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Updated: May 27, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Guided medication dosing for elderly emergency patients using real-time, computerized decision support.

Richard T Griffey¹, Helen G Lo, Elisabeth Burdick

¹Division of Emergency Medicine, Washington University Institute for Public Health, St. Louis, Missouri, USA. griffeyr@wustl.edu

Journal of the American Medical Informatics Association : JAMIA

|November 5, 2011

Summary

This summary is machine-generated.

Computerized decision support for elderly medication dosing in the emergency department increased physician adherence to recommendations and reduced adverse drug events (ADEs). This technology shows promise for improving patient safety in geriatric care.

Related Experiment Videos

Last Updated: May 27, 2026

Improving IV Insulin Administration in a Community Hospital

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Area of Science:

Health Informatics
Geriatric Medicine
Emergency Medicine

Background:

Elderly patients are at higher risk for adverse drug events (ADEs) due to physiological changes and polypharmacy.
Medication dosing in the emergency department (ED) requires careful consideration for geriatric patients.
Computerized decision support systems (CDSS) offer potential to optimize medication management.

Purpose of the Study:

To assess the impact of a real-time CDSS on physician prescribing behavior for elderly patients in the ED.
To evaluate the effect of the CDSS on the incidence of adverse drug events (ADEs) in this population.

Main Methods:

A prospective controlled trial utilized an alternating OFF/ON design of a CDSS over 26 weeks.
The study focused on patients aged 65 and older receiving specific medications (benzodiazepines, opiates, NSAIDs, sedative-hypnotics).
Physician adherence to CDSS recommendations (dosing adjustments or alternative medications) and ADE rates were primary outcomes.

Main Results:

Physician orders were more consistent with CDSS dosing recommendations when the system was ON (31.4%) compared to OFF (23%) (p≤0.0001).
Despite low acceptance of alternative medication suggestions (92.5% declined), overall adherence to dosing guidance improved.
The rate of adverse drug events (ADEs) was significantly lower when the CDSS was active (3.4%) versus inactive (7.1%) (p=0.02).

Conclusions:

Real-time computerized decision support, even with limited acceptance of medication changes, led to increased adherence to dosing recommendations.
The implementation of this CDSS was associated with a reduction in adverse drug events in elderly ED patients.
Further research is warranted, acknowledging the single-institution, retrospective ADE review limitations.