Medication Safety
Elizabeth Briand
As anyone who has helped an aging parent maintain their regimen of prescriptions knows, keeping track of timing, interaction risks, and adverse effects can be a dizzying task. It can get even more difficult when new medications are added to the list—which often follows an emergency department (ED) visit.
Ensuring medication safety for older adult patients has long been a goal of emergency medicine teams. A recent investigation, published March 11, 2025, in JAMA Network Open, found a number of practices that could potentially reduce risk and enhance outcomes for adults over 65 years who may require new medications following an ED visit.
Safer way forward
The article’s investigative team conducted a review and meta-analysis of 25 eligible studies that included nearly 45,000 participants. The studies were focused on ED-based geriatric medication programs designed to avoid potentially inappropriate medications and adverse drug effects.
The data showed that multidisciplinary approaches to the care of older adult ED patients—including the involvement of clinical pharmacists and geriatricians—were associated with better prescribing outcomes, reducing the unnecessary addition of new medications.
“Clinical pharmacists bring specialized expertise in medication safety and optimization,” said Rachel M. Skains, MD, assistant professor in the UAB Department of Emergency Medicine in Birmingham, AL. “When pharmacists review medication lists in the ED, they can spot potentially inappropriate medications, drug interactions, and opportunities to deprescribe or recommend safer alternatives.”
Their review, according to Skains, found that pharmacist-led interventions, such as medication reconciliation and real-time consultations, consistently led to a reduction in potentially inappropriate medication use through targeted deprescribing efforts.
Pharmacists can make a lifesaving difference for patients by reviewing current home medications and ED orders to identify high-risk drugs for older adults and suggest safer alternatives in collaboration with ED team members.
“Pharmacists also play a vital role in clinician, patient, and caregiver education—explaining which medications are critical, which might be stopped, and what warning signs to watch for after discharge,” Skains said.
Researchers also noted the value of computerized clinical decision support systems in flagging high-risk medications for prescribers, suggesting age-appropriate dosing adjustments, identifying potential medication interaction risks, and generally guiding safer prescribing practices.
“In the hectic ED environment, clinicians may not have time to manually check every medication’s risks, so embedded tools within the electronic health record that nudge or alert providers can help bridge that gap—improving patient safety without slowing down clinical care,” said Skains.
Ultimately, creating more opportunities for collaborative decision making and ensuring the input of pharmacists could make a significant difference for older patients, said Skains.
“Moving forward, integrating pharmacists more deeply into ED care teams and leveraging technology will be crucial steps toward safer, more effective medication management for older adults,” she said.
Increased risks with age
According to the research, older adults account for more than 20% of annual ED visits, and more than half of those patients are discharged from the ED with at least one new prescription medication.
Skains points out that physiology changes with age. Older adults may metabolize drugs more slowly and are more likely to have multiple chronic conditions, leading to complex medication regimens, according to Skains.
In the often fast-paced ED environment, this can result in inappropriate prescribing, drug–drug interactions, and adverse drug events that often lead to complications like delirium, falls, or bleeding, Skains said.
These types of interactions and drug events are increasing among older adults, the researchers noted in the article. Several factors could be contributing to this rise, including the fact that more people are living longer with chronic illnesses and, as a result, are being prescribed more medications. In addition, despite advances in electronic medical recordkeeping, physicians may not always realize what other clinicians have already prescribed.
Timing may also be a factor.
“There’s often pressure to quickly address symptoms without fully reassessing whether each medication someone takes is still necessary or safe, especially in time-constrained settings like the ED,” said Skains. ■