Front Door Frailty: Reducing Falls Risk Through Pharmacist-Led Medicines Optimisation in the Emergency Department

Introduction

Older people attending emergency departments (EDs) commonly present with frailty, multimorbidity and polypharmacy. Medicines optimisation is a key component of Comprehensive Geriatric Assessment and may improve patient outcomes, particularly in relation to falls prevention. Antrim Area Hospital ED has an established Early Intervention Team (EIT), but no dedicated pharmacist input. This service evaluation aimed to assess the impact of a Medicines Optimisation in Older People (MOOP) Independent Prescriber pharmacist providing medicines optimisation for older patients attending ED. 

Method

Over eight consecutive working days in March 2025, patients aged over 65 years attending Antrim Area Hospital ED and referred to the EIT underwent pharmacist-led medicines optimisation reviews. During periods of low EIT referrals, older patients were proactively identified via the ED dashboard. Reviews included medicines reconciliation, assessment of prescribing appropriateness, identification of falls-risk increasing drugs (FRIDs), anticholinergic burden (ACB), and implementation of optimisation interventions. Clinical significance was assessed using the Eadon scale and potential cost avoidance estimated using the ScHARR economic model. 

Results

Thirty-two patients were reviewed (mean age 87 years; 63% female), with an average Clinical Frailty Scale score of 5.5 and mean medication count of 10.4. Falls or collapse accounted for 65.6% of attendances. A total of 115 medicines optimisation interventions were made (mean 3.6 per patient), including 41 falls-related interventions (36%). Ninety percent of interventions were graded as Eadon 4 or 5, indicating a significant improvement in patient care. Estimated healthcare cost avoidance ranged from £15,700 to £28,614 over the 8-day period. Following review, FRIDs scores were reduced in 69% of patients, with the average score decreasing from 5.3 to 3.5. Average ACB scores reduced from 0.8 to 0.6. 

Conclusion(s)

Pharmacist-led medicines optimisation in the ED demonstrated significant clinical value for older patients with mild to moderate frailty. The service identified multiple opportunities to improve prescribing, reduce falls risk and optimise medicines use, with substantial potential healthcare cost avoidance. These findings support consideration of dedicated pharmacy input within ED frailty pathways and further development of emergency department-based medicines optimisation services.