Jason M Moss1, William E Bryan2, Loren M Wilkerson3, George L Jackson4, Ryan K Owenby2, Courtney Van Houtven5, Melissa B Stevens6, James S Powers7, Camille P Vaughan8, William W Hung9, Ula Hwang9, Alayne D Markland10, Gerald McGwin11, Susan Nicole Hastings12. 1. 1 Assistant Professor of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, and Clinical Pharmacy Specialist, Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina. 2. 2 Clinical Pharmacy Specialist, Pharmacy Service, Veterans Affairs Medical Center, Durham, North Carolina. 3. 3 Medical Instructor, Duke University School of Medicine, Durham, North Carolina. 4. 4 Research Health Scientist, Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, and Associate Professor, Duke University School of Medicine, Durham, North Carolina. 5. 5 Associate Professor, Duke University School of Medicine, and Research Scientist, Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina. 6. 6 Assistant Professor, Emory University School of Medicine, and Affiliate Investigator, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta VA Medical Center, Atlanta, Georgia. 7. 7 Associate Clinical Director, Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, and Associate Professor, Vanderbilt University School of Medicine, Nashville, Tennessee. 8. 8 Assistant Professor, Emory University School of Medicine, and Investigator, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta VA Medical Center, Atlanta, Georgia. 9. 9 Assistant Professor, Icahn School of Medicine at Mount Sinai, and Associate Director/Clinical (Acting), Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Bronx, New York. 10. 10 Investigator, Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center, and Assistant Professor, University of Alabama School of Medicine at Birmingham. 11. 11 Investigator, Department of Veterans Affairs Birmingham, Birmingham, Alabama/Atlanta Geriatric Research, Education, and Clinical Center; Professor and Vice Chairman, Department of Epidemiology; and Director, Biostatistics, Epidemiology and Research Design, Center for Clinical and Translational Science, University of Alabama at Birmingham. 12. 12 Investigator, Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina; Associate Professor, Duke University School of Medicine; and Investigator, Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina.
Abstract
BACKGROUND: As the proportion of older adult patients who interface with the health care system grows, clinical pharmacy specialists (CPS) have a pivotal role in reducing potentially inappropriate medication (PIM) use in this population. OBJECTIVES: To (a) describe CPS involvement in the design and implementation of a quality improvement (QI) initiative to decrease PIM prescribing in a Veterans Affairs (VA) emergency department (ED) and (b) report on changes in PIM prescribing before and after the initiative. METHODS: Enhancing Quality of Prescribing Practices for Veterans Discharged from the Emergency Department (EQUiPPED) is an ongoing multisite QI project that aims to decrease ED PIM prescribing. We used a mixed-method approach that applied qualitative and quantitative measures in describing the CPS role and evaluating PIM rates. PIMs were defined using the 2012 Beers Criteria. We reported monthly PIM rates in patients aged 65 years and older who were discharged from the ED from January 2012 to November 2014. A piecewise, nonlinear regression model evaluated the pattern in PIM prescriptions over time. RESULTS: At the Durham, North Carolina, VA Medical Center, a total of 4 CPS were involved with tailoring the design and implementation of the EQUiPPED intervention for local use. CPS input led to 3 key innovations: academic detailing performed by a physician-CPS pair, medication alert messages identifying medications as PIMs in the computerized patient record system, and automated reports describing the frequency and type of PIMs prescribed by each ED provider. Between February 2013 and November 2014, 73 ED providers received the academic detailing. The ED facility experienced a relative reduction of 47.5% in the rate of PIM prescribing over the observation period. CONCLUSIONS: This QI project resulted in a meaningful decrease in PIM prescribing in older ED adults. CPS contributions to QI can extend beyond pharmacotherapy and provider education to also include information technology tools using formulary management expertise.
BACKGROUND: As the proportion of older adult patients who interface with the health care system grows, clinical pharmacy specialists (CPS) have a pivotal role in reducing potentially inappropriate medication (PIM) use in this population. OBJECTIVES: To (a) describe CPS involvement in the design and implementation of a quality improvement (QI) initiative to decrease PIM prescribing in a Veterans Affairs (VA) emergency department (ED) and (b) report on changes in PIM prescribing before and after the initiative. METHODS: Enhancing Quality of Prescribing Practices for Veterans Discharged from the Emergency Department (EQUiPPED) is an ongoing multisite QI project that aims to decrease ED PIM prescribing. We used a mixed-method approach that applied qualitative and quantitative measures in describing the CPS role and evaluating PIM rates. PIMs were defined using the 2012 Beers Criteria. We reported monthly PIM rates in patients aged 65 years and older who were discharged from the ED from January 2012 to November 2014. A piecewise, nonlinear regression model evaluated the pattern in PIM prescriptions over time. RESULTS: At the Durham, North Carolina, VA Medical Center, a total of 4 CPS were involved with tailoring the design and implementation of the EQUiPPED intervention for local use. CPS input led to 3 key innovations: academic detailing performed by a physician-CPS pair, medication alert messages identifying medications as PIMs in the computerized patient record system, and automated reports describing the frequency and type of PIMs prescribed by each ED provider. Between February 2013 and November 2014, 73 ED providers received the academic detailing. The ED facility experienced a relative reduction of 47.5% in the rate of PIM prescribing over the observation period. CONCLUSIONS: This QI project resulted in a meaningful decrease in PIM prescribing in older ED adults. CPS contributions to QI can extend beyond pharmacotherapy and provider education to also include information technology tools using formulary management expertise.
Authors: Ann E Vandenberg; Melissa Stevens; Katharina V Echt; S Nicole Hastings; James Powers; Alayne Markland; Ula Hwang; William Hung; Stephanie Belbis; Camille P Vaughan Journal: Fed Pract Date: 2016-04
Authors: Grace Kuo Chair; Jennifer L Bacci; Michelle A Chui; Joel Farley; Peter M Gannett; Sheldon G Holstad; Melanie Livet; Dorothy Farrell Journal: Am J Pharm Educ Date: 2020-10 Impact factor: 2.047
Authors: Jason M Moss; William E Bryan; Loren M Wilkerson; Heather A King; George L Jackson; Ryan K Owenby; Courtney H Van Houtven; Melissa B Stevens; James Powers; Camille P Vaughan; William W Hung; Ula Hwang; Alayne D Markland; Richard Sloane; William Knaack; Susan Nicole Hastings Journal: J Pharm Pract Date: 2017-12-25
Authors: Audrey Rankin; Cathal A Cadogan; Susan M Patterson; Ngaire Kerse; Chris R Cardwell; Marie C Bradley; Cristin Ryan; Carmel Hughes Journal: Cochrane Database Syst Rev Date: 2018-09-03
Authors: Daniela A Rodrigues; Ana I Plácido; Ramona Mateos-Campos; Adolfo Figueiras; Maria Teresa Herdeiro; Fátima Roque Journal: Front Pharmacol Date: 2022-01-24 Impact factor: 5.810