Acad Emerg Med. 2026 Mar;33(3):e70257. doi: 10.1111/acem.70257.
ABSTRACT
BACKGROUND: Older adults are susceptible to adverse drug effects due to age-related changes, a higher prevalence of comorbidities, and complexities in medication management. Nearly half of geriatric patients are prescribed at least one new medication at ED discharge. This study evaluated potential pharmacist interventions on ED discharge prescriptions for older adults using the Geriatric Emergency Medicine Safety Recommendations (GEMS-Rx) list.
METHODS: This single-center, IRB-approved, retrospective review analyzed ED discharge prescriptions for potentially inappropriate medications based on GEMS-Rx criteria from October 2021 to September 2024 for patients ≥ 65 years who were discharged from the ED. Prescriptions were reviewed by a trained pharmacist for medication-related problems (MRPs). Outcomes included: rate of potential pharmacist intervention, number of prescriptions with at least one MRP, MRP types, missing risk vs. benefit documentation, rates of current practice pharmacist review, two or more GEMS-Rx prescriptions at discharge, and polypharmacy. All prescriptions during the study period were reviewed to determine medication sub-class distribution, with a random sample of 250 patients, ensuring at least 10 prescriptions per sub-class, if available. Descriptive statistics were utilized.
RESULTS: During the study period, 1458 prescriptions were written for included sub-classes. Of 284 prescriptions screened, 265 (for 250 patients) were included. The median (IQR) age was 69.5 (67-75) years with patients on a median (IQR) of 5 (3-8) scheduled home medications and discharged with a median (IQR) of 2 (1-3) new medications. Skeletal muscle relaxants (37.0%) and first-generation antihistamines (28.7%) were most frequent. Pharmacist intervention was potentially needed in 204 patients (81.6.%) with a median (IQR) of 2 (1, 2) MRPs per patient. Common MRPs included dose adjustment (53.2%), indication mismatch (41.1%), and frequency (38.1%).
CONCLUSIONS: Most GEMS-Rx prescriptions had at least one MRP, indicating an opportunity for enhanced prescribing. Future research should target strategies to optimize medications at ED discharge for older adults.
PMID:41803059 | PMC:PMC12971621 | DOI:10.1111/acem.70257