Falls prevention focused medication review by a pharmacist in an acute hospital: implications for future practice
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.
KeywordsFalling Falls Falls risk medicines Ireland Medication review PIP Potentially inappropriate prescribing
- 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.
- 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
- 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.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
- 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.
- 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.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.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.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.Royal College of Physicians (GB). FallSafe. 2012. [cited 2012 Jan 7] http://www.rcplondon.ac.uk/projects/fallsafe.
- 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.
- 26.Lowrie R. The Glasgow pharmacy falls service. Pharm Manag. 2008;24(1):10–5.Google Scholar
- 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