Objective: To determine the effectiveness of drug-disease best practice advisory alerts at preventing the administration of contraindicated medications in patients with parkinsonism as a quality improvement initiative

Background: Studies show that hospitalized PWP frequently receive contraindicated medications, leading to prolonged hospital stays, higher readmission rates, and worsened motor symptoms. In an effort to prevent contraindicated medications being administered to our PWP at the Cleveland Clinic, we activated drug-disease BPAs at the contraindicated level for our hospital system on January 12, 2023. The BPA alerts any electronic medical record (EMR) user when a contraindicated medication (shown in Table 1, left) was ordered for a patient with a diagnosis of parkinsonism; however, many medications were not included at the contraindicated level that should be based on current literature. We updated our system’s EMR to include these contraindicated medications (Table 1, right) on August 8, 2023 and inquired with First Databank, the database that creates and monitors drug-disease alerts for many EMRs nationwide to update their list of contraindicated medications. These changes were accepted and instituted in all EMRs using First Databank on October 20, 2023. Here, we seek to determine the impact of the BPA alerts in our hospital system.

Method: We will analyze EMR data from the Cleveland Clinic campuses in Ohio to assess the impact of the drug-disease BPAs for parkinsonism at preventing the administration of contraindicated medications. Patients with parkinsonism will be categorized into three groups: pre-BPAs (January 11, 2022 – January 11, 2023), partial-BPAs (January 12, 2023 – August 7, 2023), and updated-BPAs (August 8, 2023 – August 8, 2024).

Results: Results will include the difference in the number of administrations of contraindicated medications between the pre- and updated-BPA groups, whether or not the BPAs were ignored by providers in the updated-BPA group, and if so, which specialties and level of training these providers had and what indication was given for ignoring the alert. Results will also include whether BPAs taught providers to change their prescribing habits.

Conclusion: Tools within the EMR may be a helpful tool in preventing the administration of contraindicated medications in PWP.

Table 1

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-effectiveness-of-drug-disease-best-practice-advisory-alerts-for-preventing-the-administration-of-contraindicated-medications-in-patients-with-parkinsonism/