EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) Older adults are a vulnerable population at high risk for medication adverse drug events (ADEs) especially when they are discharged from the Emergency Department (ED). Recent studies have found that more than half of older adults discharged from the ED leave with a new prescription medication. Prescribing new medications for elderly patients outside the setting of geriatric primary care increases chances for suboptimal prescribing as well as ADEs, both major reasons for repeat ED visits, hospitalization or death 1,2 2-8. A system-wide approach to increase patient safety for older adults at the time of ED discharge is the focus of this proposal. EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) is an innovative quality improvement initiative designed to reduce potentially inappropriate medication prescribing to adults aged 65 years and older in the setting of the ED. EQUIPPED comprises three interventions that all address the Patient Safety Research Framework promoted by AHRQ: a) provider education via didactic education and journal club; b) electronic clinical decision support via specialized geriatric pharmacy order sets and links to online educational content at the point of prescribing; and c) academic detailing including audit and feedback and peer benchmarking. EQUIPPED is informed by the Beers Criteria, which are widely used by government agencies and supported by research in various settings1,6-7 as a marker of prescribing quality. EQUIPPED is currently underway in 8 Veterans Affairs EDs under the leadership of Drs. Vaughan and Stevens and a multidisciplinary team including geriatricians, emergency medicine providers, pharmacists, nurses, and gerontologists9. EQUIPPED implementation sites consistently demonstrate a relative reduction in the use of potentially inappropriate medications by nearly 50% at 6 months9,10. We propose an implementation study to evaluate EQUIPPED outside of the VA healthcare system. During the funding period we will develop a toolkit to facilitate broad dissemination and improved care for older adults receiving care through the ED as there is a pressing need in the ED for modern, easy to access resources to increase provider knowledge and disseminate best practices for safe medication prescribing to older adults who are discharged from the ED. We anticipate that the adaptation and then implementation of EQUIPPED will lead to a 50% relative reduction in potentially inappropriate medication prescriptions for older adults discharged from the ED at 6 months post-implementation.
Specific Aim 1 : IMPLEMENT EQUIPPED at three non-VA sites (Grady, Duke, and Mt. Sinai) to demonstrate feasibility outside the VA system.
Specific Aim 2 : EVALUATE EQUIPPED in these 3 sites using the REAIM framework.
Specific Aim 3 : Develop a toolbox for widespread DISSEMINATION to non-VA sites.
As of 2013, adults ages 65 years and older accounted for >19 million Emergency Department (ED) visits in the US. Older adults are a more vulnerable to medication adverse effects, yet they are frequently prescribed at least one new medication upon ED discharge, which adds complexity for patients and increases the risk of drug-drug interactions, adverse drug events, or dosing errors. EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) is a multi-component quality improvement initiative to reduce potentially inappropriate medication prescriptions written by ED providers for older adults at the time of ED discharge. Originally developed within the VA, EQUIPPED leverages strong preliminary data that support expanding the intervention beyond the VA system to enable dissemination nationwide to EDs that evaluate high numbers of older adults.
