Nursing Insights

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


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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: 
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Nursing InsightsBy NJCCN