• Rachel M Skains, Jennifer L Koehl, Amer Aldeen, Christopher R Carpenter, Cameron J Gettel, Elizabeth M Goldberg, Ula Hwang, Keith E Kocher, Lauren T Southerland, Pawan Goyal, Carl T Berdahl, Arjun K Venkatesh, and Michelle P Lin.
• Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL; Geriatric Research, Education and Clinical Center, Birmingham VAMC, Birmingham, AL.
• Ann Emerg Med. 2024 Sep 1; 84 (3): 274284274-284.

Study ObjectiveHalf of emergency department (ED) patients aged 65 years and older are discharged with new prescriptions. Potentially inappropriate prescriptions contribute to adverse drug events. Our objective was to develop an evidence- and consensus-based list of high-risk prescriptions to avoid among older ED patients.MethodsWe performed a modified, 3-round Delphi process that included 10 ED physician experts in geriatrics or quality measurement and 1 pharmacist. Consensus members reviewed all 35 medication categories from the 2019 American Geriatrics Society Beers Criteria and ranked each on a 5-point Likert scale (5=highest) for overall priority for avoidance (Round 1), risk of short-term adverse events and avoidability (Round 2), and reasonable medical indications for high-risk medication use (Round 3).ResultsFor each round, questionnaire response rates were 91%, 82%, and 64%, respectively. After Round 1, benzodiazepines (mean, 4.60 [SD, 0.70]), skeletal muscle relaxants (4.60 [0.70]), barbiturates (4.30 [1.06]), first-generation antipsychotics (4.20 [0.63]) and first-generation antihistamines (3.70 [1.49]) were prioritized for avoidance. In Rounds 2 and 3, hypnotic "Z" drugs (4.29 [1.11]), metoclopramide (3.89 [0.93]), and sulfonylureas (4.14 [1.07]) were prioritized for avoidability, despite lower concern for short-term adverse events. All 8 medication classes were included in the final list. Reasonable indications for prescribing high-risk medications included seizure disorders, benzodiazepine/ethanol withdrawal, end of life, severe generalized anxiety, allergic reactions, gastroparesis, and prescription refill.ConclusionWe present the first expert consensus-based list of high-risk prescriptions for older ED patients (GEMS-Rx) to improve safety among older ED patients.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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