Falls prevention focused medication review by a pharmacist in an acute hospital: implications for future practice
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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
Sincere thanks to the Falls Committee, St. Vincent’s University Hospital, and in particular Dr. Diarmuid O’Shea, Consultant Physician in Geriatric Medicine, and Amanda Groarke, Clinical Specialist Occupational Therapist and Falls Programme Co-ordinator. The co-operation of the medical and nursing staff caring for the patients included in the study was also greatly appreciated.
Conflicts of interest
The first author has received partial funding of a continuing education course from Novartis and sponsorship from Roche to attend a conference. This funding had no connection with or influence on this study. Other authors: no conflicts of interest.
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