Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients

Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients

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Introduction: TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties.The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety.Methods: Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR.The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up MASCARA BLACK BROWN #1310 completed within 30 days of medication initiation.

Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention.Results: After intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of Metal Sign all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (P=.01).Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased.

All other secondary outcomes numerically increased but did not reach statistical significance.Discussion: Improvement was seen in adherence with prescribing and practice guidance following the implementation of the CDST.This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.