Use of computer alerts to prevent the inappropriate use of metformin in an inpatient setting.

Abstract:

BACKGROUND:Metformin is recommended as initial therapy for most patients with type 2 diabetes mellitus. Its most serious adverse effect, lactic acidosis, is a rare entity with a high mortality rate. Despite well-publicized contraindications, metformin is inappropriately prescribed to many hospitalized patients. OBJECTIVE:To determine the efficacy of computer alerts at reducing inappropriate metformin prescribing. METHODS:Retrospective chart review of all hospitalized patients who received an order for metformin, before (n = 144) and after (n = 147) an intervention designed to reduce inappropriate administration. This intervention included 2 "hard-stop" computer alerts that prevented prescribing metformin to patients with renal dysfunction and in critical care or postoperative units; and 2 "soft" alerts that fired when no serum creatinine was available or the patient was in an outpatient surgical unit. Charts were reviewed for the presence of contraindications: renal insufficiency, congestive heart failure, recent myocardial infarction, surgery, or intravenous contrast use within 48 hours of metformin administration. RESULTS:In the preintervention group there were 47 violations compared with 13 violations in the postintervention group (P < .001). The greatest improvement was in surgical patients (39 violations vs 11, P < .001). CONCLUSIONS:Computer alerts at order entry were effective in decreasing the inappropriate prescribing of metformin in an inpatient setting.

journal_name

Qual Manag Health Care

authors

Rossi AP,Wellins CA,Savic M,Devlin JT

doi

10.1097/QMH.0b013e31826d1ef9

subject

Has Abstract

pub_date

2012-10-01 00:00:00

pages

235-9

issue

4

eissn

1063-8628

issn

1550-5154

pii

00019514-201210000-00005

journal_volume

21

pub_type

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