliations: Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tenn (Dr Peterson); New York Presbyterian Hospital, New York, NY (Dr Kuperman); Partners Healthcare, Boston, Mass (Drs Shek and Bates); Divisions of General Internal Medicine (Drs Patel and Bates) and Pharmacoepidemiology and Pharmacoeconomics (Dr Avorn), Brigham and Women’s Hospital, Boston; and Harvard Medical School (Drs Avorn and Bates) and Harvard School of Public Health, Boston (Dr Bates).

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