High‐Risk Medications in Hospitalized Elderly Adults: Are We Making It Easy to Do the Wrong Thing?

Objectives To examine dosages of high‐risk medications administered to elderly adults who fall in the hospital and to determine whether electronic default doses are appropriate for elderly adults. Design Retrospective. Setting Large urban academic hospital. Participants Individuals aged 65 and older experiencing a fall. Measurements Prescribed daily dosages and use of high‐risk medications (opiates, benzodiazepines, benzodiazepine‐receptor agonists (BRAs), sleep medications, muscle relaxants, antipsychotics) administered within 24 hours before a fall were ascertained and compared with published recommended dosages for older adults and the hospital's electronic medical record (EMR) default doses for these drugs. Results Of 328 falls, 62% occurred in individuals administered at least one high‐risk medication within the 24 hours before the fall, with 16% of the falls involving individuals receiving two, and another 16% in individuals receiving three or more. High‐risk medications were often administered at higher‐than‐recommended geriatric daily doses, in particular benzodiazepines and BRAs, for which the dose was higher than recommended in 29 of 51 cases (57%). Hospital EMR default doses were higher than recommended for 41% (12/29) of medications examined. Conclusion High‐risk medications were administered to older fallers. Doses administered and EMR default doses were often higher than recommended. Decreasing EMR default doses for individuals aged 65 and older and warnings about the cumulative numbers of high‐risk medications prescribed per person may be simple interventions that could decrease inpatient falls.