Inappropriate Prescribing In the Emergency Room

Inappropriate PrescribingOne-third of older emergency department (ED) patients may be taking a potentially inappropriate medication, according to a retrospective analysis from Cleveland Clinic and MetroHealth Medical Center.

The average number of medications taken per patient was 8.4. Of the 352 patients, 111 (32%) were taking at least one potentially inappropriate drug when they arrived at the ED. Propoxyphene/ acetaminophen drug (Darvocet, Xanodyne), muscle relaxants, and antihistamines were the most common ones.

Among 101 patients discharged home with a new prescription, 13% received potentially inappropriate prescriptions, most commonly propoxyphene/ generic acetaminophen, diazepam (Valium, Roche), cyclobenzaprine (Flexeril, McNeil), and diphenhydramine (Benadryl, Johnson & Johnson).

In contrast to earlier studies, this study focused on drugs reported in the usual medication lists of older ED patients, who may be at a higher risk for future adverse drug events. Unlike medications prescribed from the ED, which are often intended for short-term use, many of the drugs in this study are likely to be taken for a longer time. Patients with painful musculoskeletal problems may be at even higher risk: Darvocet and muscle relaxants accounted for 11% of all inappropriate prescriptions in outpatient medication lists.

The medications on the list have been associated with increased morbidity and mortality in older patients.
Education to enhance awareness of medication risks in older patients is needed for all health care groups, the researchers suggest; they say that the physician-patient interaction in the ED provides a good opportunity for improving care.

Even if emergency physicians in the study had focused only on the three most common inappropriate drugs (Darvocet, muscle relaxants, and routine outpatient use of antihistamines), they could have reduced the number of potentially inappropriate prescriptions by nearly 15%.

(Source: Am J Emerg Med 2007;