# CMS Domain 2: Responsible Medication Management Medication Management in the ED Domain 2 focuses on optimizing medication management. Here, hospitals and health systems are expected to identify potentially inappropriate medications (PIMs) for older adults. In busy EDs, older adults are especially vulnerable to medication-related errors, so it's essential to have strong protocols in place for medication reconciliation and safe prescribing. To help your ED operationalize Domain 2, the Geriatric Emergency Department Accreditation (GEDA) program has developed specific care processes. Continue exploring our Domain 2 resources to learn more. Domain 2 | AFHS 4Ms | GEDA Making the Connections Meeting the CMS Measure means having concrete processes that are rooted in evidence. The Institute for Healthcare Improvement (IHI) and GEDA frameworks provide exactly that. Discover how each approach aligns with Domain 2 — and brings value to your ED, hospital, and health system. Linking CMS with AFHS and GEDA CMS Domain 2 Responsible Medication Management Aligns With AFHS's 4Ms Medications Achieved Through GEDA Care Processes B1: High-Risk Med Identification & Reduction  B2: Structured Med Reconciliation B3: Pain Control  B4: Order Sets With Med Dosing  Jump to GEDA Care Processes Why It Matters Investing in Medication Management Pays Off Medication management care processes allow the ED to demonstrate its value as an indispensable hospital and health system partner. They help reduce medication errors during cardiac arrests and code strokes - and when caring for critically ill adults, and older adults with complex polypharmacy. By hardwiring safer medication practices into ED workflows, your site can decrease preventable drug errors, lowering clinical risk and potential malpractice exposure. And with support from a clinical pharmacist, these protocols become easier to sustain. The cost savings and risk mitigation create a strong business case to invest in dedicated ED pharmacy support. Consistent access to a pharmacist reduces cognitive burden on frontline clinicians and streamline care in high-acuity situations. As a result patient outcomes improve - along with efficiency and reliability. Make the Case Review the evidence for pharmacist involvement in the Emergency Department. investment in age-friendly care processes with a well-summarized pitch deck to share with your C-suite or board of directors. Continue Making the Case for Pharmacist Involvement in the ED Learn more and access an editable slide deck designed to make the case. Read Article Download Slide Deck FUTURE STATE BLOCK - Alignment with Rural Project Work in a Rural or Critical Access Hospital? Call out how rural and remote hospitals are unique. Making the case for them is not the same as for larger systems (e.g. attracting new patients rather than optimizing bed usage) Push to rural-targeted materials - the making the case is different and the implentation is different. Likely will have a Rural and Critical Access Hub eventually. Call to Action Explore Resources We have a large library of resources to support hospitals and EDs as they work to meet the CMS Measure. Medication management is an important competency in the ED and should be well integrated into the EMR to prevent medication errors. For support in this area, we have curated a few relevant resources. TOOLKIT Enhancing Medication Management in the Geriatric ED Tools, guidelines, and resources for successful implementation of medication-focused quality improvement. View Toolkit COURSE Medication Management in the Older ED Patient A one-hour AMA and ANCC accredited course on physiologic changes in aging, polypharmacy, communication, and safe ED prescribing. View Course WEBINAR Medication Management and the CMS Hospital Measure A look at how EDs can align with system priorities by introducing policies and procedures that reduce PIMs and incorporate pharmacy into consults. View Webinar View All Med Management Resources > GEDA Care Processes Ways to Implement Change Responsible medication management requires more than awareness alone. It takes clear, consistent action informed by best practice. GEDA care processes are a practical way to make that happen. They build important medication-related protocols into ED workflows, an that helps operationalize the standards outlined in the CMS measure. Interested in learning more about GEDA accreditation for your ED? Visit GEDA Eliciting “What Matters Most”  GEDA Care Process F3 F3 provides a structured way to reduce moral distress while strengthening coordination across the hospital. When what matters most to older adults is reliably elicited in the ED, clinicians are less likely to deliver care that feels misaligned with patient values - a major driver of moral injury in emergency medicine. To help you implement this care process, we offer a range of practical tools and resources.  Explore F3 Implementation Toolkit medication management toolkit Call out panel Explore TOolkit High-Risk Medication Identification and Reduction  GEDA Care Process B1 Systematic screening for high-risk medications, including Beers Criteria PIMs, makes medication safety more reliable and less dependent on individual vigilance in a chaotic ED environment. To help you implement this care process, we offer a range of practical tools and resources.   Implementation Toolkit Reducing PIMs Find resources for operationalizing PIM reduction for older adults in the emergency department. Explore B1 High-Risk Medication Identification and Reduction  GEDA Care Process B1 Systematic screening for high-risk medications, including Beers Criteria PIMs, makes medication safety more reliable and less dependent on individual vigilance in a chaotic ED environment. To help you implement this care process, we offer a range of practical tools and resources.   Implementation Toolkit Medication Reconciliation Discover resources for implementing a structured medication reconciliation care process. Explore B2 Structured Medication Reconciliation GEDA Care Process B2 Accurate medication reconciliation is one of the few interventions shown to reduce medication errors at transitions of care. ED-implemented medication reconciliation with pharmacist support has been associated with fewer medication discrepancies, lower rates of adverse drug events, and reduced length of hospital stay. If you’re looking to implement this care process, we have tools and resources you may find useful.  Implementation Toolkit Pain Control Learn how to create an appropriate pain control protocol for older adults in your ED. Explore B3 Pain Control GEDA Care Process B3 Standardized, age-appropriate pain management in the ED reduces clinical variability at the bedside, making care more predictable, safer, and easier for ED teams to deliver, especially for older adults with complex conditions. When pain is assessed consistently and treated thoughtfully and safely, clinicians spend less time managing agitation, confusion, or distress. For help implementing this care process, explore our B3 resources.   Implementation Toolkit Integrating Order Sets for Medication Dosing See examples of medication management integrated into the EMR. Explore B4 Order Sets with Medication Dosing  GEDA Care Process B4 B4 operationalizes B1–B3 by hardwiring safer medication practices into the electronic medical record (EMR) through standardized order sets and clinical decision support. Embedding age- and weight-adjusted dosing, high-risk medication alerts, and drug–drug interaction warnings into ED workflows reduces inappropriate prescriptions at the point of care. Implement this process with practical guidance from GEDC resources.   Applying These Processes? You're Meeting the Mark If you adhere to these care processes, your ED is doing its part to meet CMS criteria. This is because GEDA care processes directly support Domain 2 of the CMS Measure — and the IHI's “Medication” framework. By implementing them, your emergency department can position itself as a clinical innovator that improves hospital flow, alleviates boarding, and advances system reliability — all while delivering better, more humane care. When these safeguards are consistently and thoughtfully applied, hospitals experience fewer adverse drug events, fewer downstream complications, and more reliable care processes. This leads to fewer avoidable admissions, shorter length of stay, and better bed utilization. < Back to Domain 1 Continue to Domain 3 > Subject Matter Expert Payal Sud, MD, FACEP Payal Sud, MD, FACEP, an Associate Professor of Emergency Medicine and a Medical Toxicologist, is a leading voice in Geriatric Emergency Medicine (GEM). As Chief of GEM for Northwell Health and Associate Chairperson of Emergency Medicine at North Shore University Hospital, she works to optimize patient flow in the emergency department (ED) based on what matters most to older adults and caregivers.  Beyond her administrative work, Dr. Sud investigates the impact of early Palliative Care in the ED, and conducts NIH-funded research on ED care for older adults with delirium and dementia. Applying her extensive experience leading successful GEM initiatives, Dr. Sud now helps shape national standards as a reviewer for ACEP’s GEDA program.