Appropriateness of Dopamine Antagonist Prescribing in Hospitalized Patients with Dopamine Requiring Diseases after Implementation of an Automated Prescribing Alert System (S49.005)

OBJECTIVE: To evaluate the effectiveness of an automated prescription alert system in preventing inappropriate dopamine antagonist prescriptions in hospitalized patients with dopamine requiring diseases. BACKGROUND: Dopamine antagonists are prescribed for psychosis and nausea, but are contraindicated in dopa-requiring conditions such as Parkinson disease. This retrospective, observational study examined dopamine antagonist prescriptions in hospitalized patients with dopa-requiring diseases, and physician response to an automated drug alert system. DESIGN/METHODS: We performed a detailed review of patient hospital medical records for alert events generated when a physician prescribed a dopamine antagonist concurrently with levodopa. A consensus of two movement disorders neurologists classified each prescription as appropriate or inappropriate based on patient medical record review. We compared physician response to alert by disease and physician specialty. RESULTS: Of 237 alerts, 197 (83%) prescriptions for dopamine antagonists were inappropriate and 40 (17%) appropriate. Prochlorperazine was the most common inappropriately prescribed drug. The prevalence of inappropriate dopamine antagonist prescription was 16% (95% CI 9.5, 23) in psychiatry, 7.5% (6.2, 8.9) in general medicine, 6.1% (4.5, 7.8) in surgery, and 0.90% (0.46, 1.3) in neurological/neurosurgical specialties. Inappropriate prescriptions were more often made at night (6pm-6am) than during the day (6am-6pm) (χ2=11.9, df=1, p=0.001). Of inappropriate prescriptions, 146 (74%) were continued in spite of the alert. Response to alert varied by specialty- 82% of surgical, 68% of general medicine, 95% of psychiatric, and 67% of neurological/neurosurgical patients had inappropriate medications continued after the physician had been alerted. CONCLUSIONS: An automated alert system that identifies concurrent dopamine antagonists and levodopa prescription in an academic medical center had little impact on physician prescribing behavior. Inappropriate dopamine antagonists were prescribed more often on the psychiatry service and at night. This study highlights the need for improved education of health care providers and possibly greater supervision of residents at night. Disclosure: Dr. Morris has nothing to disclose. Dr. Willis has nothing to disclose. Dr. McCann has nothing to disclose. Dr. Birke has nothing to disclose. Dr. Racette has received research support from Phytopharm, PLC, NeuroSearch, Novartis Pharmaceuticals Corporation, Schering-Plough Research Institute, Biotie Therapies Inc, Siena Biotech SpA, Abbott Products, Inc., and Allergan, Inc.