Impact of Clinical Pharmacy Specialists on the Design and Implementation of a Quality Improvement Initiative to Decrease Inappropriate Medications in a Veterans Affairs Emergency Department

• Authors: Jason M. Moss, Campbell University; William E. Bryan, III, Veteran Affairs Medical Center; Loren M. Wilkerson, Duke University; George L. Jackson, Duke University; Ryan K. Owenby, Veteran Affairs Medical Center; Courtney Van Houtven, Duke University; Melissa Stevens, Emory University; James S. Powers, Tennessee Valley Healthcare System; Camille Vaughan, Emory University; William W. Hung, Icahn School of Medicine at Mount Sinai; Ula Hwang, Icahn School of Medicine at Mount Sinai; Alayne D. Markland, University of Alabama Birmingham; Gerald McGwin, University of Alabama Birmingham; Susan Nicole Hastings, Veteran Affairs Medical Center
• Journal Title: JOURNAL OF MANAGED CARE & SPECIALTY PHARMACY
• Volume: Volume 22, Number 1
• Publisher: ACAD MANAGED CARE PHARMACY | 2016-01-01, Pages 74-80
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.18553/jmcp.2016.22.1.74
• Subjects: Health Sciences, Pharmacology; Gerontology; Health Sciences, Pharmacy
• Keywords: Science & Technology; Life Sciences & Biomedicine; Health Care Sciences & Services; Pharmacology & Pharmacy; OLDER-ADULTS; HEPATITIS-C; DRUG; PHARMACOTHERAPY; DISEASE

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.