Using a clinical process map to identify prescribing cascades in your patient
Katrina Piggott, Nishila Mehta, Camilla L. Wong, Paula A. Rochon
Abstract
### What you need to know The adverse effects of a drug may “hide” behind common presenting symptoms.1 Prescribing cascades occur when a healthcare provider misinterprets an adverse drug event as a new medical condition and provides a second drug to address the side effect, as described in 1997 by Rochon and Gurwitz in the BMJ .2 The concept has also been expanded to include unnecessary diagnostic tests, medical devices, and over-the-counter therapies,3 which may expose the patient to risk and harm. There is no universally accepted approach to identifying whether a drug is responsible for a symptom, but by identifying prescribing cascades, clinicians can reduce the number of unnecessary medications, investigations, consultations, and harms. To date, more than 20 prescribing cascades have been identified by cohort and population studies4 (see fig 1 for examples). These prescribing cascades are the result of medications for common conditions such as heart disease, hypertension, obstructive lung disease, diabetes, dementia, and chronic pain.356 Fig 1 Simple clinical process maps of three common prescribing cascades While prescribing cascades are well …