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MU element: 2011 Measure = Use of high-risk medications in the elderly (cf. Beers criteria)
Resources:
Pearls:
[from the guide noted above:]
- As always, consider alerts as a safety net, and try to use CDS delivered “upstream” to support correct prescribing decisions. For example, condition management information available at the medication selection stage—for example, via infobuttons—can offer guidance regarding appropriate drug selection and dosing in the elderly population. Similarly, order sets can include such imbedded or linked guidance.
- When alerts are used and triggered on order entry, they should suggest an appropriate alternative that can be directly ordered from the alert. Construct the alert so the “reason to avoid use” is prominent. For example, “Caution in older patients: Has a long half-life in the elderly, producing prolonged sedation and increasing the risk for falls and fractures. Alternative medications are preferred; [list of medications with option to order directly].”
- An alternative “downstream” method to alerts in the inpatient setting is producing a report listing patients who are receiving potentially contraindicated medications; this list can then be reviewed by pharmacists or a geriatrics consult service. Analogous reports, handled through appropriate channels, may be of value in outpatient settings as well.
[please feel free to comment on the bullets above, and/or add your own below:]
- Diagnosis based order sets with embedded instructions and orders regarding caring for the elderly can be effective. The order set can remind the clinician to limit total medications and can also include orders/research papers for plans of care (advanced directives, etc.).
Discussions:
- Question: Should the polypharmacy rules that are usually built for CPOE in the elderly be applied to patients of all ages? Certainly, the Beers Criteria need to be applied to high risk medications in the elderly, but shouldn't systems assist physicians in limiting the number of medications. What is the best way to educate physicians and especially residents regarding polypharmacy, custom term papers and high risk medications
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