28 | It’s Raining Meds: Fixing How We Prescribe for Older Adults

Nursing Insights

What if a small change in your electronic health record could save lives?

In this episode of Nursing Insights, we dive into a quiet revolution in geriatric care: the Geriatric Prescribing Context (GPC). Host Stephanie Olaso, MHCI, BSN, RN is joined by:

• Dr. Katie Drago, geriatrician and lead researcher behind the GPC
• Jean Stoerger, PharmD and clinical geriatric pharmacist
• Mary Jo Phillips, DNP and geriatric program director

Together, they unpack how the GPC came to life after a tragic medical error, how it functions invisibly within Epic to nudge safer prescribing decisions, and what the real-world results look like – like a 50% reduction in dose-related adverse drug events.

Whether you’re a nurse, pharmacist, or physician, this episode will challenge the way you think about clinical decision support, EHR design, and the hidden power of tiny nudges in patient care.

Key Takeaways:

• A tragic overdose case involving haloperidol in a 90-year-old patient became the catalyst for the GPC.
• The GPC adjusts default medication doses in Epic for patients aged 65+, making them more age-appropriate – without pop-ups or hard stops.
• Implementation led to a 50% reduction in dose-related adverse drug events, with sustained results over 4 years.
• Most clinicians didn’t even realize it was active – meaning no alert fatigue and seamless workflow.
• Nurses play a powerful, often overlooked role in influencing prescribing decisions.
• The GPC is now part of Epic’s foundations package (post-Nov 2023) and available to others via the Community Library.

Relevant Links:

• New Jersey Collaborating Center for Nursing: https://njccn.org
• Safer prescribing for hospitalized older adults with an electronic-health record based prescribing context: https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16640
• Long term impact of a geriatric prescribing context: https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.17799
• In pursuit of the quadruple aim: A geriatric prescribing context’s impact on clinician workflows and alert fatigue: https://journals.sagepub.com/doi/abs/10.1177/07334648221079103
• Improving dose related adverse drug events among hospitalized older adults using a geriatric prescribing context: https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18754
• IHI Age Friendly Health Systems, main page, including overview of the movement and how to join: https://www.ihi.org/partner/initiatives/age-friendly-health-systems
• Getting started on an Age Friendly journey:

Chapters

1. 28 | It’s Raining Meds: Fixing How We Prescribe for Older Adults (00:00:00)

2. Marker 13 (00:23:14)

3. Marker 14 (00:23:19)

4. Marker 15 (00:23:28)

5. Marker 16 (00:26:10)

6. Marker 12 (00:26:14)