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

被引:2
作者
Skains, Rachel M. [1 ,2 ]
Koehl, Jennifer L. [3 ]
Aldeen, Amer [4 ]
Carpenter, Christopher R. [5 ]
Gettel, Cameron J. [6 ]
Goldberg, Elizabeth M. [7 ]
Hwang, Ula [6 ,8 ]
Kocher, Keith E. [9 ]
Southerland, Lauren T. [10 ]
Goyal, Pawan [11 ]
Berdahl, Carl T. [12 ]
Venkatesh, Arjun K. [6 ]
Lin, Michelle P. [13 ]
机构
[1] Univ Alabama Birmingham, Dept Emergency Med, Birmingham, AL USA
[2] Birmingham VAMC, Geriatr Res Educ & Clin Ctr, Birmingham, AL USA
[3] Massachusetts Gen Hosp, Dept Med, Boston, MA USA
[4] US Acute Care Solut, Canton, OH USA
[5] Mayo Clin, Dept Emergency Med, Rochester, MN USA
[6] Yale Univ, Smilow Canc Hosp, New Haven, CT USA
[7] Univ Colorado, Dept Med, Aurora, CO USA
[8] James J Peters VAMC, Geriatr Res Educ & Clin Ctr, Bronx, NY USA
[9] Univ Michigan, Dept Internal Med, Ann Arbor, MI USA
[10] Ohio State Univ, Dept Emergency Med, Columbus, OH USA
[11] Amer Coll Emergency Phys, Qual Div, Irving, TX USA
[12] Cedars Sinai Med Ctr, Dept Emergency Med, Los Angeles, CA USA
[13] Stanford Univ, Dept Emergency Med, Palo Alto, CA 94304 USA
关键词
PHARMACOLOGICAL MANAGEMENT; UNINTENDED CONSEQUENCES; ALCOHOL-WITHDRAWAL; ALLERGIC RHINITIS; ADULTS; DELIRIUM; QUALITY; EFFICACY; CARE; GUIDELINES;
D O I
10.1016/j.annemergmed.2024.01.033
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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, fi ed, 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 (51/4highest) 1 / 4 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]), fi rst-generation antipsychotics (4.20 [0.63]) and fi rst-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 fi nal 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. fi ll. Conclusion: We present the fi rst expert consensus-based list of high-risk prescriptions for older ED patients (GEMS-Rx) to improve safety among older ED patients. [Ann Emerg Med. 2024;84:274-284.]
引用
收藏
页码:274 / 284
页数:11
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