Implementation of Screening for High Fall Risk Medications in Hospitalized Older Adults

Abstract

Problem: Accidental falls are a leading cause of injury and death in older adults, leading to loss of function and increased healthcare costs. Falls are also commonly reported sentinel events in hospitals. A community hospital identified falls as an organizational priority with 73 inpatient falls last year. Expert guidelines recommend multifactorial fall risk assessment modalities, including screening for medications that increase risk of falling in older adults and deprescribing or adjusting inappropriate medications, however, the institution has no such process in place. Purpose: The purpose of this quality improvement (QI) project was to implement an interdisciplinary process for screening older adults’ prescriptions for medications that increase risk of falling and mitigate unnecessary high-risk medication use. Methods: Between September and December 2021, the Screening Tool for Older Persons’ Prescriptions (STOPP) Tool was utilized for daily medication screening on patients aged 65 and older during interdisciplinary rounds on the 12-bed Intensive Care Center (ICC). STOPP is a Delphi-validated tool to screen for potentially inappropriate prescriptions (PIPs) in adults aged 65 and older, with demonstrated efficacy in reducing PIPs and adverse drug reactions (ADRs). Registered nurses (RNs), pharmacists, and intensivists received education on the standard of care, and the screening process prior to implementation. Daily screening and deprescribing were measured through weekly chart audits. Data were analyzed utilizing Microsoft Excel. Descriptive statistics were calculated to evaluate goal attainment for the process measure (medication screening) and outcomes (deprescribing). Results: One hundred percent of intensive care providers (n=7), 66% of ICC RNs (n=19) and 60% of pharmacists (n=3) received a review of the medication screening process and STOPP tool. Sixty-six percent of RNs (n=19) completed education through Nurses Improving Care for Healthsystem Elders (NICHE) on the role of nurses in deprescribing. Seventy-four patients were eligible for screening with 167 daily screening opportunities, with median weekly screening compliance of 54%. High-risk medications identified through screening had a median weekly deprescribing rate of 20%. There were two falls in the implementation period. Conclusions: Interdisciplinary medication screening is a feasible adjunct fall prevention measure. Ongoing outcome measurement is necessary.