Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.
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2021-11
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Enhancing quality of prescribing practices for older adults discharged from the Emergency Department (EQUIPPED) aims to reduce the monthly proportion of potentially inappropriate medications (PIMs) prescribed to older adults discharged from the ED to 5% or less. We describe prescribing outcomes at three academic health systems adapting and sequentially implementing the EQUIPPED medication safety programme.EQUIPPED was adapted from a model developed in the Veterans Health Administration (VA) and sequentially implemented in one academic health system per year over a 3-year period. The monthly proportion of PIMs, as defined by the 2015 American Geriatrics Beers Criteria, of all medications prescribed to adults aged 65 years and older at discharge was assessed for 6 months preimplementation until 12 months postimplementation using a generalised linear time series model with a Poisson distribution.The EQUIPPED programme was translated from the VA health system and its electronic medical record into three health systems each using a version of the Epic electronic medical record. Adaptation occurred through local modification of order sets and in the generation and delivery of provider prescribing reports by local champions. Baseline monthly PIM proportions 6 months prior to implementation at the three sites were 5.6% (95% CI 5.0% to 6.3%), 5.8% (95% CI 5.0% to 6.6%) and 7.3% (95% CI 6.4% to 9.2%), respectively. Evaluation of monthly prescribing including the twelve months post-EQUIPPED implementation demonstrated significant reduction in PIMs at one of the three sites. In exploratory analyses, the proportion of benzodiazepine prescriptions decreased across all sites from approximately 17% of PIMs at baseline to 9.5%-12% postimplementation, although not all reached statistical significance.EQUIPPED is feasible to implement outside the VA system. While the impact of the EQUIPPED model may vary across different health systems, results from this initial translation suggest significant reduction in specific high-risk drug classes may be an appropriate target for improvement at sites with relatively low baseline PIM prescribing rates.
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Vaughan, Camille P, Ula Hwang, Ann E Vandenberg, Traci Leong, Daniel Wu, Melissa B Stevens, Carolyn Clevenger, Stephanie Eucker, et al. (2021). Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme. BMJ open quality, 10(4). p. e001369. 10.1136/bmjoq-2021-001369 Retrieved from https://hdl.handle.net/10161/27520.
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Stephanie Ann Eucker
Stephanie Eucker, MD, PhD, FACEP is an Assistant Professor and Assistant Director of Acute Care Research in the Duke University Department of Emergency Medicine. Her primary research interest is in preventing and treating chronic pain, disability, and opioid use disorder (OUD) by incorporating innovative multimodal and nonpharmacologic pain management strategies in the Emergency Department (ED). Her broad clinical and research training includes Emergency Medicine, Bioengineering, Clinical and Translational research. Her research comprises three main synergistic areas of focus: (1) innovative nonpharmacologic ED pain care models, (2) patient-centered, personalized medicine approaches to pain care selection, and (3) transforming ED care best practices.
In the nonpharmacologic realm, Dr. Eucker is PI of a SAMHSA-funded pragmatic randomized clinical trial of acupuncture to treat acute musculoskeletal pain in the ED, to which her team has successfully recruited 599 patients with >50% identifying as African-American and/or Latinx. Her team successfully developed an approach to acupuncture that is feasible for the fast-paced ED setting, produces significantly greater pain reductions than usual care alone, and is used and rated highly acceptable by diverse ED patients with acute musculoskeletal pain.
In the patient-centered focus, she leads several ongoing studies investigating the relationship between biopsychosocial factors and pain-related outcomes in ED patients, patient expectations for ED pain management, and the relationship between post-ED care pathways and downstream opioid use.
Regarding research on improving and implementing ED best practices, Dr. Eucker is site-PI for the multi-site PROCOVAXED study aiming to improve COVID-19 vaccination rates among ED patients through multi-media informational platforms. She has been a co-investigator in a multi-center AHRQ implementation study to improve safe ED prescribing for older adults. She also leads a multi-professional quality improvement and research effort to improve naloxone and buprenorphine prescribing for ED patients with opioid overdose and OUD. She has also partnered with Durham County and other community partners to improve linkages to care through peer support specialists in the ED.
Regarding training, Dr. Eucker has mentored numerous trainees in research, including undergraduates, graduate students, medical student, resident physicians, physician assistants and junior faculty over the past several years. She is highly experienced at engaging learners at their level of understanding and interest in the research process, from novice researchers to those with extensive experience. Her mentees have coauthored numerous publications and progressed to leading projects under her mentorship.
Susan Nicole Hastings
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