Geriatric ED Prescribing: CDS Tool Improves Safety
- A new study reveals that integrating a clinical decision support (CDS) system into electronic health records (EHRs) significantly boosts adherence to geriatric prescribing recommendations within emergency departments (EDs).
- Researchers analyzed data from 6,745 ED orders during 5,814 patient visits and 1,440 discharge prescriptions for PIMs involving adults 65 and older.
- the primary goal was to assess adherence to CDS recommendations.
A groundbreaking study highlights how incorporating a clinical decision support (CDS) tool into electronic health records (EHRs) dramatically enhances medication safety for older adults in emergency departments. This integration significantly boosts adherence to geriatric prescribing guidelines, reducing the risk associated with potentially inappropriate medications (PIMs). Researchers found that after implementing the CDS system, adherence to geriatric recommendations for targeted PIMs jumped substantially. They also examined the utilization rates of the CDS panel demonstrating its impact on improving care, and adherence to CDS suggestions. Explore News Directory 3 to discover insights into the evaluation of data from thousands of ED orders, proving the effectiveness of CDS in improving geriatric prescribing. Discover what’s next for this crucial study.
Clinical Decision Support Improves Geriatric Prescribing in Emergency Departments
A new study reveals that integrating a clinical decision support (CDS) system into electronic health records (EHRs) significantly boosts adherence to geriatric prescribing recommendations within emergency departments (EDs). This leads to safer medication practices for older patients, reducing the use of potentially inappropriate medications (PIMs).
Researchers analyzed data from 6,745 ED orders during 5,814 patient visits and 1,440 discharge prescriptions for PIMs involving adults 65 and older. The median patient age was 72; approximately 70% were white and 22.7% were Black. In october 2021, Cleveland Clinic implemented a geriatric CDS system within its EHR, offering dosing advice and suggesting option medications for 12 high-risk PIMs.
the primary goal was to assess adherence to CDS recommendations. Secondary goals included evaluating the use of the CDS panel and adherence rates for specific medications.
Following the implementation of the clinical decision support system, adherence to geriatric recommendations for targeted PIMs rose from 52% to 71% for ED orders and from 0.5% to 31.7% for discharge prescriptions. The geriatric CDS order panel was used in 62.1% of ED orders and 36.7% of discharge prescriptions. Among orders placed using the CDS panels, 90% of ED orders and 80.4% of discharge prescriptions followed geriatric CDS recommendations.
Adherence improved for most ED orders, with some exceptions, including diphenhydramine, indomethacin, ketorolac (oral and IV), and lorazepam.
”Geriatric clinical decision support implemented in the ED for targeted potentially inappropriate medications significantly increased the proportion of ED orders and discharge prescriptions adherent to geriatric drug therapy recommendations,” the authors wrote. “As the volume of older patients in the ED increases, electronic health record–based clinical decision support can allow for care that is both better tailored and safer for this vulnerable population.”
What’s next
Future research should consider patient factors such as ethnicity, dementia history, and language, and also variations in patient volume and site-specific differences to refine and optimize clinical decision support tools further.