When Sheila Colburne's mother, Lily, took a turn for the
worse, it took some serious detective work to trace her
dizzy spells and drowsiness back to an adverse interaction
between two drugs in the cocktail she was downing twice
a day at her nursing home.
Ms Colburne suspects that the problem
— an antidepressant interacting with her regular
arthritis regimen — might have been the result
of illegible handwriting on her mother's prescription
slip. "Then again," she says, "she's on so many pills,
it would be easy to miss a conflict like that."
ELDERLY
ISSUE
It's the kind of scenario that all too often threatens
patients in long-term care facilities, where many patients
are on pharmaceutical regimens that would make Elvis
himself blush. But at Toronto's Baycrest Geriatric Institute,
geriatrician Dr Paula Rochon is helping to develop a
system to eliminate the problem.
Working with Dr Jerry Gurwitz and
other researchers at the Meyers Primary Care Institute
of the University of Massachusetts Medical School, Dr
Rochon has helped develop a computerized physician order
entry (CPOE) system with clinical decision support (CDS).
These dizzying acronyms add up to a pretty simple idea:
a database of patient information cross-referenced with
information on drug interactions, accessible via computer
anywhere in the Institute. "If a physician orders penicillin
and the patient has a penicillin allergy," Dr Rochon
explains, "they would get that message coming right
back at them." Doctors also get feedback about things
like the patient's weight and kidney function that help
determine how they should be dosed. "And if a physician
orders a combination of therapies that tend to be problematic,
he'll get a warning."
It's similar to systems already
in place in many acute care centres, but they hadn't
yet made their way into long-term care facilities. In
fact, it's so new in that setting that Dr Rochon had
to 'home-grow' the software to run the system, in concert
with health software company MEDITECH. They consulted
pharmacists, nurses, IT professionals and physicians
over a period of about three years to test and customize
the system.
The work is paying off already.
"Some physicians don't have great handwriting," says
Dr Rochon. "Now because the order's on the computer,
it's legible. All the requisite information is there:
the dose, how long are they going to have to take it
for, the route of administration. Also, when they write
the order, it goes directly to the pharmacist." Another
nice feature of the system is that it alerts doctors
about ordering drugs that aren't on the formulary.
"Prescribing in a long-term care
situation is very complex," adds Dr Rochon. "Each decision
requires a lot of thought, and you don't always have
much time to make decisions. This system provides a
lot of security, and I think physicians like that."
|
