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Safer prescribing for older adults after emergency care

January 14, 2018


Photo for illustrative purposes only. ©iStock/Steve Debenport

Adverse drug events are injuries resulting from medical interventions related to a drug. Such events can include medication errors, adverse drug reactions, allergic reactions, and overdoses. Certain drugs are classified as potentially inappropriate medications (PIMs) for the elderly, because they carry an increased risk of adverse drug events for people in this age group.

PIMs are a particular problem in hospital emergency departments (EDs), because EDs are unlike any other health care setting. Many ED patients may not know their medical conditions or medications or are unable to tell others this information. ED staff work in a fast-paced, potentially chaotic environment, and ED physicians often don’t have access to information on the safest medications for older people. Veterans aged 65 or older account for about 40 percent of all VA ED visits, and nearly two-thirds of those patients leave with a new prescription. Some of those new prescriptions may cause adverse drug events.

To reduce this danger, VA researchers and others have developed an initiative, called the Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED), to help providers prescribe the safest drugs to older Veterans who are discharged from an ED. The EQUiPPED program includes providing educational sessions, including lectures by geriatricians and clinical pharmacists, to ED care providers and residents. It also includes a clinical decision support process designed to help prescribers choose the right medication for older people; and one-on-one feedback to doctors on the drugs they are administering and how their prescribing decisions compare with those of other health care providers.

The initiative has been implemented at 10 VA facilities and has impacted more than 40,000 Veterans as of November 2018. Researchers have looked at the program at four sites and found each of them showed a “significant and sustained” reduction in the use of PIMs. Three non-VA EDs are also implementing the program.

Principal investigator: Dr. Melissa Stevens, Birmingham/Atlanta Geriatric Research Education and Clinical Center

Selected publications:

Stevens M, Hastings SN, Markland AD, Hwang U, Hung W, Vandenberg AE, Bryan W, Cross D, Powers J, McGwin G, Fattouh N, Ho W, Clevenger C, Vaughan CP. Enhancing Quality of Provider Practices for Older Adults in the Emergency Department. J Am Geriatr Soc. 2017 Jul;65(7):1609-1614.

Vandenberg AE, Stevens M, Echt KV, Hastings SN, Powers J, Markland A, Hwang U, Hung W, Belbis S, Vaughan CP. Implementing the EQUiPPED Medication Management Program at 5 VA Emergency Departments, Fed Pract. 2016 Apr;33(4):29-33.

VA program shows promise in improving safety of drug prescriptions for older patients, VA Research Currents, Aug. 2, 2017

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