Improving Falls Risk Inducing Drugs (FRIDs) reviews during hospital admission: a quality improvement project
Abstract
Introduction
Falls are a leading cause of morbidity and mortality in older adults. Medications, known as falls risk increasing drugs (FRIDs), significantly contribute to this risk. Several tools are available to support structured medication review for FRIDs. In the acute hospital setting, the standard of medication reviews and consistency of documentation can vary, with little consideration to FRIDs. This can result in an undressed key component of falls risk reduction.
The aim of the study was to evaluate the effectiveness of a pharmacy-led FRIDs review process by improving documentation, identification of older adults at risk of falls prescribed FRIDs, and assessment of related outcomes during admission.
Methods
This quality improvement project was implemented across frailty and ageing wards at a large teaching NHS Trust. A FRIDs review process was introduced into the medicine reconciliation and pharmacist clinical review. Data was collected prospectively for 220 patients aged ≥65 years in July 2024. Outcomes included documentation of FRIDs reviews and changes to FRIDs during admission and at discharge.
Results
Of 220 patients (mean age 86 years, 51% female), 95% were prescribed one or more FRIDs, with an average of three per patient. Before intervention, 13% had a documented comprehensive FRIDs review by the medical team. After implementation, 78% had a comprehensive review recorded, predominantly by pharmacy.
There were no statistically significant differences in started, stopped or amended FRIDs, between the two patient groups those with or without a pharmacy-led review. It was observed that more FRIDs overall were discontinued than initiated during admission.
Conclusions
A structured, pharmacy-led FRIDs review process is a low-resource intervention that improves documentation and is feasible in routine hospital care. Structured FRIDs review supports medicines optimisation and pro-active falls prevention. Pharmacy led reviews raises multidisciplinary awareness of medication-related falls risk and supports multifactorial falls prevention strategies.
Comments
Transition to community care
Excellent work highlighting the role of pharmacy in improving recognition of medication-related falls risk - it is an area we are currently exploring in our inpatient space to align with the NAIF guidance. Have you considered how recommendations from the inpatient FRIDs review are communicated to primary care and community falls services to support ongoing deprescribing where appropriate?
Great question! It's in our next cycle of improvement
Hi, Yes great question! Our plan for the next cycle is around improved documentation and processes on discharge. Firstly to increase communication to primary care services, but also to provide clear person centred education.
Currently the process is quite variable but our system has a nice feature where you can document additional information in the electronic prescribing record for an in-patient medication, and when the discharge letter is produced this moves over automatically. This can be quite useful for adding in next steps for deprescribing and brief details of rationale at the time of consultation, confidently knowing that this will be included in the discharge letter. But as I said quite inconsistently used so still some work to do.
As for the community falls teams we are lucky to have an excellent community frailty centre in our area. The community falls team is part of the same organisation, so they can refer people in for a comprehensive geriatric assessment (CGA). But they don’t have a pharmacist as part of the community falls team, so for people that wouldn’t necessarily need a full CGA, there’s likely a gap that our project could fill. Another area for development.
Example of FRIDs form and abstract
Hello everyone,
It has been noted that the QR code may not be working. You can access the file using the Google Drive link below:
https://drive.google.com/file/d/1T9WkdxdbjTBCLhFX-skzhuoQy_Eu3laK/view?usp=drive_link
If you have any difficulties accessing the file, please get in touch and I will be happy to email it to you directly.