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Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

Authors :
Stephanie Eucker
Ula Hwang
Carolyn Clevenger
Traci Leong
Camille P Vaughan
Ann E Vandenberg
Daniel Wu
Melissa B Stevens
Nick Genes
Wennie Huang
Edidiong Ikpe-Ekpo
Denise Nassisi
Laura Previl
Sandra Rodriguez
Martine Sanon
David Schlientz
Debbie Vigliotti
S Nicole Hastings
Source :
BMJ Open Quality, Vol 10, Iss 4 (2021)
Publication Year :
2021
Publisher :
BMJ Publishing Group, 2021.

Abstract

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.

Subjects

Subjects :
Medicine (General)
R5-920

Details

Language :
English
ISSN :
23996641
Volume :
10
Issue :
4
Database :
Directory of Open Access Journals
Journal :
BMJ Open Quality
Publication Type :
Academic Journal
Accession number :
edsdoj.bc75aaf172144fae9c01b6905046ba32
Document Type :
article
Full Text :
https://doi.org/10.1136/bmjoq-2021-001369