Patient Falls: Can Pharmacy Help?

There is a wonderful post on The Health Care Blog today about patient falls, truly a national tragedy of preventable injury. To quote the authors "One in three adults 65 and older falls each year and every 35 minutes someone in this population dies as a result of their injuries..." According to the blog post, this results in a cost to the health care system of almost $55 billion a year. Ouch.

And it touches many lives. My own great grandmother, a spry lady well into her upper 80's and driving a Dodge Charger (as my dad would so aptly noted, "like a bat outta hell..."), fell at home, was admitted to a local hospital for a broken hip and was dead two weeks later from complications of hospital-acquired pneumonia. This happens far too often.

Where does pharmacy fit into this?

One of the primary risk factors for falls is medication use, specifically, medications the cause or exacerbate motor instability. There are some meds that wouldn't come to mind. CNS agents (narcotics, benzodiazepines, anticonvulscents and the like) are commonly known. But what about cardiovascular agents? Antihypertensives can cause dramatic syncope and lead to destabilization and loss of motor reflex. Couple these drugs with a sleeper and a pain-killer and the results can be devastating.

Can pharmacy really make a difference? The simple answer - YES, IT CAN. In 2003, Haumschild et al published an article in AJHP (Am J Health-Syst Pharm. 2003; 60:1029-32). They identified elderly inpatients on one or more medications known to increase incidence of falls by running a simple report out of their drug delivery systems. This report was delivered to nursing staff daily. Nurses then used this information to institute fall precautions in higher risk patients. The outcome? A 47% reduction in fall rate.

The key to this system is having a proactive, simple medication surveillance system in place (shameless plug) like the one my current employer has developed.

So what drugs does one look for? Basically anyone over the age of 65 on one or more medication classes found HERE. It's not an exhaustive list, but a good place to start. Another great overview of the problem by the CDC can be found HERE.

So let's have it in the comments. Do you have a proactive fall prevention program going on at your hospital? Have you been able to quantify the outcomes of the program?

~charles