List of 39 Warning Messages Targeting Prescribing Decisions Designed to Prevent Adverse Drug Events in Long-Term Care

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From: Rochon PA, Field TS, Bates DW, Lee M, Gavendo L, Erramuspe-Mainard J, Judge J, Gurwitz JH. 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
Warning Messages Targeting Prescribing Decisions Designed to Prevent Adverse Drug Events in Long-Term Care


Scenario DescriptionWarning/Message
Warfarin order in setting of most-recent INR of >3 WARNING—BLEEDING RISK -- INR is ——. Current INR is high. Reduce WARFARIN dose and/or monitor closely.
Warfarin interaction with trimethoprim/sulfamethoxazole, amoxicillin/clavulanate 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.
Warfarin-antibiotic interaction WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Repeat the INR in 3 days. Consider reducing warfarin dose.
Warfarin-nonantibiotic interaction (e.g., amiodarone) WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days.
Warfarin-antiplatelet drug or NSAID interaction WARNING—BLEEDING RISK -- The use of WARFARIN with NSAIDs and/or ANTIPLATELET AGENTS increases bleeding risk. Reevaluate need for concomitant therapy.
Warfarin-nonantibiotic interaction (e.g., amiodarone) WARNING—BLEEDING RISK -- This drug interacts with WARFARIN. Monitor very closely. Repeat the INR in 3 days.
Antiplatelet drug—NSAID interaction WARNING—BLEEDING RISK -- The use of ANTIPLATELET AGENTS with NSAIDs increases bleeding risk. Evaluate need for concomitant therapy.
Any use of NSAIDs, ACE inhibitors, diuretics in resident with BUN and/or creatinine above certain threshold level 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.
Any drug therapy that can increase potassium level (ACE inhibitors, potassium-sparing diuretics, potassium supplements, NSAIDs) 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.
Any new prescription for thiazide or loop diuretic therapy WARNING—HYPOKALEMIA RISK -- Hypokalemia can result from use of thiazide and loop diuretics. Check POTASSIUM level in 7–10 days and continue monitoring.