Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients
Authors: 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, Michelle P Lin
Published in: Annals of Emergency Medicine, 2024 March 13
Conclusion:
The study introduces the first expert consensus-based list of high-risk prescriptions for older ED patients, named GEMS-Rx, aiming to enhance medication safety for this vulnerable population.
Methods:
- Utilization of a modified, 3-round Delphi process involving 10 ED physician experts in geriatrics or quality measurement and 1 pharmacist.
- Evaluation of all 35 medication categories from the 2019 American Geriatrics Society Beers Criteria.
- Medications were ranked using a 5-point Likert scale across three rounds focusing on overall priority for avoidance, risk and avoidability of short-term adverse events, and reasonable medical indications for high-risk medication use.
Results:
- High response rates were achieved across all three rounds: 91%, 82%, and 64%.
- Initial prioritization for avoidance included benzodiazepines, skeletal muscle relaxants, barbiturates, first-generation antipsychotics, and first-generation antihistamines.
- Subsequent rounds emphasized the avoidability of hypnotic "Z" drugs, metoclopramide, and sulfonylureas, considering their risk of short-term adverse events.
- The final list encompasses 8 medication classes deemed high-risk for older ED patients.
- Identified reasonable indications for using high-risk medications include seizure disorders, benzodiazepine/ethanol withdrawal, end of life care, severe generalized anxiety, allergic reactions, gastroparesis, and prescription refill needs.