Improving sedative-hypnotic prescribing in older hospitalized patients: Provider-perceived benefits and barriers of a computer-based reminder

BACKGROUND: Older adults are commonly prescribed sedative-hypnotic (SH) medications when hospitalized, yet these drugs are associated with important adverse effects such as falls and delirium. OBJECTIVE: To identify provider-perceived benefits or barriers of a computer-based reminder regarding appropriate use of SH medications. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS AND SETTING: Thirty-six house staff physicians at a university hospital. MEASUREMENTS: Information was collected regarding the experiences of prescribing an SH using a computer order entry system with a reminder intervention. Clinicians were asked about their perceptions of the reminder and what they found most and least useful about it. Responses were analyzed using grounded theory methodology. RESULTS: The 36 participants (including 29 interns) had prescribed an SH medication for a hospitalized patient over age 65 years. Three themes associated with benefits of a computer reminder were identified: increasing awareness of safety, including risk of delirium, falls, and general patient safety risks; usefulness of information technology; and the value of the educational content, including geriatric pharmacology review and nonpharmacologic treatment options. Barriers included the demands of the reminder with regard to time needed to read the reminder, the role of clinician experience with regard to preserving clinical autonomy, and the information content of the reminder, including its being too basic or not relevant for a particular patient. The mean satisfaction rating for the reminder was 8.5 (+/-9 SD), with 10 indicating high satisfaction. CONCLUSIONS: Improving decision support systems involves an understanding of how clinicians respond to real-time strategies encouraging better prescribing.