International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 969–975 | Cite as

Falls prevention focused medication review by a pharmacist in an acute hospital: implications for future practice

Research Article

Abstract

Background Patients at risk of falling are regularly prescribed medicines which increase falls risk. Medication review is a widely advocated risk reduction strategy. Objective The objectives of this descriptive study were to determine the number and types of falls risk medicines suitable for intervention, and to develop guidance to optimise the effectiveness of future medication related falls prevention initiatives. Setting An Irish acute teaching hospital and tertiary referral centre. Method 50 hospital in-patients at risk of falls underwent medication review focused on falls prevention by a pharmacist. Falls risk medicines were identified, and reviewed. If scope to discontinue, dose reduce or switch to a safer alternative was identified by the pharmacist, the suggested medication changes were communicated to the patient’s care team. Main outcome measure Identification of the classes of falls risk medicines and types of prescriptions with greatest potential for intervention. Results The mean number of falls risk medicines prescribed to each patient was 4.8 (±2.8) and the total number prescribed to the 50 patients was 238. Following medication review, the pharmacist identified 48 (20 %) as suitable for intervention. Consequently, 34 medication changes (70.8 %) were implemented. Four medication classes accounted for over 80 % of medication changes. These were anti-emetics, opioid analgesics, anti-cholinergic agents acting on the bladder and benzodiazepines/hypnotics. Intervention was statistically significantly more likely to be possible in the case of p.r.n. medicines compared to regular medicines (p < 0.001, Chi square test). Medication reviews focused on falls prevention took an average of 23.5 min per patient to complete. Conclusion Medication reviews focused on falls prevention involve striking a balance between minimising medicines associated with falls and effectively treating medical conditions. We found only 20 % of falls risk medicines were suitable for change, and reviews were time consuming and resource intensive. However, targeting four medication classes, and being particularly alert to the potential to discontinue ‘as required’ medicines, has the potential to achieve most of the benefits of more comprehensive reviews. This information will guide the development of future falls risk medicine review initiatives in our hospital, increasing their feasibility in the acute hospital setting.

Keywords

Falling Falls Falls risk medicines Ireland Medication review PIP Potentially inappropriate prescribing 

References

  1. 1.
    National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of Osteoporosis throughout Life. (IE) Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population. 2008. [cited 2011 Aug 8] http://www.hse.ie/eng/services/publications/olderpeople/Strategy_to_Prevent_Falls_and_Fractures_in_Ireland%e2%80%99s_Ageing_Population_-_Full_report.pdf.
  2. 2.
    Cameron ID, Murray GR, Gillespie LD, Robertson MC, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev. 2010;(1):CD005465.PubMedGoogle Scholar
  3. 3.
    Healey F, Monro A, Cockram A, Adams V, Heseltine D. Using targeted risk factor reduction to prevent falls in older in-patients: a randomised controlled trial. Age Ageing. 2004;33(4):390–5.PubMedCrossRefGoogle Scholar
  4. 4.
    Joint Commission International. Joint commission international accreditation standards for hospitals 4th edition effective from 01/01/2011. USA. 2010. ISBN: 978-1-59940-434-9.Google Scholar
  5. 5.
    Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case–control and cohort studies. BMJ. 1997;315:1049–53.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Bongue B, Laroche ML, Gutton S, Colvez A, Gueguen R, Moulin JJ, et al. Potentially inappropriate drug prescription in the elderly in France: a population-based study from the French National Insurance Healthcare system. Eur J Clin Pharmacol. 2011;67(12):1291–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Byrne S, O’Mahony D, Hughes C, Parsons C, Patterson S, McCormack B, et al. An evaluation of the inappropriate prescribing in older residents in long term care facilities in the greater Cork and Northern Ireland regions using the STOPP and Beers’ criteria. Centre for Ageing Research and Development in Ireland. 2011. [cited 2011 May 10] http://www.cardi.ie/userfiles/S%20Byrne%20Final%20Report%2024-03-11%20_formatted_(1).pdf.
  8. 8.
    Dalleur O, Deliens C, Losseau C, Spinewire A, Boland B. Inappropriate Prescriptions according to STOPP and related hospital admission in geriatric patients. Int J Clin Pharm. 2011;33(4):707.Google Scholar
  9. 9.
    Egger SS, Bachmann A, Hubmann N, Schlienger RG, Krahenbuhl S. Prevalence of potentially inappropriate medication use in elderly patients: comparison between general medical and geriatric wards. Drugs Aging. 2006;23(10):823–37.PubMedCrossRefGoogle Scholar
  10. 10.
    Gallagher P, O’Mahony D. STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers’ criteria. Age Ageing. 2008;37(6):673–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Gallagher P, Lang PO, Cherubini A, Topinkova E, Cruz-Jentoft A, Montero EB, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol. 2011;67(11):1175–88.PubMedCrossRefGoogle Scholar
  12. 12.
    Guaraldo L, Cano FG, Damasceno GS, Rozenfeld S. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC Geriatr. 2011;11(1):79.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Hamilton H, Gallagher P, Ryan C, Byrne S, O’Mahony D. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients. Arch Intern Med. 2011;171(11):1013–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Ryan C, O’Mahony D, Kennedy J, Weedle P, Byrne S. Potentially inappropriate prescribing in an Irish elderly population in primary care. Br J Clin Pharmacol. 2009;68(6):936–47.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    National Medicines Information Centre. (IE) Prescribing in the Elderly (NMIC Bulletin). 2010. [cited 2010 August 15] http://www.stjames.ie/GPsHealthcareProfessionals/Newsletters/NMICBulletins/NMICBulletins2010/prescribing%20in%20elderly%202010.pdf.
  16. 16.
    Gallagher P, O’Mahony D. Inappropriate prescribing in older people. Rev Clin Gerontol. 2008;18:65–76.CrossRefGoogle Scholar
  17. 17.
    World Health Organisation. WHO Global Report on Falls Prevention in Older Age. 2007. [cited 2010 Aug 20] http://www.who.int/ageing/publications/Falls-prevention7March.pdf.
  18. 18.
    American Geriatric Society/British Geriatric Society. Prevention of Falls in Older Persons (Clinical Practice Guideline). 2010. [cited 2010 Aug 8] http://www.medcats.com/FALLS/frameset.htm.
  19. 19.
    National Institute for Clinical Excellence. (GB) The assessment and prevention of falls in older people. 2004. [cited 2010 Aug 8] http://www.nice.org.uk.
  20. 20.
    National Patient Safety Agency/Patient Safety First. (GB) The ‘How to’ Guide for Reducing harm from falls. 2010. [cited 2010 Aug 8] http://www.patientsafetyfirst.nhs.uk.
  21. 21.
    Royal College of Physicians (GB). FallSafe. 2012. [cited 2012 Jan 7] http://www.rcplondon.ac.uk/projects/fallsafe.
  22. 22.
    Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J Am Geriatr Soc. 1999;47(7):850–3.PubMedGoogle Scholar
  23. 23.
    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2009;(2):CD007146. doi:10.1002/14651858.CD007146.pub2.
  24. 24.
    Haumschild MJ, Karfonta TL, Haumschild MS, Phillips SE. Clinical and economic outcomes of a fall-focused pharmaceutical intervention program. Am J Health Syst Pharm. 2003;60(10):1029–32.PubMedGoogle Scholar
  25. 25.
    Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.PubMedCrossRefGoogle Scholar
  26. 26.
    Lowrie R. The Glasgow pharmacy falls service. Pharm Manag. 2008;24(1):10–5.Google Scholar
  27. 27.
    van der Velde N, Stricker BH, Pols HA, van der Cammen TJ. Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. Br J Clin Pharmacol. 2007;63(2):232–7.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J, et al. Clinical medication review by a pharmacist of elderly people living in care homes-randomised controlled trial. Age Ageing. 2006;35(6):586–91.PubMedCrossRefGoogle Scholar
  29. 29.
    O’Mahony D, Gallagher P, Ryan C, Byrne S, Hamilton H, Barry P, et al. STOPP & START criteria: a new approach to detecting potentially inappropriate prescribing in old age. Eur Geriatr Med. 2010;1(1):45–51.CrossRefGoogle Scholar
  30. 30.
    Wilson NM, Hilmer SN, March LM, Cameron ID, Lord SR, Seibel MJ, et al. Associations between drug burden index and falls in older people in residential aged care. J Am Geriatr Soc. 2011;59(5):875–80.PubMedCrossRefGoogle Scholar
  31. 31.
    Casteel C, Blalock SJ, Ferreri S, Roth MT, Demby KB. Implementation of a community pharmacy-based falls prevention program. Am J Geriatr Pharmacother. 2011;9(5):310–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Patel S, Chahine-Chakhtoura C. Impact of a pharmacist-driven consult service for falls prevention. [Conference abstract] American Society of Health-System Pharmacy Midyear Clinical Meeting, Nevada, 2009.Google Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  1. 1.Pharmacy DepartmentSt. Vincent’s University HospitalDublin 4Ireland
  2. 2.Co. DublinIreland

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