Reducing Falls and Medicines Related Harm in Frail Care Home Resident

Falls and medicines-related harm are significant and preventable causes of morbidity among frail older adults living in care homes. Frailty is a long-term condition associated with reduced physiological reserve, increased susceptibility to stressors, and poorer health outcomes. Compared with non-frail individuals, frail residents are substantially more likely to experience falls, adverse drug events, functional decline, and hospital admissions. Polypharmacy and the use of high-risk medicines further increase these risks, highlighting the need for proactive and structured approaches to medicines management.

This quality improvement initiative aimed to reduce falls risk and medicines-related harm among frail care home residents through the implementation of a Structured Medication Review (SMR) pathway and targeted medicines optimisation interventions. Residents aged 65 years and over were identified through proactive and reactive cohorts, including those with recent falls, indicators of frailty, multiple long-term conditions, dementia, or use of multiple medicines. Frailty assessments were undertaken using the Rockwood Clinical Frailty Scale, with residents requiring review referred for pharmacist assessment.

The intervention was delivered collaboratively by pharmacists and pharmacy technicians and wider MDT, focusing on comprehensive medication reviews, identification of potentially inappropriate prescribing, deprescribing where appropriate, optimisation of treatment, and shared decision-making with residents and carers. Supporting resources utilised included decision-support tools, and medicines optimisation guidance.

A total of 124 pre-SMR assessments were completed, leading to 111 structured medication reviews. Medicines optimisation outcomes included 12 high-risk medicines deprescribed, 11 moderate-risk medicines deprescribed (as defined by FRID), 32 reductions in anticholinergic burden, 76 medicines discontinued, and 5 referrals to specialist services. These interventions contributed to reducing medicines-related risks while supporting safer prescribing practices.

The project demonstrated that a structured, multidisciplinary approach to frailty assessment and medication review in care homes can identify significant opportunities to reduce falls risk and medication-related harm. Key learning points included the importance of improved medicines management, optimisation of polypharmacy, structured review processes, and proactive frailty identification. The findings support wider adoption of systematic medication review programmes to enhance safety and quality of care for frail care home residents.