Physician response to a medication alert system in inpatients with levodopa-treated diseases

Marie Morris, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
Allison W. Willis, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
Susan Searles Nielsen, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
Franklin McCann, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
Angela Birke, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa.
Brad A. Racette, From the Department of Neurology (M.M., A.B., B.A.R.), Washington University School of Medicine, St. Louis, MO; Departments of Neurology and Biostatistics and Epidemiology (A.W.W.), Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Neurology (S.S.N.), University of Washington, Seattle, WA; Barnes-Jewish Hospital (F.M.), St. Louis, MO; and School of Public Health (B.A.R.), Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa. racetteb@neuro.wustl.edu.

Document Type

Article

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.

Medical Subject Headings

Aged; Aged, 80 and over; Dopamine Antagonists (adverse effects); Drug Prescriptions; Female; Hospitalization; Humans; Levodopa (adverse effects); Male; Medical Order Entry Systems (standards, statistics & numerical data); Medication Errors (prevention & control); Middle Aged; Physician's Role; Retrospective Studies; Treatment Outcome

Publication Date

8-4-2015

Publication Title

Neurology

E-ISSN

1526-632X

Volume

85

Issue

5

First Page

420

Last Page

4

PubMed ID

26092916

Digital Object Identifier (DOI)

10.1212/WNL.0000000000001745

Link to Full Text

Share

COinS