Medication management and falls procedure

Contents

1 Aim

A number of medicines can cause or contribute to falls. Effective medication review is essential for people who are at risk of falls or fractures. Medication review in people at risk of falls is often not straight forward as people will often have multiple co-morbidities, be older and, or be living with frailty hence medicines use in this population requires a balance between the risks and benefits of multiple treatments (NFPCA, 2023).

This procedure reinforces the importance of medication reviews as part of the multifactorial falls risk assessment (MFRA) process in order to ensure we are optimising patient safety, reducing the risk of harm from falling. Medication reviews also form a key part of the RCP FallSafe care bundle.

2 Scope

This is a trust wide procedure which is applicable to all patients under our care. It focuses in particularly on the needs of those patients who are in the higher falls risk groups or who already have a history of falls (over 65’s and, or patients with pre-existing health conditions which means they are at a higher risk of falling).

3 Link to overarching policy, and or procedure

• Patient falls manual (prevention and management)

4 Procedure or implementation

In July 2023, the National Falls Prevention Coordination Group (NFPCG) provided updated guidance with respect to medicines management and the prevention of falls. They recommended that:

• all patients at risk of falls should have their medicine burden reviewed with respect to its propensity to cause falls
• the history should establish the reason the medicine was given, when it was started, whether it is effective and if the person is having any side effects
• an attempt should be made to reduce the number and dosage of medicines, and ensure they are appropriate and not causing undue side effects
• falls can be caused by almost any drug that acts on the brain or on the circulation. Usually, the mechanism leading to a fall is one or more of:
  • sedation, with slowing of reaction times and impaired balance.
  • hypotension, including the 3 syndromes of paroxysmal hypotension, orthostatic hypotension, vasovagal syndrome and vasodepressor carotid sinus hypersensitivity
  • bradycardia, tachycardia or periods of asystole
• falls may be the consequence of recent medication changes but are usually caused by medicines that have been given for some time
• information to be provided to GP at transfer of care identifying any medications that have been amended because of falls risk or may impact on falls risk
• consider non-pharmacological treatments if appropriate
• no new night sedation prescribed as routine on admission (unless there were good clinical reasons to do so) until an assessment of sleep carried out and difficulty with sleeping identified. Checks to drug cards to look for doses of night sedation given on the night-time drug round the night before (usually 10pm)

The Royal College of Physicians (RCP) through a project called FallSafe, advise that there should be no prescribing of new night sedation (unless there are documented medical reasons to do so) There is a comprehensive list of “medicine and falls in hospital” available (Implementing FallSafe, Royal College of Physicians 2012)

Appendix E provides a comprehensive list of medicines which can contribute to fall risk. Relevant treatments have been graded using a traffic light system according to their potential to cause a fall (note this is not an exhaustive list and any further advice and updates should be sought from pharmacists and medical colleagues).

• Red, high risk, consider referral for medication review.
• Amber, medium risk, consider referral for medication review after consideration of other risk factors which may have contributed to a fall.

The anticholinergic burden of medication also increases falls risk and this is also indicated in the medicines list with suggested alternatives. (NFPCP, 2023)

The link below is a simple-to-use medication checker (supported by the Maudsley prescribing guidelines 2021) which assesses medications risk with respect to:

• anticholinergic Burden
• dizziness
• sedation
• constipation
• QTc prolongation
• bleeding risk

Multiple drugs can be added, and a summary printed.

Medichec website (opens in new window).

5 References

• NFPCA (2023) (opens in new window).

6 Appendices

Please see patient falls manual (prevention and management) webpage for appendices attached to this procedure.

• Appendix E List of medications and their impact on falls

Document control

• Version: 1.1.
• Unique reference number: 1049.
• Approved by: Clinical policy review and approval group.
• Date approved: 20 December 2023.
• Name of originator or author: Clinical team leader.
• Name of responsible individual: Executive director of nursing and AHPs.
• Date issued: 27 December 2023 (amendment).
• Review date: 31 August 2026.
• Target audience: Clinical staff.
• Description of change: A new document was released by the national falls prevention coordination group in July 2023 which included an updated list of medications which are associated with an increased falls risk. The existing list within the current medication management procedure within the falls manual and policy has been replaced by this updated list. See appendix E. Some minor tweaks have also been made to the language and referencing within the procedure itself to reflect this update. There is no change to the process with respect to what staff need to do with regard to medicines management and falls.

Page last reviewed: September 13, 2024
Next review due: September 13, 2025