Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients.

Autor: Skains RM; Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL; Geriatric Research, Education and Clinical Center, Birmingham VAMC, Birmingham, AL., Koehl JL; Department of Pharmacy, Massachusetts General Hospital, Boston, MA., Aldeen A; US Acute Care Solutions, Canton, OH., Carpenter CR; Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA., Gettel CJ; Department of Emergency Medicine, Yale University, New Haven, CT., Goldberg EM; Department of Emergency Medicine, University of Colorado, Aurora, CO., Hwang U; Department of Emergency Medicine, Yale University, New Haven, CT; Geriatric Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY., Kocher KE; Department of Emergency Medicine, University of Michigan, Ann Arbor, MI., Southerland LT; Department of Emergency Medicine, The Ohio State University, Columbus, OH., Goyal P; Quality Division, American College of Emergency Physicians, Irving, TX., Berdahl CT; Department of Emergency Medicine, Cedars Sinai Medical Center, Los Angeles, CA., Venkatesh AK; Department of Emergency Medicine, Yale University, New Haven, CT., Lin MP; Department of Emergency Medicine, Stanford University, Palo Alto, CA. Electronic address: mplin@stanford.edu.
Jazyk: angličtina
Zdroj: Annals of emergency medicine [Ann Emerg Med] 2024 Sep; Vol. 84 (3), pp. 274-284. Date of Electronic Publication: 2024 Mar 12.
DOI: 10.1016/j.annemergmed.2024.01.033
Abstrakt: Study Objective: Half of emergency department (ED) patients aged 65 years and older are discharged with new prescriptions. Potentially inappropriate prescriptions contribute to adverse drug events. Our objective was to develop an evidence- and consensus-based list of high-risk prescriptions to avoid among older ED patients.
Methods: We performed a modified, 3-round Delphi process that included 10 ED physician experts in geriatrics or quality measurement and 1 pharmacist. Consensus members reviewed all 35 medication categories from the 2019 American Geriatrics Society Beers Criteria and ranked each on a 5-point Likert scale (5=highest) for overall priority for avoidance (Round 1), risk of short-term adverse events and avoidability (Round 2), and reasonable medical indications for high-risk medication use (Round 3).
Results: For each round, questionnaire response rates were 91%, 82%, and 64%, respectively. After Round 1, benzodiazepines (mean, 4.60 [SD, 0.70]), skeletal muscle relaxants (4.60 [0.70]), barbiturates (4.30 [1.06]), first-generation antipsychotics (4.20 [0.63]) and first-generation antihistamines (3.70 [1.49]) were prioritized for avoidance. In Rounds 2 and 3, hypnotic "Z" drugs (4.29 [1.11]), metoclopramide (3.89 [0.93]), and sulfonylureas (4.14 [1.07]) were prioritized for avoidability, despite lower concern for short-term adverse events. All 8 medication classes were included in the final list. Reasonable indications for prescribing high-risk medications included seizure disorders, benzodiazepine/ethanol withdrawal, end of life, severe generalized anxiety, allergic reactions, gastroparesis, and prescription refill.
Conclusion: We present the first expert consensus-based list of high-risk prescriptions for older ED patients (GEMS-Rx) to improve safety among older ED patients.
(Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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