Early prescribing outcomes after exporting the EQUIPPED medication safety improvement programme

• Authors: Camille Vaughan, Emory University; Ula Hwang, Yale School of Medicine; Ann Vandenberg, Emory University; Traci Leong, Emory University; Daniel Wu, Emory University; Melissa Stevens, Emory University; Carolyn Clevenger, Emory University; Stephanie Eucker, Duke University; Nick Genes, Icahn School of Medicine at Mount Sinai; Wennie Huang, Duke University; Edidiong Ikpe-Ekpo, Permanente Medical Group; Denise Nassisi, Icahn School of Medicine at Mount Sinai; Laura Previl, Duke University; Sandra Rodriguez, Columbia University; Martine Sanon, Icahn School of Medicine at Mount Sinai; David Schlientz, Duke University; Debbie Vigliotti, Grady Health System; S. Nicole Hastings, Duke University
• Journal Title: BMJ Open Quality
• Volume: Volume 10, Number 4
• Publisher: BMJ | 2021-11-08
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjoq-2021-001369
• Subjects: Health Sciences, Health Care Management; Health Sciences, Pharmacy
• Keywords: audit and feedback; emergency department; quality improvement

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.