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| + | #REDIRECT [[CDS]] |
| − | <table style="background-color: FFFFFF;" border="12">
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| − | From: Rochon PA, Field TS, Bates DW, Lee M, Gavendo L, Erramuspe-Mainard J, Judge J, Gurwitz JH. [http://www.ncbi.nlm.nih.gov/pubmed/16181180?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Computerized physician order entry with clinical decision support in the long-term care setting: insights from the Baycrest Centre for Geriatric Care]. J Am Geriatr Soc. 2005 Oct;53(10):1780-9. Accessed 2-10-2009
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| − | <th>Warning Messages Targeting Prescribing Decisions Designed to Prevent Adverse Drug Events in Long-Term Care</th> <tr>
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| − | <table style="background-color: FFFFFF;" border="4">
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| − | <th align=left>Scenario Description</th><th align=left>Warning/Message</th>
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| − | <tr><td align=left>Warfarin order in setting of most-recent INR of >3</td>
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| − | <td> WARNING—BLEEDING RISK --
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| − | INR is ——. Current INR is high. Reduce WARFARIN dose and/or monitor closely.<tr>
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| − | <td align=left>Warfarin interaction with trimethoprim/sulfamethoxazole, amoxicillin/clavulanate</td>
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| − | <td> WARNING—BLEEDING RISK -- This drug can interact profoundly with WARFARIN. Consider an alternative antibiotic or monitor very closely. Repeat the INR in 3 days and consider reducing warfarin dose.<tr>
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| − | <td align=left>Warfarin-antibiotic interaction</td>
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| − | <td> WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Repeat the INR in 3 days. Consider reducing warfarin dose.<tr>
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| − | <td align=left>Warfarin-nonantibiotic interaction (e.g., amiodarone)</td>
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| − | <td> WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days.<tr>
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| − | <td align=left>Warfarin-antiplatelet drug or NSAID interaction</td>
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| − | <td> WARNING—BLEEDING RISK -- The use of WARFARIN with NSAIDs and/or ANTIPLATELET AGENTS increases bleeding risk. Reevaluate need for concomitant therapy.<tr>
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| − | <td align=left>Warfarin-nonantibiotic interaction (e.g., amiodarone)</td>
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| − | <td> WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days.<tr>
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| − | <td align=left>Antiplatelet drug—NSAID interaction</td>
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| − | <td> WARNING—BLEEDING RISK -- The use of ANTIPLATELET AGENTS with NSAIDs increases bleeding risk. Evaluate need for concomitant therapy.<tr>
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| − | <td align=left>Any use of NSAIDs, ACE inhibitors, diuretics in resident with BUN and/or creatinine above certain threshold level</td>
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| − | <td> WARNING—RENAL INSUFFICIENCY RISK -- Current BUN=——, Creatinine=——. Worsening renal insufficiency can result from ACE inhibitors, angiotensin receptor blockers (e.g., losartan), diuretics, and NSAIDs. Evaluate medication regimen and monitor BUN and CREATININE closely. <tr>
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| − | <td align=left>Any drug therapy that can increase potassium level (ACE inhibitors, potassium-sparing diuretics, potassium supplements, NSAIDs)</td>
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| − | <td> WARNING—HYPERKALEMIA RISK -- Most recent POTASSIUM is —. HYPERKALEMIA can result from therapy with any of the following: ACE inhibitors, angiotensin receptor blockers (e.g., losartan), potassium-sparing diuretics, NSAIDs, and mineralocorticoids. Reevaluate medication regimen and monitor POTASSIUM level closely.<tr>
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| − | <td align=left>Any new prescription for thiazide or loop diuretic therapy</td>
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| − | <td> WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring. <tr>
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| − | <td align=left>Anticholinergic medications (e.g., nortriptyline)</td>
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| − | <td>WARNING—RISK OF ANTICHOLINERGIC EFFECTS -- This drug poses a high risk of dry mouth, constipation, urinary retention, and delirium. Use the lowest feasible dose. Monitor closely for these effects. <tr>
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| − | <td align=left>Oxybutynin and tolterodine</td>
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| − | <td>WARNING—RISK OF URINARY RETENTION -- Order a bladder scan 7 days after initiation of therapy or any change in dose and monitor. <tr>
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