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Emergency Department Programs to Support Medication Safety in Older Adults: A Systematic Review and Meta-Analysis
Rachel M Skains1,2, Jane M Hayes3, Katherine Selman4
1Department of Emergency Medicine, Heersink School of Medicine, The University of Alabama at Birmingham.
JAMA Network Open
|March 11, 2025
Summary
Emergency department (ED) programs using clinical pharmacists and computerized clinical decision support systems (CDSS) improve medication safety for older adults. These interventions reduce potentially inappropriate medications (PIMs), enhancing prescribing and deprescribing practices.
Area of Science:
- Geriatric Medicine
- Clinical Pharmacy
- Health Services Research
Background:
- Older adults are highly susceptible to adverse drug events (ADEs).
- Geriatric medication programs aim to optimize medication safety through improved ordering, prescribing, and deprescribing.
Purpose of the Study:
- To identify emergency department (ED)-based geriatric medication programs associated with reduced potentially inappropriate medications (PIMs) and ADEs.
Main Methods:
- Systematic literature search of multiple databases (Scopus, Embase, PubMed, etc.) conducted on February 14, 2024.
- Included randomized clinical trials and observational studies of ED-based geriatric medication programs (≥65 years).
- Data abstraction and quality assessment followed PRISMA guidelines and Cochrane risk-of-bias tool.
Main Results:
- 25 studies (44,640 participants) were included, categorized into clinical pharmacist reviews, geriatrician teleconsultation, clinician educational interventions, computerized clinical decision support systems (CDSS), and fall risk-increasing drug (FRID) reviews.
- Clinical pharmacist reviews showed a 32% reduction in PIMs via deprescribing.
- Clinician educational interventions reduced PIM prescribing by 19%, and computerized CDSS reduced PIM ordering by 40%.
Conclusions:
- Multidisciplinary teams (clinical pharmacists, geriatricians) in EDs improve PIM deprescribing.
- Computerized CDSS, with or without clinician education, enhances geriatric medication ordering and prescribing.
- Findings will inform updates to Geriatric ED Guidelines.
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