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.