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Background: Adverse drug events (ADEs) during hospitalization are a serious, yet preventable concern for older adults. Our institution designed a Geriatric Prescribing Context (GPC) to adjust doses for the older adult population but its impact on ADEs was unknown. The goal of this study was to assess any differences in rates of ADEs before and after its implementation in July 2017. Methods: We used relevant ICD‐10 codes followed by confirmatory chart review to identify dose‐related ADEs from 10 commonly used medications at our institution. We assessed differences in the number of admissions with an ADE before and after the GPC implementation using a test of binomial proportions. The pre‐period was from July 2016 through June 2017 and the post‐period was from August 2017 through July 2018. We compared the rate of ADEs per 1000 patient days between periods with a Poisson rate test and further examined any differences in harm categories using a Fisher's exact test. Results: The proportion of admissions with any dose‐related ADEs significantly decreased from 0.0082 to 0.0037 after the GPC (p = 0.04). The rate of dose‐related ADEs also declined from 2.5 per 1000 patient days to 1.1 per 1000 patient days (p = 0.001). Harm categories did not change significantly between time points (p = 0.30). Conclusions: Based on our list of relevant ICD‐10 codes, the GPC was associated with lower dose‐related ADEs for our selected medications among hospitalized older adults. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study on how healthcare providers can understand the experiences of patients having serious illness conversation (SIC) about their end-of-life preferences. Topics mentioned include the impact of SIC on patients' relationship with their healthcare provider, a list of themes and representative quotes from thematic analysis, and some confusion of patients about the term, goal, when discussing their preferences for their care.

Background: The medication‐related death of a hospitalized older adult elucidated the inappropriateness of medication default doses in our electronic health record (EHR) for older adults. In response, we created and implemented the Geriatric Prescribing Context (GPC), an EHR‐based set of age‐specific dose and frequency defaults for patients 75 years and older, in July 2017. Inpatient medication orders aligned with GPC defaults and showed significant dose decreases at one year for nine of ten most commonly used medications. This follow‐up investigation examined GPC alignment of dose and frequency over the 42‐month time period after its implementation. Methods: Order data for the ten most commonly used medications at OHSU Hospital were collected retrospectively from July 2016 through December 2020. We used Statistical Process Control charts to assess the proportion of medication orders aligning with the GPC's recommendations. Signals of special cause were evaluated to identify time periods when shifts in process averages likely occurred and suspected shifts were assessed using binomial proportion tests. We used RStudio (RStudio, Inc., version 1.2.5001) and Microsoft Excel (2016) to perform statistical analyses and control charts, respectively. Results: The preimplementation phase of all medications displayed no special causes. After significant initial improvement in 2017, control charts revealed three different patterns of performance. Eight medications maintained the initial improvement with one medication displaying a second significant improvement at a later date. Two medications showed a subsequent decline in performance not statistically different from baseline. Overall, eight of the ten medications were prescribed at more age‐friendly doses and frequencies compared to baseline after 42 months. Conclusions: The GPC is an effective method to support safer prescribing for hospitalized older patients, but long‐term impacts may be medication‐specific. Further investigation is needed to ensure appropriate prescribing across drug classes and understand the GPC's impact on patient outcomes like adverse drug events. [ABSTRACT FROM AUTHOR]