# Getting ED Specific with Medication Safety

About This Podcast

Older patients are often discharged from the emergency department with a new prescription, however this population is also at increased for adverse drug events (ADEs). Today’s episode focuses on two recent papers on medication safety published by Dr. Rachel Skains, assistant professor in the Department of Emergency Medicine at the University of Alabama at Birmingham. Dr. Skains joins GEMCast host Dr. Christina Shenvi as the two dive into how to ensure the right medications are being prescribed to geriatric patients in the ED context. 

Play the Episode

https://youtu.be/BccgtF18kKI

Subscribe on YouTube

Subscribe on iTunes

Key Points

Older adults are more susceptible to ADEs due to age related changes in pharmacokinetics, polypharmacy and comorbidities. ADEs are associated with ED revisits, hospitalisation and mortality. 

Improving medication safety for older adults also improves the patient experience and outcomes.

Prescription of potentially inappropriate medications (PIMs) contributes to functional decline, increased costs due to increased health care utilisation, and higher mortality.

The ED is a fast-paced, complex and unique environment where there is an increased likelihood of prescribing PIMs. 

Linked below are the two studies discussed in this episode.

Annals of Emergency Medicine | March 12, 2024

Geriatric Emergency Medication Safety Recommendations (GEMS-Rx): Modified Delphi Development of a High-Risk Prescription List for Older Emergency Department Patients

An expert review of acute high-risk medications for older ED patients at ED discharge. Many resources used by clinicians, such as the Beers Criteria, were not designed for the ED and can therefore be difficult to apply in the ED context. This paper is the first study to produce a list of 8 high risk medications classes that should be avoided to reduced ADEs in older adults following ED discharge.

View Article

Key Points

GEMS-Rx is a high quality consensus-based criteria that can be used to assist ED prescribers. The list of medications includes:

Benzodiazepines

Skeletal muscle relaxants

Barbiturates

First-generation antipsychotics

First-generation antihistamines 

Non-benzodiazepine and benzodiazepine receptor agonist hypnotics (ie, “Z-drugs”) 

Metoclopramide 

Sulfonylureas

The transition from the ED to the community is a high risk phase for older adults which can be made safer by using the GEMS-Rx list.

This list uniquely focuses on drugs with increased risk of short term ADEs, rather than medications with long term risk. 

JAMA | March 11, 2025

Emergency Department Programs to Support Medication Safety in Older Adults:

A systematic review and meta-analysis of ED-based geriatric medication safety programs aiming to find which programs reduce PIMs and ADEs amongst older adults.

View Article

Key Points

A multidisciplinary team, including a clinical pharmacist and geriatricians have a positive impact on PIMs deprescribing.

Computerised clinical decision support systems (CDSS), both alone or when used alongside ED clinician education measures, lead to enhanced medication safety.

Routine ED implementation and use of computerised CDSS is a practical option given widespread use of electronic health records.

Next, listen to ED Boarding of Older Adults: Risks and Opportunities with Dr. Maura Kennedy.

Play Episode

TOOLKIT | June 24, 2025

Enhancing Medication Management in the Geriatric ED

This new GEDC toolkit brings together tools, guidelines, and educational resources for emergency department administrators and teams to successfully implement medication management quality improvement projects and support safe prescribing – and de-prescribing – in the ED for complex older patients.

Explore Toolkit

View All Medication Management Resources >