Implementation of Screening for High Fall Risk Medications in Assisted Living Residents

Abstract

Problem: Falls are often preventable, yet they continue to be the leading cause of injury and injury-related death of adults over 65 years old in the United States. In 2021, 24% of residents in an urban assisted living facility had a reported fall, and over half of hospital transfers were related to falls. The literature supports deprescribing high fall risk medications in older adults as a fall prevention strategy. At this assisted living facility, there is currently not a standardized screening or validated way to encourage deprescribing high fall risk medications. Purpose: The purpose of this Quality Improvement (QI) initiative is to implement a standardized screening process for use by prescribers to support identification and deprescribing of medications that increase risk of falling. Methods: The Screening Tool for Older Persons’ Prescriptions in older adults with high fall risk (STOPPFall) was implemented over 15 weeks in 2022 at an urban assisted living facility. Prior to implementation, education was provided to the nurse practitioner and nursing staff. All assisted living patients were eligible for screening. STOPPFall was utilized when reviewing the patients’ medication administration record at regulatory visits. An audit tool was then completed by the nurse practitioner for data collection including date of patient encounter, if screening was used, and high fall risk medications identified and deprescribed. Number of patients with a reported fall was tracked weekly. Results: One hundred percent of staff was educated on the process change. Since completion of education, 100% of eligible residents have been screened. Three high fall risk medications were deprescribed. There were fifteen falls during implementation. However, there were six weeks throughout implementation with zero patient falls. Conclusions: Implementation of STOPPFall successfully identified high fall risk medications in assisted living residents. Findings suggest that medication screening and deprescribing is a feasible addition to fall prevention strategies for assisted living residents.