Many of you have expressed an interest in GRACE (Global Risk Assessment and Careplan for Elders). This is an experimental protocol designed to improve the care of all hospitalized elders admitted to BIDMC, with the hope that we will reduce the risk of delirium, falls, pressure ulcers, and functional decline.
A key component of GRACE is its integration with our computerized provider order entry system. Here is a recent article on that from Scientific American, which in turn is based on an (unfortunately subscription-required) article in the Archives of Internal Medicine. Here's an excerpt, quoting Doctor Melissa Mattison on our staff:
"Our study found that when doctors were alerted that the drugs they were ordering could pose a danger to older hospital patients, the orders dropped almost immediately," said Mattison, who was the first author on the study.
After the new CPOE function was installed at BIDMC in 2005, the orders for potentially inappropriate medication (PIM) for older adults dropped—and stayed—some 20 percent lower than what they had been (down from an average of 11.6 a day to 9.9 a day).
"Many drugs commonly used today have not been tested in seniors or elderly patients," Mattison said. "As a result, a dose that is appropriate for a younger adult may lead to potentially harmful side effects in older individuals, who tend to metabolize medications more slowly."