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Editor's Correspondence
Less Is More
March 14, 2011

Time to Change the Paradigm—From “Potentially Inappropriate” to Real Patient Harms—Reply

Author Affiliations

Author Affiliations: Divisions of Gerontology (Dr Mattison) and General Medicine and Primary Care (Drs Mattison, Ngo, and Mukamal), Department of Medicine, and Department of Clinical Systems Development (Mr Afonso), Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Arch Intern Med. 2011;171(5):473-474. doi:10.1001/archinternmed.2011.49

In reply

Drs Shehab and Budnitz are correct that we did not prove that our institution's CPOE reduced clinical harm resulting from a decrease in the use of PIMs in hospitalized elderly patients, nor did we claim to do so. To our knowledge, ours is the first study to demonstrate a systematic method that effectively and specifically reduces use of PIMs in hospitalized elderly patients institutionwide, a necessary first step to determine if reduced use ultimately improves outcomes.1 However, we should note that a simple reliance on proving clinical harm in this setting ignores a substantial body of clinical practice and research. For example, we can imagine no geriatrician who would recommend diphenhydramine be administered more frequently to frail hospitalized elderly patients, yet that very result would have occurred had this CPOE system not been implemented. Thus, the mere fact that there are other possible avenues for reducing adverse drug events in no way suggests that effective, standardized, and systemic approaches such as CPOE warning systems should be ignored. Instead, our patients will benefit most from multifaceted efforts of varying complexity and impact that collectively offer the best chance to produce substantial gains in patient safety.

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