Abstract
Background
An important modifiable risk factor associated with falling is the use of falls-risk inducing drugs (FRIDs). The World Falls Guidelines identified this as a key domain and recommended that a validated tool should be used in medication reviews targeted to falls prevention in older adults (1).
A proforma was created based on the STOPPFall Tool (2) to aid doctors in performing structured medication reviews in patients with falls. The research question was ‘in older adult inpatients with falls, does use of the STOPPFall screening tool increase deprescribing of FRIDs?’
Methods
The project was carried out on Geriatric Medicine wards. Patients were included if they were inpatients and had been admitted with a fall, had a history of recurrent falls and/or had an inpatient fall. FRID classes were identified using STOPPFall, and FRIDs prescribed on admission and discharge were determined using discharge letters. The primary outcome was the number of FRIDs stopped or dose reduced on discharge. An online survey assessed HCOP doctors’ confidence in deprescribing.
Results
102 patients were reviewed at baseline. The percentage of patients prescribed at least 1 FRID was reduced from 84.3% on admission to 65.7% on discharge. A total of 162 FRIDs were prescribed on admission; 73 (45.1%) of these were stopped and 12 (7.4%) were dose reduced.
19 prescribers responded to the online survey, and self-assessment of confidence in deprescribing averaged at 7.74 (1-10 - ‘not confident at all’ to ‘very confident’). Confidence increased with seniority; average confidence ranged from 6.5 in foundation doctors to 9.0 in consultants.
Conclusion
52.5% of FRIDs prescribed in older adult inpatients with falls were stopped or reduced. Introduction of a STOPPFall proforma shows potential in encouraging deprescribing of FRIDs.