investigators were able to develop
a relatively standardized process
model to improve ED prescribing
practices for clinicians caring for
older adults. The implementation
model captures factors at the level
of context (alignment with priorities
of care), inputs (resources available),
outputs (activities and participation),
and outcomes (short, medium, and
long-term). In addition to the process
model, EQUiPPED has developed
an implementation tool kit, which
includes order set logic, the Beers
look-up tool developed by Durham,
education materials, and provider
The implementation model and
components of the tool kit are available by request through the Birmingham/Atlanta GRECC. With these
materials, the EQUiPPED project is
poised for implementation at other
VA EDs or at sites beyond the VA.
Successful implementation of
EQUiPPED, an innovative geriatric
practice intervention to reduce PIM
prescribing in the ED, is dependent
on careful planning and site custom-
ization. Distilling factors that differed
across VA sites resulted in a model
intended to promote implementation
and dissemination of the EQUIPPED
The authors report no actual or potential conflicts of interest with regard to
The opinions expressed herein are those
of the authors and do not necessarily
reflect those of Federal Practitioner,
Frontline Medical Communications
Inc., the U.S. Government, or any of its
agencies. This article may discuss unlabeled or investigational use of certain
drugs. Please review the complete prescribing information for specific drugs
or drug combinations—including indications, contraindications, warnings,
and adverse effects—before administering pharmacologic therapy to
1. Beers MH, Storrie M, Lee G. Potential adverse drug
interactions in the emergency room: an issue in the
quality of care. Ann Intern Med. 1990;112(1): 61-64.
2. Chin MH, Wang LC, Jin L, et al. Appropriateness of
medication selection for older persons in an urban
academic emergency department. Acad Emerg Med.
1999; 6( 12):1232-1242.
3. Hustey FM, Wallis N, Miller J. Inappropriate prescribing in an older ED population. Am J Emerg
Med. 2007; 25( 7):804-807.
4. Hastings SN, Schmader KE, Sloane RJ, et al. Quality
of pharmacotherapy and outcomes for older veter-
ans discharged from the emergency department. J
Am Geriatr Soc. 2008; 56( 5):875-880.
5. The American Geriatrics Society 2012 Beers Criteria
Update Expert Panel. American Geriatrics Society
Updated Beers Criteria for Potentially Inappropriate
Medication Use in Older Adults. J Am Geriatr Soc.
2012; 60( 4):616-631.
6. American Geriatrics Society 2015 Beers Criteria
Update Expert Panel. American Geriatrics Society
2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am
Geriatr Soc. 2015; 63( 11):2227-2246.
7. Hwang U, Shah MN, Han JH, Carpenter CR,
Siu AL, Adams JG. Transforming emergency
care for older adults. Health Aff (Millwood).
2013; 32( 12):2116-2121.
8. Stevens MB, Hastings SN, Powers J, et al. Enhancing the Quality of Prescribing Practices for Older
Veterans Discharged from the Emergency Department (EQUiPPED): preliminary results from Enhancing Quality of Prescribing Practices for Older
Veterans Discharged from the Emergency Department, a novel multicomponent interdisciplinary
quality improvement initiative. J Am Geriatr Soc.
2015; 63( 5):1025-1029.
9. Moss JM, Bryan WE, Wilkerson LM, et al. Impact
of clinical pharmacy specialists on the design and
implementation of a quality improvement initiative
to decrease inappropriate medications in a Veterans
Affairs emergency deepartment. J Manag Care Spec
Pharm. 2016; 22(1):74-80.
10. O’Brien MA, Rogers S, Jamtvedt G, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database
Syst Rev. 2007;( 4):CD000409.
11. Terrell KM, Perkins AJ, Dexter PR, Hui SL, Cal-lahan CM, Miller DK. Computerized decision
support to reduce potentially inappropriate prescribing to older emergency department patients:
a randomized, controlled trial. J Am Geriatr Soc.
2009; 57( 8):1388-1394.
12. The American Geriatrics Association. A Pocket
Guide to the AGS Beers Criteria. New York, NY: The
American Geriatrics Association; 2012.
13. Wilkerson LM, Owenby R, Bryan W, et al. An interdisciplinary academic detailing approach to
decrease inappropriate medication prescribing for
older veterans treated in the Emergency Department. In: Proceeding from the American Geriatrics
Society 2015 Annual Scientific Meeting; May 14-17,
2015; National Harbor, MD. Abstract B67.
Interested in being part of the peer-review
Federal Practitioner welcomes applications from physicians,
clinical pharmacists, physician assistants, and nurse
practitioners working within the VA, DoD, and PHS.
The following medical specialties are especially
needed: primary care, endocrinology, telemedicine,
urology, dermatology, pain management, mental health,
pharmacology, infectious diseases, and neurology.
To apply, e-mail a copy of your CV and describe all subject
areas of interest to email@example.com.
CALL for REVIEWERS