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Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

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 t...

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Autores principales: Vaughan, Camille P, Hwang, Ula, Vandenberg, Ann E, Leong, Traci, Wu, Daniel, Stevens, Melissa B, Clevenger, Carolyn, Eucker, Stephanie, Genes, Nick, Huang, Wennie, Ikpe-Ekpo, Edidiong, Nassisi, Denise, Previl, Laura, Rodriguez, Sandra, Sanon, Martine, Schlientz, David, Vigliotti, Debbie, Hastings, S Nicole
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576471/
https://www.ncbi.nlm.nih.gov/pubmed/34750188
http://dx.doi.org/10.1136/bmjoq-2021-001369
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author Vaughan, Camille P
Hwang, Ula
Vandenberg, Ann E
Leong, Traci
Wu, Daniel
Stevens, Melissa B
Clevenger, Carolyn
Eucker, Stephanie
Genes, Nick
Huang, Wennie
Ikpe-Ekpo, Edidiong
Nassisi, Denise
Previl, Laura
Rodriguez, Sandra
Sanon, Martine
Schlientz, David
Vigliotti, Debbie
Hastings, S Nicole
author_facet Vaughan, Camille P
Hwang, Ula
Vandenberg, Ann E
Leong, Traci
Wu, Daniel
Stevens, Melissa B
Clevenger, Carolyn
Eucker, Stephanie
Genes, Nick
Huang, Wennie
Ikpe-Ekpo, Edidiong
Nassisi, Denise
Previl, Laura
Rodriguez, Sandra
Sanon, Martine
Schlientz, David
Vigliotti, Debbie
Hastings, S Nicole
author_sort Vaughan, Camille P
collection PubMed
description 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.
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spelling pubmed-85764712021-11-19 Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme Vaughan, Camille P Hwang, Ula Vandenberg, Ann E Leong, Traci Wu, Daniel Stevens, Melissa B Clevenger, Carolyn Eucker, Stephanie Genes, Nick Huang, Wennie Ikpe-Ekpo, Edidiong Nassisi, Denise Previl, Laura Rodriguez, Sandra Sanon, Martine Schlientz, David Vigliotti, Debbie Hastings, S Nicole BMJ Open Qual Quality Improvement Report 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. BMJ Publishing Group 2021-11-08 /pmc/articles/PMC8576471/ /pubmed/34750188 http://dx.doi.org/10.1136/bmjoq-2021-001369 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Quality Improvement Report
Vaughan, Camille P
Hwang, Ula
Vandenberg, Ann E
Leong, Traci
Wu, Daniel
Stevens, Melissa B
Clevenger, Carolyn
Eucker, Stephanie
Genes, Nick
Huang, Wennie
Ikpe-Ekpo, Edidiong
Nassisi, Denise
Previl, Laura
Rodriguez, Sandra
Sanon, Martine
Schlientz, David
Vigliotti, Debbie
Hastings, S Nicole
Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title_full Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title_fullStr Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title_full_unstemmed Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title_short Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme
title_sort early prescribing outcomes after exporting the equipped medication safety improvement programme
topic Quality Improvement Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8576471/
https://www.ncbi.nlm.nih.gov/pubmed/34750188
http://dx.doi.org/10.1136/bmjoq-2021-001369
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