Default Settings in Electronic Records Can Facilitate Over-Prescribing Interview with:

Jashvant Poeran MD PhD Assistant Professor Dept. of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York, NY

Dr. Jashvant Poeran

Jashvant Poeran MD PhD
Assistant Professor
Dept. of Population Health Science & Policy
Icahn School of Medicine at Mount Sinai
New York, NY What is the background for this study?

Response: Falls are an important patient safety issue among elderly patients and may lead to extended hospitalization and patient harm. Particularly important in elderly patients are high risk drugs such as sleep medications which are known to increase fall risk and should be dosed lower in elderly patients.

In this study we looked at patients aged 65 years or older who fell during hospitalization. We found that in 62%, patients had been given at least one high risk medication that was linked to fall risk, within 24 hours before their fall. Interestingly, we found that also a substantial proportion of these medications were given at doses higher than generally recommended for elderly patients. What are the main findings?

Response: Upon further investigation we found that electronic prescribing may be partly responsible as the default dose in our electronic medical record system -the pre-selected option- was higher than recommended for 41% of medications that were examined. Even though doctors can choose between a variety of drug doses during electronic prescribing, having a pre-selected dose that is higher than recommended “makes it easy to do the wrong thing”. What should readers take away from your report?

Response: High risk drugs play an important part in falls among hospitalized elderly patients. Before the almost universal use of electronic prescribing, doctors had to consciously determine the appropriate drug dosage for a patient.

What our study mainly highlights is that with electronic prescribing, default doses do matter and lowering these defaults or pre-selected options for elderly patients may be an easy way to reduce inappropriate use of high risk drugs for these patients.

These findings are important for other hospitals nationwide because settings for defaults or pre-selected options seen at electronic prescribing are generally set by the hospital and not the electronic medical record system vendor. What recommendations do you have for future research as a result of this study?

Response: The million-dollar question now of course is: ‘When you lower the default or pre-selected drug dose during electronic prescribing, does that indeed result in more appropriate use of high risk drugs in elderly patients?’ Our study group is currently assessing this using our hospital data. Thank you for your contribution to the community.

Blachman, N. L., Leipzig, R. M., Mazumdar, M. and Poeran, J. (2016), High-Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing?. Journal of the American Geriatrics Society. doi: 10.1111/jgs.14703

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 29, 2016 by Marie Benz MD FAAD