Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.

dc.contributor.author

Vaughan, Camille P

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Hwang, Ula

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Vandenberg, Ann E

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Leong, Traci

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Wu, Daniel

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Stevens, Melissa B

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Clevenger, Carolyn

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Eucker, Stephanie

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Genes, Nick

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Huang, Wennie

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Ikpe-Ekpo, Edidiong

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Nassisi, Denise

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Previl, Laura

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Rodriguez, Sandra

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Sanon, Martine

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Schlientz, David

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Vigliotti, Debbie

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Hastings, S Nicole

dc.date.accessioned

2023-06-01T15:42:01Z

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2023-06-01T15:42:01Z

dc.date.issued

2021-11

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2023-06-01T15:42:01Z

dc.description.abstract

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.

dc.identifier

bmjoq-2021-001369

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2399-6641

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2399-6641

dc.identifier.uri

https://hdl.handle.net/10161/27520

dc.language

eng

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BMJ

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BMJ open quality

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10.1136/bmjoq-2021-001369

dc.subject

Humans

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Patient Discharge

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Aged

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Emergency Service, Hospital

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United States

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Inappropriate Prescribing

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Potentially Inappropriate Medication List

dc.title

Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme.

dc.type

Journal article

duke.contributor.orcid

Eucker, Stephanie|0000-0001-9986-5773

duke.contributor.orcid

Hastings, S Nicole|0000-0002-5750-8820

pubs.begin-page

e001369

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4

pubs.organisational-group

Duke

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School of Medicine

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Basic Science Departments

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Clinical Science Departments

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Institutes and Centers

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Medicine

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Medicine, Geriatrics

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Center for the Study of Aging and Human Development

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Population Health Sciences

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Emergency Medicine

pubs.publication-status

Published

pubs.volume

10

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