Standardized Medication Screening to Decrease Fall Rates in Hospitalized Older Adults
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Spalt, Lauren N.
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Abstract
Problem & Purpose: In fiscal year 2023, a mid-sized Maryland hospital reported 243 falls, with 34.4% causing harm. One medical-surgical unit had 55 falls, highest among the units in the organization, primarily affecting adults aged 65 and older. Internal review revealed inadequate assessment of high fall-risk medications (HFRM’s) impacting mobility, strength, and blood pressure, contributing to high fall rates. No standardized HFRM screening process existed. This quality improvement (QI) project aimed to implement a HFRM screening process among older adults on a medical-surgical unit using section K of the Screening Tool for Older Persons’ Prescriptions (STOPP) during rounds to mitigate unnecessary polypharmacy and decrease falls. Methods: Over 15 weeks, electronic medication records of patients 65 years of age and older on a 26-bed medical-surgical unit were screened daily for HFRM’s using the STOPP tool. A pharmacist conducted screenings with nurses, presenting findings at rounds for hospitalists to assess and take appropriate deprescribing actions. Training was provided to all staff prior to implementation. Visual aids, bulletin boards, and pocket reference cards reinforced the process. Weekly chart audits tracked compliance and deprescribing actions. Descriptive statistics were used to evaluate outcomes. Results: One hundred percent of pharmacists (n=4), 84% of nurses (n=32), and 86% of hospitalists (n=77) were trained on the screening process and tool. Of 311 eligible patients, the median weekly screening compliance was 53%, with a median deprescribing rate of 14.7% for identified HFRM’s. Two falls occurred during implementation. Conclusions: HFRM screening and deprescribing are feasible, effective strategies for fall prevention in hospitalized older adults. Long-term implications for practice include a reduction in adverse drug reactions, falls and fall-related complications, and health care expenditures. Keywords: high fall risk medications, screening, falls, deprescribe, hospital, pharmacist