Title: Implementation of a screening process for identifying polypharmacy in patients 65 and older in the emergency room
Abstract:
As individuals age, they are more likely to have two or more chronic health conditions requiring prescribing of multiple medications to manage those conditions. Polypharmacy, or the presence of five or more medications, and inappropriate prescribing of drugs are primary health concerns among older populations. Polypharmacy increases the risk of adverse drug reactions (ADEs), which contribute to falls with injuries, causing increased emergency room (ER) visits. Therefore, the project aimed to implement a polypharmacy screening process for patients 65 and older presenting to the emergency room. Kurt Lewin’s Three-Step Change Theory and the Iowa Method of Evidence-Based Practices guided the theoretical and conceptual frameworks for the project. The quality improvement project incorporated a standard process whereby emergency room nurses were cued to screen patients 65 and older for polypharmacy. A newly created mandatory documentation field in the electronic health record (EHR) prompted nursing staff to confirm patients aged 65 and older, which required completion of the medication history field in the EHR to assess for polypharmacy. As a result of the interventions, polypharmacy was identified in 69% (n=78) of 112 patients 65 and older records in a deidentified report between July 2023 and August 2023. A comparison of pre-intervention data from a previous report of 172 patient records of those 65 and older between June 2023 and July 2023 showed 19% (n=32.68) completion of the medication history section and identification of polypharmacy. Implementing a standard process for emergency room nurses to screen for polypharmacy in patients 65 and older proved successful. The project aimed to add to the nursing literature regarding the importance of screening for polypharmacy in older adults presenting to the emergency room, as the literature is limited in nursing’s role in this setting. The project’s findings supported the need to implement standards of practice for emergency room nurses when conducting a comprehensive medication history and identifying polypharmacy in patients 65 and older.
Keywords: Polypharmacy, potentially inappropriate medications, older adults, polypharmacy screening, adverse drug events.
Audience Take Away Notes:
• Emergency room nursing staff and their leadership team learn how to incorporate evidence-based screening processes into their current workflows and protocols to help identify polypharmacy in patients 65 and older presenting to the emergency room
• Screening for polypharmacy in patients 65 and older presenting to the emergency room will help with early identification of this issue and provide an opportunity to deprescribe potentially inappropriate medications, thereby decreasing adverse drug events that contribute to increased emergency room visits. Identifying polypharmacy in patients 65 and older through screening provides an opportunity to simplify medication regimens, which can reduce healthcare spending for older populations and enhance the quality of life for older adults
