Polypharmacy and High-risk Medications in Older Veterans Presenting for Emergency Care

Abstract

Background: Guidelines suggest screening for polypharmacy and documentation of high-risk medications in the geriatric Emergency Department (ED) setting. The purpose of this quality improvement initiative was to describe high-risk medications and polypharmacy in older Veterans presenting to the ED in order to inform the workflow of a Geriatric ED pharmacist. Methods: This was a retrospective, quality improvement project that included patients age 65 years or older who presented to the ED between 10/1/2017 and 9/30/2019. The endpoints included the number of patients with at least one high-risk medication and the mean number of medications on the outpatient medication list. The number of patients age greater than 75 and one at least 10 medications or one high-risk medication was also evaluated. Results: A total of 27,018 patients were included in the analysis. Approximately 83% of patients had at least one high-risk medication, with a mean of 13 ± 7 active outpatient medications per patient. Thirty-one percent of patients were at least 75 years of age, on 10 medication, or a high-risk medication. The three most common high-risk drug classes were antihypertensives, antidepressants, and opioids. Discussion: A high prevalence of high-risk medications and polypharmacy was found in this population. Screening criteria was developed for comprehensive medication reviews to be completed by a clinical pharmacist in a geriatric ED setting.