Appropriate Geriatric Emergency Medication Recommendations (AGEM Sponsored)

The rapidly aging U.S. population demands a shift in the emergency model of care for older adults, which has unique challenges for medication safety including complex geriatric syndromes, polypharmacy, and high-risk medication use. These challenges are further compounded in the emergency department (ED) by disorganized sleep patterns, unfamiliar surroundings, lack of activities of daily living, and rapid patient evaluation leading to prescribing cascades. Much of the existing Geriatric Emergency Medicine (GEM) clinical practice and research has focused on the Age-Friendly Healthcare System 4M framework, including ‘Medication’ that ensures appropriate prescribing, deprescribing, and medication management to minimize adverse drug events (ADEs) and promote health. To improve geriatric medication safety, the American Geriatrics Society (AGS) Beers Criteria was developed to identify potentially inappropriate medication (PIM) use in older adults. While prescribing tools are helpful in reducing ADEs in older adults, they are not comprehensive and may miss several important patient-level considerations nuanced to the geriatric population. The Geriatric ED Guidelines recommend a structured, comprehensive geriatric assessment that includes a medication reconciliation process using computerized clinical decision support (CDS) tools, pharmacist involvement, and a multidisciplinary team approach. Furthermore, interactive CDS tools in the form of high-risk medication alerts, geriatric-friendly medication order sets, and multidisciplinary geriatric consultations with subsequent ED provider education leads to the greatest sustainable improvement in minimizing the use of PIMs in older adults. There have been several ED-based medication safety programs that are individualized, multidisciplinary, and multifaceted that effectively reduce the prescription and administration of PIMs, which can improve adverse outcomes, ED revisits, and mortality of older adults. Implementation of a concise, goal-oriented, team approach to medication management beginning in the ED can potentially increase awareness of ADEs as presenting diagnoses, minimize the use of high-risk medications, polypharmacy, and drug-drug interactions, and positively influence the ED care of geriatric patients.

Presenters:

• Rachel M. Skains, MD, MSPH
• Jennifer Koehl, PharmD, BCEMP