Medication sick day guidance in a Falls Clinic: Patient awareness and feasibility of a patient information leaflet

Introduction
Patients attending falls clinics frequently have polypharmacy. During acute illness, some commonly prescribed medications may need to be temporarily withheld to reduce the risk of complications. Guidance on this is commonly known as medication “sick day rules”. Medications review is an inherent part of Comprehensive Geriatric Assessment but patient education on sick day rules is not routinely included. This project assessed whether improved awareness of sick days rules was needed in this population and whether a patient information leaflet could be a feasible educational tool.  

Method
Patients attending a Geriatrician-led Falls Clinic completed a questionnaire in January 2024. This included questions on relevant medications, use of a medication compliance aid, assistance with medication management, and awareness the need to hold medications when unwell. A patient leaflet was developed explaining, medication groups to withhold, when to restart medicines, and when to seek medical advice. Feedback was collected using a follow-up questionnaire assessing confidence, clarity and information burden.

Results
Fifty-four patients completed the baseline questionnaire. Thirty-three patients (61%) were taking at least one medication requiring sick day guidance. Only 13/54 patients (24%) were aware of this guidance. Among patients taking relevant medications, only 2/33 (6%) could correctly identify which of their medications should be withheld. Thirty-five patients (65%) were interested in receiving written information. Twenty-one patients (39%) attending clinic were suitable for targeted education as they or their family managed medicines, did not use a compliance aid, and were taking relevant medication. Early leaflet feedback from 10 patients was broadly positive, although comments highlighted difficulty with abbreviations and generic medication names. Free-text comments suggested that clinician explanation should accompany leaflet delivery.

Conclusion(s)
A high proportion of patients attending a Frailty Assessment Unit were taking medications requiring sick day guidance, but awareness was limited, suggesting a need for education. A patient information leaflet delivered at a Falls Clinic could help increase awareness with clinician explanation.

Take Home Message

Medical Staff should ensure that Sick Day Guidance is discussed during polypharmacy review of frail older adults in Community Practice.