Physician response to a medication alert system in inpatients with levodopa-treated diseases
Authors:
- Marie MorrisMMMarie Morris
- Allison W. WillisAWAllison W. Willis
- Susan Searles NielsenSNSusan Searles Nielsen
- Franklin McCannFMFranklin McCann
- Angela BirkeABAngela Birke
- Brad A. RacetteBRBrad A. Racette
- 4 August 2015
- journal article
- Published by Wolters Kluwer Health in Neurology
- Vol. 85 (5) , 420-424
Abstract
Objective: To evaluate the appropriateness of dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases after implementation of an automated prescription alert system. Methods: We examined dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases and physician response to an automated drug contraindication alert system at Barnes-Jewish Hospital from 2009 to 2013. A detailed review of patient medical records was performed for all alert events generated when a physician prescribed a dopamine receptor antagonist concurrently with a dopamine receptor agonist in hospitalized patients. Two movement disorders neurologists determined the appropriateness of each prescription, based on patient medical history, through consensus. Physician response to alert was compared by indication for the prescription and physician specialty. Results: Of 237 orders, 197 (83.1%) prescriptions for dopamine receptor antagonists were considered inappropriate. The prevalence of inappropriate dopamine receptor antagonist prescriptions per levodopa prescriptions was 16.10% (95% confidence interval 9.47, 22.73) in psychiatry, 7.51% (6.16, 8.86) in general medicine, 6.14% (4.49, 7.79) in the surgical specialties, and 0.85% (0.46, 1.25) in the neurologic/neurosurgical specialties. Of the inappropriate prescriptions, 146 (74.1%) were continued despite the alert. The strongest predictor of discontinuation of dopamine receptor antagonist medications was use of the medication to treat nausea or emesis (p < 0.001). Conclusions: Despite successfully identifying instances when dopamine antagonists were prescribed to patients with dopamine-requiring diseases, the alert system modestly affected physician prescribing behavior, highlighting the need for improved education of health care providers.Keywords
This publication has 13 references indexed in Scilit:
- Drug interaction alert override rates in the Meaningful Use eraApplied Clinical Informatics, 2014
- A Clinical Case of Electronic Health Record Drug Alert Fatigue: Consequences for Patient OutcomePediatrics, 2013
- Drug—drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health recordsJournal of the American Medical Informatics Association, 2012
- Provider and pharmacist responses to warfarin drug-drug interaction alerts: a study of healthcare downstream of CPOE alertsJournal of the American Medical Informatics Association, 2011
- Development of a context model to prioritize drug safety alerts in CPOE systemsBMC Medical Informatics and Decision Making, 2011
- Practice Parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): [RETIRED]Neurology, 2006
- Overriding of Drug Safety Alerts in Computerized Physician Order EntryJournal of the American Medical Informatics Association, 2006
- Olanzapine treatment for dopaminergic‐induced hallucinationsMovement Disorders, 2002
- Olanzapine in the treatment of dopamimetic-induced psychosis in patients with Parkinson’s diseaseBiological Psychiatry, 2002
- Best Clinical Practice with Ziprasidone: Update After One Year of ExperienceJournal of Psychiatric Practice, 2002