Safer Prescribing for Hospitalized Older Adults with an Electronic Health Records-Based Prescribing Context

BACKGROUND/OBJECTIVES: Hospitalized older adults are at risk of receiving potentially inappropriate medication (PIM) doses, driven in part by age-independent dose defaults used by electronic health records (EHRs), leading providers to prescribe for older adults as they do for younger adults. We studied whether an automated EHR-based medication support tool would reduce PIM dosing for hospitalized older adults. DESIGN: Pre-post study design. SETTING: Tertiary care, level 1 trauma, academic medical center in Oregon. PARTICIPANTS: Hospitalized adults 75 years and older in the inpatient, nonemergency setting prescribed medications with geriatric-specific dose considerations. INTERVENTION: An EHR-based, automated set of evidence-based, age-specific dose and frequency defaults called the Geriatric Prescribing Context (GPC). MEASUREMENTS: The process measure is percentage of orders consistent with geriatric dose recommendations, and outcome measures are average dose (AD) in milligrams and total daily dose (TDD) in milligrams in the 12 months before and after implementation. RESULTS: Use of recommended geriatric doses with the context improved for all 10 of the most commonly ordered medications. In the year after implementation, there was a trend toward decreasing TDD and AD across all drug classes. CONCLUSION: The GPC is a simple, elegant, and effective means to align prescribing practices with safety standards for older adults, improving prescribing safety for all. It works within the current prescriber workflow without triggering alert fatigue and requires minimal resources for development and maintenance.