Half 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. We 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). For 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. We present the first expert consensus-based list of high-risk prescriptions for older ED patients (GEMS-Rx) to improve safety among older ED patients.

中文翻译：

---

老年紧急用药安全建议 (GEMS-Rx)：针对老年急诊科患者的高风险处方清单的修改德尔菲开发

一半 65 岁及以上的急诊科 (ED) 患者出院时持有新处方。不适当的处方可能会导致药物不良事件。我们的目标是制定一份基于证据和共识的高风险处方清单，老年 ED 患者应避免使用。我们进行了修改后的 3 轮 Delphi 流程，其中包括 10 名老年病学或质量测量方面的 ED 医师专家和 1 名药剂师。共识成员审查了 2019 年美国老年病学会 Beers 标准中的所有 35 种药物类别，并根据避免的整体优先级（第一轮）、短期不良事件的风险和可避免性，按照 5 点李克特量表（5=最高）对每种药物进行排名（第 2 轮），以及高风险药物使用的合理医疗指征（第 3 轮）。每轮的问卷回复率分别为 91%、82% 和 64%。第 1 轮后，苯二氮卓类药物（平均值，4.60 [SD，0.70]）、骨骼肌松弛剂（4.60 [0.70]）、巴比妥类药物（4.30 [1.06]）、第一代抗精神病药（4.20 [0.63]）和第一代抗组胺药（ 3.70 [1.49]）被优先考虑避免。在第 2 轮和第 3 轮中，催眠“Z”药物 (4.29 [1.11])、甲氧氯普胺 (3.89 [0.93]) 和磺酰脲类 (4.14 [1.07]) 被优先考虑，以可避免，尽管对短期不良事件的担忧较低。所有 8 类药物均包含在最终列表中。开出高风险药物的合理指征包括癫痫症、苯二氮卓/乙醇戒断、生命终结、严重广泛性焦虑、过敏反应、胃轻瘫和处方续药。我们推出第一份基于专家共识的老年 ED 患者高风险处方清单 (GEMS-Rx)，以提高老年 ED 患者的安全性。