QUIP to implement STOPP-FALL criteria for reducing medication related falls in patients aged over 65 using the PDSA model

Introduction:

Patients over 65 often have multiple comorbidities and complex polypharmacy regimens, many including falls-risk-increasing drugs (FRIDs). Falls are a leading cause of morbidity in this group and are frequently associated with polypharmacy. A quality improvement project on Marjory Warren ward, King’s College Hospital, reviewed FRID prevalence and aimed to de-prescribe them where appropriate. A retrospective review revealed that all patients were on at least one FRID. Using the STOPP-FALL criteria, we systematically identified and reviewed FRIDs during hospital stays to reduce falls and improve prescribing safety. The multidisciplinary team included consultants, resident doctors and nursing staff.

Methods:

Cycle 1 data obtained for patients who were either admitted with a fall or had a history of falls, along with their current medications, showed that all of them were on atleast one FRID. To facilitate the practical use of the STOPP-FALL tool, we developed a color coded template for each category of FRID and educated the ward team to review each patient’s medication regimen using the template, and document this on the ward round entry. 

Results:

A re-audit was conducted under PDSA model, one month after implementing the intervention, reviewing a total of 35 patients. 69% were admitted with a fall or had a documented history of falls. Among these, 83% were prescribed one or more FRIDs. In 25% of these cases, it was considered clinically appropriate to deprescribe one or more FRIDs. Although the issue of polypharmacy remains ongoing, this intervention marked a meaningful first step towards reducing medication-related fall risk.

The introduction of the STOPP-FALL tool led to a structured approach in identifying high-risk medications, which improved clinical awareness and accountability. Moreover, it promoted patient safety, leading to a potential reduction in future falls. 

Conclusion:

This project highlighted that working closely as a team helped us to use the STOPP-FALL criteria to make prescribing safer for older patients. Future plans include expanding the use of the STOPP-Fall tool across other Health & Ageing wards, large group teaching sessions and further integration into electronic prescribing systems to ensure a consistent and sustainable practice across the Department of Clinical Gerontology at King’s College Hospital.