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Innovation Update

EQUIPPED for Medication Safety in VA Emergency Departments

EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults in the Emergency Department) is a quality improvement program associated with improved prescribing toward older adults who are discharged from the ED.¹ The program was initiated within the Atlanta VAHCS and has been implemented in twelve VA EDs. EQUIPPED involves education, clinical decision support, and provider audit and feedback. The provider feedback component is typically delivered at least once in person by a local EQUIPPED champion, representing a clinical colleague (ED physician or advanced practice provider, geriatrician, pharmacist) with knowledge of principles of safe prescribing toward older adults. This implementation strategy using an academic detailing approach has been successful at multiple sites, with most EQUIPPED implementation sites demonstrating significantly fewer potentially inappropriate medications prescribed each month.² However, incorporating academic detailing is time and personnel intensive. With the advent of clinical dashboards, which leverage VA’s robust clinical informatics infrastructure, centralized mechanisms of provider feedback may be more efficient and have similar impact on provider behavior change and prescribing safety.

 The EQUIPPED team received 2018 HSR&D funding to evaluate two implementation strategies to determine the most effective strategy for broader EQUIPPED dissemination. Eight VA medical centers have been randomized to implement either ‘traditional’ EQUIPPED, which involves in-person academic detailing, or ‘dashboard’ EQUIPPED, where prescribing feedback is provided using a near real-time interactive dashboard supported by VA’s Corporate Data Warehouse and developed by the Salt Lake City VA IDEAS COIN center. Both methods for prescribing feedback will highlight potentially inappropriate medications according to the American Geriatrics Society Beers Criteria®, recommend alternative medication choices, and include peer benchmarking.³ All sites will receive implementation support from EQUIPPED leads based in the Birmingham/Atlanta GRECC. Formative evaluation of EQUIPPED implementation will be led by investigators at the Durham VA COIN based upon the Organizational Theory of Implementation Effectiveness.

References

1. Stevens M, Hastings SN, Markland AD, et al. “Enhancing Quality of Provider Practices for Older Adults in the Emergency Department (EQUiPPED),” Journal of the American Geriatrics Society 2017; 65(7):1609-14.
2. Stevens MB, Vandenberg A, Hwang U, et al. “Impact of Local Implementation Adaptation on Prescribing Change through the EQUIPPED Medication Safety Program” (abstract). Journal of the American Geriatrics Society 2019; 67:S13-14.
3. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 Updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society 2019; 67(4):674-94./li>