In Pursuit of the Quadruple Aim: A Geriatric Prescribing Context’s Impact on Clinician Workflows and Alert Fatigue

Abstract

The impact of a novel Geriatric Prescribing Context (GPC) on hospital clinicians’ prescribing workflows is still unknown. A cross-sectional survey was distributed to 346 inpatient pharmacists, physicians, and advance practice providers employed at three pilot site hospitals affected by the GPC to assess awareness and impact to usual workflow. The GPC, a set of medication default doses and frequencies for patients 75 years and older, was unnoticed by 74% of survey respondents ( n = 119) with pharmacists more likely to be aware of the context than prescribers. The impact of the GPC on clinicians’ workflow differed by setting, with academic respondents reporting no change or decreased time to write or verify orders, and community respondents reporting no change or increased time to write or verify orders. The GPC has smoothly integrated into usual prescribing workflows for both prescribers and pharmacists and both overall reported positive responses to the implementation.

Improving dose‐related adverse drug events among hospitalized older adults using a geriatric prescribing context

“…Previous investigation has demonstrated 10%–30% improvement in orders for age‐appropriate defaults across the top 10 most commonly used medications affected by the GPC 8 and these effects were largely sustained at 3.5 years out 9 . Prior survey results showed that prescribing workflows and user experiences were not adversely affected by the GPC 10 . The GPC is a sustainable, invisible intervention within the EHR leading to significant improvements in appropriate geriatric dosing of high‐risk medications.…”

“…9 Prior survey results showed that prescribing workflows and user experiences were not adversely affected by the GPC. 10 The GPC is a sustainable, invisible intervention within the EHR leading to significant improvements in appropriate geriatric dosing of high-risk medications. What remains unknown, however, is if this translates into an actual decrease in dose-related ADEs.…”