ED use by older adults has risen dramatically over the past decade. As of 2017, adults ages 65 and older accounted for more than 22.4 million ED visits in the US. Between one-half and two-thirds of older patients are discharged from the ED after a diagnosis and treatment plan have been formulated.
Adding to the complexity of caring for older adults in the ED, between 40-66% of these older patients are prescribed at least one new medication upon discharge from the ED.
Problems with the quality of discharge medications, such as potentially inappropriate prescribing, have been described in a number of studies in the ED. There is accumulating evidence that inappropriate medication use is associated with increased risk of hospitalization among older adults.
Avoiding the use of inappropriate and high-risk drugs is an important, simple, and effective strategy to reduce medication-related problems in older adults.
What is EQUIPPED?
EQUIPPED is a quality improvement program that focuses on medication safety in older adults discharged from the ED.
The goal of the program is to reduce the number of Potentially Inappropriate Medications (PIMs), as defined by the American Geriatrics Society update to the Beers Criteria®, prescribed at discharge.
It was developed by an interdisciplinary team comprised of ED physicians, geriatricians, clinical pharmacists, and quality improvement nurses in the VA, and includes clinical and educational tools for use by clinicians in everyday practice as well as tools for quality managers and institutions to track performance.
What are the EQUIPPED Components?
Didactic education and academic detailing focused on reducing potentially inappropriate medications.
Clinical Decision Support
Discharge medication order sets designed to promote safer prescribing and provide alternatives to potentially inappropriate medications.
Individual Provider Feedback
Individual provider performance feedback, including audit and feedback, and peer benchmarking.
Results from the first four implementation sites demonstrate a significant (p < 0.05) and sustained reduction in the average monthly proportion of PIMs prescribed to older Veterans at the time of discharge.
Potentially inappropriate prescriptions at first 4 VA sites from the six months prior to EQUIPPED implementation to the period of at least 12 months following full implementation at
- Atlanta decreased from 11.9% (SD 1.8) to 5.1% (SD 1.4)
- Durham from 8.2% (SD 0.8) to 4.5% (SD 1.0)
- Birmingham from 8.9% (SD 1.9) to 6.1% (SD 1.7)
- Bronx from 7.5% (SD 1.7) to 5.7% (SD 0.8)
Identifying Inappropriate Medications
EQUIPPED leverages the 2019 update to the American Geriatrics Society Beers Criteria® to identify medications, drug classes, or medication/disease combinations to avoid in older people.