E.Q.U.I.P.P.E.D.

 描述(由申请人提供)：装备(提高急诊科出院老年人的护理质量)老年人是一个易受伤害的人群，药物不良反应事件(ADE)的风险很高，尤其是当他们从急诊科(ED)出院时。最近的研究发现，超过一半从急诊室出院的老年人带着新的处方药离开。在老年初级保健的背景下为老年患者开新药会增加次优处方和不良反应的机会，这两个主要原因都是重复急诊、住院或死亡的1，2，2-8。在ED出院时为老年人提高患者安全性的全系统方法是本提案的重点。装备(提高急诊科出院老年人的处方质量)是一项创新的质量改进举措，旨在减少在急诊科环境中向65岁及以上的成年人开出可能不适当的药物处方。设备包括三种干预措施，都针对AHRQ推动的患者安全研究框架：a)通过教学教育和期刊俱乐部进行提供者教育；b)通过专门的老年药房订单集和处方点到在线教育内容的链接提供电子临床决策支持；以及c)学术细节，包括审计和反馈以及同行基准。装备是由啤酒标准提供信息的，该标准被政府机构广泛使用，并得到各种环境中的研究支持，作为处方质量的标志。目前，在Vaughan博士和Stevens博士领导下的8个退伍军人事务部急诊室和一个包括老年病学家、急救药物提供者、药剂师、护士和老年病学家9在内的多学科团队正在进行装备。装备的实施地点始终表明，在6个月9，10个月时，潜在不适当药物的使用相对减少了近50%。我们建议进行一项实施研究，以评估退伍军人管理局医疗系统以外的装备。在资助期内，我们会为透过教育署接受护理的长者广泛宣传和改善护理服务，因为教育署迫切需要现代化和方便的资源，以增加服务提供者的知识，并向已从教育署出院的长者推广安全用药的最佳做法。我们预期在实施装备后6个月，教育署为长者开出的潜在不适当药物处方，可相对减少50%。具体目标1：在三个非退伍军人事务部(Grady、Duke和Mt.西奈半岛)，以证明退伍军人制度外的可行性。具体目标2：使用REAIM框架对这3个地点的装备进行评估。具体目标3：开发一个工具箱，广泛传播到非退伍军人事务部网站。

 DESCRIPTION (provided by applicant): EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) Older adults are a vulnerable population at high risk for medication adverse drug events (ADEs) especially when they are discharged from the Emergency Department (ED). Recent studies have found that more than half of older adults discharged from the ED leave with a new prescription medication. Prescribing new medications for elderly patients outside the setting of geriatric primary care increases chances for suboptimal prescribing as well as ADEs, both major reasons for repeat ED visits, hospitalization or death 1,2 2-8. A system-wide approach to increase patient safety for older adults at the time of ED discharge is the focus of this proposal. EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) is an innovative quality improvement initiative designed to reduce potentially inappropriate medication prescribing to adults aged 65 years and older in the setting of the ED. EQUIPPED comprises three interventions that all address the Patient Safety Research Framework promoted by AHRQ: a) provider education via didactic education and journal club; b) electronic clinical decision support via specialized geriatric pharmacy order sets and links to online educational content at the point of prescribing; and c) academic detailing including audit and feedback and peer benchmarking. EQUIPPED is informed by the Beers Criteria, which are widely used by government agencies and supported by research in various settings1,6-7 as a marker of prescribing quality. EQUIPPED is currently underway in 8 Veterans Affairs EDs under the leadership of Drs. Vaughan and Stevens and a multidisciplinary team including geriatricians, emergency medicine providers, pharmacists, nurses, and gerontologists9. EQUIPPED implementation sites consistently demonstrate a relative reduction in the use of potentially inappropriate medications by nearly 50% at 6 months9,10. We propose an implementation study to evaluate EQUIPPED outside of the VA healthcare system. During the funding period we will develop a toolkit to facilitate broad dissemination and improved care for older adults receiving care through the ED as there is a pressing need in the ED for modern, easy to access resources to increase provider knowledge and disseminate best practices for safe medication prescribing to older adults who are discharged from the ED. We anticipate that the adaptation and then implementation of EQUIPPED will lead to a 50% relative reduction in potentially inappropriate medication prescriptions for older adults discharged from the ED at 6 months post-implementation. Specific Aim 1: IMPLEMENT EQUIPPED at three non-VA sites (Grady, Duke, and Mt. Sinai) to demonstrate feasibility outside the VA system. Specific Aim 2: EVALUATE EQUIPPED in these 3 sites using the REAIM framework. Specific Aim 3: Develop a toolbox for widespread DISSEMINATION to non-VA sites.