Falls Prevention
Last year the local Health Overview and Scrutiny • Committee raised falls prevention as a key issue within Staffordshire. Resulting analysis found that falls admissions in over • 65s in East Staffordshire were significantly higher than regional and national levels and hip fracture rates were slightly higher than regional and national levels.
Current Figures – East Staffs CCG Average Cost Per Spell for Patients Aged Over 65 - Financial Year 2012/2013 With a fracture £4,929.20 Without a fracture £1,883.49 2012/2013 Total Cost With a fracture £778,813.80 Without a fracture £951,163.17 Total £1,729,976.90
Moderate risk drugs that can Low risk drugs that can contribute to a High risk drugs that can contribute to a fall contribute to a fall fall Antidepressants ACE inhibitors/ARB's Calcium -channel blocker Antimuscarinics Alpha-blockers Nitrates Anti-psychotic ( including atypical) AntiArrhythmics Oral Anti Diabetic drugs Proton Pump Inhibitors and H2 Benzodiazepine and hypnotics Antiepileptic's Receptor Antagonist Antihistamines Dopaminergic drugs used Parkinson's disease Beta- blockers Diuretics Opiate analgesics
Risk Factors - four or more place patients at higher risk Balance disorder • Previous falls • Visual/hearing/cognitive impairment • Poly pharmacy • Poor mobility • Alcohol >1 unit /day • Orthostatic hypertension • Over 65 years old • Maria Smith Pharm MR Pharms Berkshire falls prevention
Retrospective audit of 75 patients that had a previously fallen 40% - prescribed a “red drug” 72% prescribed a “amber drug” 26% were being prescribed both red and amber at the time of the fall 33% of the falls would appear due to medicines related Conclusion : several patients had changes in their Anti- hypertensive medication and initiations of
Cochrane review 2012 Recommended that a withdrawal/review should be considered for psychotropic medication( Antipsychotics, Hypnotics and Anti-depressants.) Based on two trials Pitt 2007- Falls Education by clinical pharmacists in GP • Practices. Campbell 1999 – Randomized trial of withdrawal/review of • Psychotropic medication.
CSU modelling against the Campbell 1999 trial on Psychotropic medication modification/review
How can Pharmacies prevent falls ? : DISCUSSION
Contact : Claire Dearden Clinical Audit Facilitator Medicine Management East Staffs Clinical Commissioning group Email : claire.dearden@northstaffss.nhs.uk Phone 01283 507135 Mobile 07966874847
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