Reducing medication burden and improving pressure injury outcomes in older emergency patients: a pharmacist-nurse...

Older adults admitted for acute conditions with pre-existing pressure injuries (PIs) often experience poor prognoses and are frequently affected by multimorbidity and polypharmacy. Medication burden and complex treatment regimens may further impede recovery. However, pharmacist-led comprehensive medication management integrated with stratified nursing care for PI management in emergency wards remains insufficiently investigated.

This retrospective before-after cohort study was conducted in a tertiary hospital. Older patients with pre-existing PIs at admission were allocated to a pre-implementation cohort (2024, n = 165) and a post-implementation cohort (2025, n = 175). The intervention consisted of a pharmacist-involved multidisciplinary stratified care model, including medication reconciliation, regimen optimization, risk-stratified nursing care, repositioning protocols, pressure off-loading measures, nutritional support, and health education. Outcomes were evaluated using changes in Braden scores, wound healing status, clinical recovery, length of stay, Charlson Comorbidity Index (CCI), Drug Burden Index (DBI), Medication Regimen Complexity Index (MRCI), number of medications, and medication cost proportion. A contemporaneous non-PI cohort (200 vs. 200) was randomly selected as a reference group to exclude systemic temporal trends.

Compared with the reference group, patients with PIs exhibited higher CCI, DBI, and MRCI scores and poorer clinical outcomes. Baseline characteristics were comparable between groups. Following implementation, the proportion of medication costs and daily MRCI scores decreased significantly (both P < 0.05). The mean number of prescribed agents decreased by 3.37 and DBI declined by 25.30%, though neither reached statistical significance. The post-implementation cohort demonstrated higher rates of clinical recovery (10.3 vs. 1.2%, P = 0.002), PI improvement (87.4 vs. 77.0%, P = 0.041), and Braden score improvement (78.9 vs. 53.9%, P < 0.001). Length of stay decreased by 1.1 days (P = 0.142). No significant changes were observed in the non-PI reference cohort over the corresponding timeframe.

A pharmacist-involved, multidisciplinary stratified care model effectively reduced medication burden and regimen complexity while improving wound healing and functional outcomes in older emergency patients with PIs, providing a feasible and pragmatic strategy for optimizing PI management.