Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Victor Morris


The inappropriate use of diphenhydramine (Benadryl™) can lead to iatrogenic complications, such as cognitive decline. Electronic reminders can be effective in implementing clinical guidelines, providing decision support to clinicians, and reducing medical errors. The purpose of this study was to determine the effect of an electronic reminder screen on physicians' routine use of diphenhydramine as a pretreatment prior to blood transfusions, and to assess their attitudes regarding this reminder. The researchers reviewed diphenhydramine use in adult inpatients before, immediately after, and one year after implementation of the reminder screen. A total of 752 transfusion episodes (467 patients) were reviewed, with 253 in the pre-screen group, 249 in the post-screen group, and 250 in the post-screen comparison group. The mean age in each group was 66 years (SD=15), 64 years (SD=15), and 69 years (SD=12), respectively. Diphenhydramine use decreased significantly after screen implementation from 41% to 20% (p<0.005) the first year and down to 12% (p<0.005) the second year. An analysis in the medical, surgical, and obstetrics/gynecology services demonstrated significant absolute reductions over time (38.6%, 28.1%, and 4.6% reductions, respectively, p<0.05). Only 17% of all treated patients had a documented indication for diphenhydramine. Treated patients had higher rates of mental status change than non-treated patients--32/83 (39%) vs. 92/513 (18%, p<030005). Fifty-six house staff completed a questionnaire regarding the electronic reminder (estimated response rate 53%). Sixty-nine percent reported ordering diphenhydramine less that 25% of the time (SD=0.9), 71% were aware of blood bank pretreatment recommendations (SD=0.5), 55% had seen the reminder (SD=0.5), 59% changed their behavior due to the reminder (SD=0.7), and 65% felt the reminder was helpful and should remain in the system (SD=0.9). Diphenhydramine use significantly declined immediately and over time with the implementation of an electronic reminder, supporting the use of this mechanism to impact physician practice patterns.


This is an Open Access Thesis.