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

Autor:	Vaughan CP; Medicine (CPV, AEV, MBS) & Emergency Medicine (DW), Emory University School of Medicine, Atlanta, Georgia, USA camille.vaughan@emory.edu.; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta VA Medical Center, Decatur, Georgia, USA., Hwang U; Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA.; Geriatric Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA., Vandenberg AE; Medicine (CPV, AEV, MBS) & Emergency Medicine (DW), Emory University School of Medicine, Atlanta, Georgia, USA., Leong T; Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, Georgia, USA., Wu D; Medicine (CPV, AEV, MBS) & Emergency Medicine (DW), Emory University School of Medicine, Atlanta, Georgia, USA., Stevens MB; Medicine (CPV, AEV, MBS) & Emergency Medicine (DW), Emory University School of Medicine, Atlanta, Georgia, USA.; Birmingham/Atlanta VA Geriatric Research Education and Clinical Center, Atlanta VA Medical Center, Decatur, Georgia, USA., Clevenger C; Emory University, School of Nursing, Atlanta, Georgia, USA., Eucker S; Medicine (LP, DS, SNH) & Emergency Medicine (SE, WH), Duke University School of Medicine, Durham, NC, USA., Genes N; Emergency Medicine (NG, DN) and Medicine (MS), Icahn School of Medicine at Mount Sinai, New York, New York, USA., Huang W; Medicine (LP, DS, SNH) & Emergency Medicine (SE, WH), Duke University School of Medicine, Durham, NC, USA., Ikpe-Ekpo E; Emergency Medicine, The Southeast Permanente Medical Group, Atlanta, Georgia, USA., Nassisi D; Emergency Medicine (NG, DN) and Medicine (MS), Icahn School of Medicine at Mount Sinai, New York, New York, USA., Previl L; Medicine (LP, DS, SNH) & Emergency Medicine (SE, WH), Duke University School of Medicine, Durham, NC, USA., Rodriguez S; Columbia University School of Social Work, New York, New York, USA., Sanon M; Emergency Medicine (NG, DN) and Medicine (MS), Icahn School of Medicine at Mount Sinai, New York, New York, USA., Schlientz D; Medicine (LP, DS, SNH) & Emergency Medicine (SE, WH), Duke University School of Medicine, Durham, NC, USA., Vigliotti D; Pharmacy Services, Grady Health System, Atlanta, Georgia, USA., Hastings SN; Medicine (LP, DS, SNH) & Emergency Medicine (SE, WH), Duke University School of Medicine, Durham, NC, USA.; Centre of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2021 Nov; Vol. 10 (4).
DOI:	10.1136/bmjoq-2021-001369
Abstrakt:	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. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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