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Inappropriate prescriptions from ER visit could harm older patients

Older adults could get the wrong prescription in the emergency room.
Older adults could get the wrong prescription in the emergency room.
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A new study from University of Michigan researchers highlights inappropriate drugs prescribed by physicians in the emergency room that could harm older patients, despite evidence that some medications can have adverse effects for those over age 65.

"There are certain medications that probably are not good to give to older adults because the potential benefits are outweighed by potential problems," says lead author, William J. Meurer, M.D., M.S., assistant professor, U-M Departments of Emergency Medicine and Neurology, yet 16.8 percent of emergency visits eligible for study resulted in prescriptions that could cause harm among older adults.

Ten drugs dispensed in emergency rooms are highlighted in the study. The most common inappropriate drugs dispensed in the emergency rooms are pain relievers and antihistamines, found in an analysis of 19.5 million older patients.

The top five potentially inappropriate medications (PIMs) included the anti-nausea drug promethazine (Phenergan), ketorolac (Toradol), propoxyphene (Darvon), meperedine (Demerol), and diphenydramine (Benadryl) that accounted for 86.5 percent of inappropriate drugs prescribed for older patients in the emergency room. Promethazine and kertolac were prescribed forty percent of the time.

The study that emergency room prescriptions can harm older adults and require scrutiny from patients and primary care doctors suggests the need for physician education and patient involvement in health care outcomes. Residents and interns were less likely to dispense inappropriate drugs compared to older physicians. Patients who are older need to ask appropriate questions, share information with ER staff, and make and effort to understand medications prescribed in the emergency room.

Dr. Meurer says it is important to remain proactive to understand what prescriptions you are taking - talk with your doctor during or shortly after visiting the emergency room to ensure you have not been given the wrong drug. The study did not take into account interactions with other medications taken by older patients that could also cause harm.

Carry a list of all the medications you are taking to share with the nurses and emergency room physicians to decrease the chances of receiving an inappropriate drug. Include any vitamins or supplements you are using. Dr. Meurer also suggests asking for a list of medications given during your emergency room stay - if you experience any adverse events call your doctor immediately or go back to the ER. Along with a list of medications, obtain a description of possible side effects.

Older ER patients receiving inappropriate, and potentially harmful drugs also occurred at higher rates at for-profit hospitals, and less often in the Northeast, compared to double the chances in other parts of the country. The analysis of 1.5 billion total visits to outpatient clinics and emergency rooms between 2000 and 2006 shows that some older adults are receiving harmful drugs in the emergency room, highlighting the need for awareness and education.

UMHS Newsroom

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