An Electronic System to Document Reasons for Medication Discontinuation and to Flag Unwanted Represcriptions in Geriatric Patients

• Published in: Drugs & aging Vol. 29; no. 12; pp. 957 - 962
• Main Authors: van der Linden, Carolien M. J., Jansen, Paul A. F., van Marum, Rob J., Grouls, René J. E., Egberts, Toine C. G., Korsten, Erik H. M.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing AG 01.12.2012; Adis International; Springer Nature B.V
• Subjects: Aged, 80 and over; Application programming interface; Biological and medical sciences; Clinical decision making; Communication; Computerized physician order entry; Decision support systems; Decision Support Techniques; Documentation - methods; Drug Information Services - instrumentation; Drug Prescriptions - statistics & numerical data; Drug stores; Electronic Prescribing; Family physicians; Female; Geriatrics; Geriatrics/Gerontology; Hospitalization; Hospitals - statistics & numerical data; Humans; Information systems; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Patient safety; Pharmaceutical industry; Pharmacology. Drug treatments; Pharmacology/Toxicology; Pharmacotherapy; Pharmacovigilance; Prescription drugs; Short Communication; Surveillance; Teaching hospitals; Netherlands; Clinical Decision Support; National Pharmacovigilance Centre; Medication Discontinuation; Clinical Decision Support System; Catharina Hospital; Human; Drug; Treatment; Electronic document; Review; Elderly; Geriatrics
• ISSN: 1170-229X; 1179-1969
• DOI: 10.1007/s40266-012-0035-y

Background Earlier studies have shown poor documentation of the reasons for medication discontinuation during hospitalization. Communication of reasons for discontinuation, e.g. adverse drug reactions (ADRs), to general practitioners and pharmacists was also found to be insufficient, leading to a rate of represcription after an ADR of 27 % during the first 6 months after discharge. Objective The aim of this study was to develop and implement a user-friendly electronic clinical decision support system to document reasons for medication discontinuation in hospitalized geriatric patients and to flag potentially undesirable represcriptions. Methods The electronic clinical decision support module was developed using the Gaston framework. Pop-up windows force physicians to document reasons for medication discontinuation, and the system alerts physicians to the represcription of drugs withdrawn because of an ADR. We interviewed users regarding the acceptability of the system. Results On a 20-bed geriatric ward, the electronic system documented 2,228 medication discontinuations and the reasons for them over 11.4 months and alerted physicians to represcription of drugs associated with an ADR 20 times. The system was considered to be user-friendly. Conclusions This clinical decision support system fulfilled its aims of documenting the reasons for medication discontinuation and alerting physicians to potentially undesirable represcription of previously withdrawn drugs. It was found to be user-friendly.