EQUIPPED is a multi-part quality improvement initiative that combines education, electronic clinical decision support and individual provider feedback to influence prescribing and improve medication safety for older adults. The goal is reducing use of potentially inappropriate medications (PIM).
Deeper dive
The initiative was developed by an interdisciplinary team of ED physicians, geriatricians, gerontologists, clinical pharmacists and quality improvement nurses in the Department of Veterans Affairs; it’s an ongoing program in eight VA emergency departments: Bronx, NY, Durham, NC, Ashville, NC, Nashville, TN, Murfreesboro, TN, Atlanta, GA, Birmingham, AL, Montgomery, AL
“The project aims to decrease the use of PIMs [potentially inappropriate medications], as identified by the Beers criteria, prescribed to veterans aged 65 and older at the time of ED discharge,,” according to participants at Emory University, one of the program sites.
EQUIPPED is more of a quality improvement initiative than a research study, which gives practitioners more flexibility. However, all project sites include three primary areas of intervention:
- Provider education — including tools for group didactic sessions, ED journal clubs and individual provider academic detailing.
- Informatics based clinical decision support — with templates for electronic medical record (EMR) embedded geriatric pharmacy order sets and links to online geriatric content.
- Individual provider performance feedback including audit and feedback, and peer benchmarking.
In a follow-up study, Melissa B. Stevens, MD, of the Atlanta VA Medical Center and assistant professor of medicine at Emory University School of Medicine and her research team concluded, “a team approach, combined with education and order sets, can significantly reduce the use of these medications.” .
Other sites saw similar drops in PIMs, according to the study,, despite some differences in the specifics of the intervention’s implementation.