Simon Thomas is an Honorary Fellow of the School of Pharmacy, Keele University and a Director at Prescribing Decision Support – a Keele University spin-out company that delivers knowledge-based e-media systems designed to support healthcare decision making. Most recently, Simon has worked with NICE and Boehringer Ingelheim Ltd on the development of an innovative anticoagulation therapy decision support tool that assists patients and doctors in shared decision-making. Simon can be contacted at firstname.lastname@example.org
Falls and fall-related injuries in older people is a high-risk, high-cost problem. Notwithstanding the considerable human impact – distress, pain, injury, loss of confidence, loss of independence and mortality – falls account for the largest number of emergency hospital admissions for older people in the UK and cost the NHS over £2 billion each year.
And yet, many falls are preventable.
Practical interventions such as the removal of falling hazards, addressing deterioration in muscle strength, balance and vision, or a medication review of psychotropic medicines could all reduce a person’s risk.
So why are so many people at risk overlooked?
One of the challenges facing primary care clinicians is the timely, workable and systematic identification of patients.
In recognition of the need to engage with primary care clinicians, we at the Centre for Medicines Optimisation at Keele University, and colleagues in the Medicines Management team at Walsall Clinical Commissioning Group, decided to jointly develop and test a falls risk assessment toolkit that could be used in general practice.
In particular, we wanted the tool to:
- Identify patients over the age of 65 who may benefit from a medication review, falls assessment and sign-posting to local falls prevention services
- Include prompt background alerts to systematically identify at risk patients upon presentation
- Reflect those predictors of falls risk as recommended by NICE
- Highlight the inappropriate use of high risk psychotropic medicines which can contribute to falls risk and, in turn, prompt a review by a GP or clinical pharmacist
- Integrate with a GP clinical system so that it was practicable and convenient to use
- Utilise read codes to allow a robust audit trail and data collection
An EMIS web protocol and template was developed by the informatics team at Walsall, and then validated and tested in local general practice. Feedback indicated that practitioners found the toolkit easy to use, intuitive and focused on high-risk patients. It was also estimated that the toolkit would identify approximately 300 at-risk patients in a CCG of 280,000 patients (figures based on testing across a sample of local practices).
When all testing was complete, we made the EMIS web protocol and template freely available to all UK healthcare professionals in April of this year – see www.fallsrisk.co.uk/.
We hope that this simple intervention will be widely taken up by practitioners and implemented in practice. Indeed, if the response is positive and adoption is high, we may look to re-develop it so it can be used with other clinical systems. Most importantly however, we hope that the toolkit encourages the identification and review of at risk patients and in turn, helps to reduce the incidence and human cost of falling amongst older people.