ArticleAnnals of emergency medicine2024
Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients.
Article in Annals of emergency medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024Pooled it
- Evaluation of Potentially Inappropriate Medications Prescribed to Older Adults Upon Emergency Department Discharge.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Implementation of geriatric clinical decision support in the emergency department for potentially inappropriate medications.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- First-Generation Antihistamine Use in Geriatric Emergency Department Patients: Retrospective Review.The western journal of emergency medicine · 2025Article
- A Model for Developing Subspecialty Clinical Practice Guidelines: The Geriatric Emergency Department Guidelines 2.0.Journal of the American College of Emergency Physicians open · 2025Article
- Pharmacogenomic Drug-Gene Interactions in Geriatric Emergency Department Patients Who Sustained Falls: A Pilot Study.The western journal of emergency medicine · 2025Article
- Team-based, Multidisciplinary Care in the Emergency Department.Emergency medicine clinics of North America · 2025Review
- Identifying Deprescribing Opportunities With Large Language Models in Older Adults: Retrospective Cohort Study.JMIR aging · 2025Article
- Data mining results for reduction of adverse drug-drug interaction events in older adults are clinically applicable.Therapeutic advances in drug safety · 2025Article
- Psychotropic Drugs for Older Adults With Psychiatric Disorders Presenting to the Emergency Department: Prescription Patterns and Treatment Outcomes.Psychiatric research and clinical practice · 2025Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
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.
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