Improving falls medication review in secondary care through introduction of a polypharmacy pharmacist

4649
M Fawkes1, L Reid1, S Kirby1.
1. Wirral University Teaching Hospital NHS Foundation Trust
Clinical Quality
CQ - Clinical Effectiveness
Falls
View DOI

Abstract

Introduction:

Problematic polypharmacy contributes to an increased risk of medicine-related harm, particularly in those living with frailty or multimorbidity [1]. This pilot aimed to evaluate the potential benefits of introducing a dedicated polypharmacy pharmacist to conduct enhanced falls medication reviews as part of consultant-led ward rounds for targeted cohorts at Wirral University Teaching Hospital NHS Foundation Trust.

 

Method:

An independent prescribing pharmacist conducted weekly medication reviews on a stepdown ward for older patients.  Medications were reviewed for safety based on their anticholinergic burden (ACB) score and if they were a Falls Risk Increasing Drug (FRID), as per trust guidance. Recommended changes were discussed with the medical team and the patient to support shared decision-making. Agreed changes were documented in the electronic prescribing record and communicated to primary care through enhanced discharge summaries.  A paired sample t-test was used to assess statistical significance (p<0.05).

 

Results:

50 patients, average age 84 years old, were reviewed between October and December 2025.  The average number of medications prescribed per patient decreased from 12.3 (range 4-26) to 10.4 (p<0.05); a total of 97 medications were stopped (average 1.9 per patient).  Combined total ACB scores decreased from 120 (average 2.4 per patient) to 89 (average 1.8 per patient)(p<0.05); the doses of 4 additional medications with an ACB score ≥1 were reduced.  The total number of FRIDs prescribed decreased from 133 (average 2.7 per patient) to 106 (average 2.1 per patient)(p<0.05); the doses of 10 additional FRIDs were reduced (Figure 1).

 

Conclusion:

The provision of a dedicated polypharmacy pharmacist demonstrated measurable improvements in medicines optimisation, ACB scores and FRID prescribing rates.  Thus, proving to be an effective strategy to address inappropriate polypharmacy in the inpatient setting and reduce patients’ risk of falls.

 

Reference(s):

[1] Department of Health and Social Care. National overprescribing review report [Internet].London:GOV.UK;22 Sep 2021[cited 2026 Jan 16]. Available from: https://www.gov.uk/government/publications/national-overprescribing-review-report

Comments

It is great to see the work of a fellow prescribing pharmacist! Would love to make contact with you to see if we can share ideas. 

You’ve said that this was on a step-down ward, is that some sort of NCTR ward? We’ve found similar on our NCTR where people tend to be more stable and more receptive to an in-depth de-prescribing conversation. 

Do you have data on what types of medicines were most commonly stopped or decreased? Cardiovascular or Psychotropic? 

In our trust we’ve done similar work but have not been able to secure the funding for a falls pharmacist. Was this role funded by the pharmacy department or as part of the stepdown ward, or was this unfunded additional activities alongside the existing service? Thank you. 

Submitted by helen.maslen1@… on

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