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Pharmacist meds review may reduce patient falls
It’s common for health care providers to have a process in which they review patients for their risk of falling, but too often that review does not include a pharmacist. A pharmacist’s review of the patient’s medications can dramatically reduce the likelihood that a patient will fall and be injured, says one medication professional who organized such a system in his facility.
The pharmacist can assess the medications to look for those that increase the risk of falls, or combinations that increase the risk, says Mark J. Haumschild, MS, PharmD, cardiovascular/thrombosis scientific manager with Aventis Pharmaceuticals in Seminole, FL, and consultant pharmacist for Morton Plant Mease Health Care (MPMHC) in Clearwater, FL. Haumschild and colleagues recently implemented a systemic review process at MPMHC, a rehabilitation center, that resulted in 47% fewer falls in a one-year period. The reduction in falls saved approximately $308,000 in health care costs.
"Falls are a huge issue and a huge risk for elderly patients," he says. "We decided to develop a program where we looked at each resident’s drug use more intensely. We wanted to make recommendations for discontinuing the drug, changing the dosage, or switching to a different drug for that particular patient, based on comorbidities."
The process was simple but effective. When a new resident was admitted, the staff at the rehab center faxed Haumschild a list of medications and dosages for him to review. In most cases, Haumschild reviewed the patient’s medications within 24 hours of admission.
To study the effectiveness of the effort, called the fall-focused pharmaceutical intervention program (FFPIP), Haumschild randomly selected 200 patients from the pre-intervention and post-intervention periods. A data analysis found that the number of patient falls was reduced in the post-intervention group by 47%, resulting in a future savings of $7.74 per patient per day. The use of several classes of medication also decreased in the post-intervention period: cardiovascular agents were reduced by 10.7%; analgesics by 6.3%; psychoactive drugs by 18.2%; and sedatives and hypnotics by 13.9% (Am J Health-Syst Pharm 2003; 60:1,029-1,032).
The research also revealed a profile of the type of patient most at risk for falls. Haumschild found that the patients most likely to fall were male, greater than 76 years of age, and had a cardiovascular or orthopedic-related diagnosis. They also were taking analgesics, cardiovascular agents, and central nervous system agents.
Though the patients identified as most at risk were male, the intervention program had a more significant effect on female patients, Haumschild says. The reason is unknown.
"The process was based on us going over each patient’s records and either reducing drug dosages or modifying their therapy in some way," he says. "That won’t work unless you have the support of their physicians, but we found that physicians were very supportive. We probably had compliance of close to 99%."
Working with nurses at the rehab center, Haumschild also helped implement new recommendations for watching patients more closely, based partly on education about how a patient’s blood pressure can be affected by a change in body position. A sudden drop in blood pressure can lead to falls. The educational efforts included almost all of the center’s staff, not only nurses but also housekeeping, transportation, and therapists.
"Everyone became more aware of what patients were at risk and which ones to watch more carefully than average," Haumschild says. "Simply educating them about blood pressure changes and positioning made them much alert to risky situations. That was part of what led to the overall reduction in falls."
Haumschild says the rehab setting had no influence on the success of the intervention program and that it could be replicated in any health care setting. He notes that he is a consultant pharmacist and not involved in actively dispensing drugs, and that dispensing pharmacists may find it more difficult to incorporate medication reviews into their workloads. But you can suggest a system that would have the dispensing pharmacist review the patient’s medications when drug prescriptions are filled. That may seem like less of a burden than having a list of medications sent for review while the pharmacist is trying to fill orders.
"The moment the drug is dispensed is a tremendous opportunity to make a difference because they can see that the patient is on certain drugs and make recommendations," he says. "They can affect the fall risk almost immediately."
The rehab center recently added pharmaceutical review as a routine part of its risk management committee meeting each month. The committee, made up of a risk manager and representatives from several departments, now includes Haumschild. The committee reviews a couple of injury cases each month, and falls are always a priority. Assessing the patient’s medication regimen is a big part of figuring out whether the injury could have been prevented.
"The pharmacist is usually not involved enough in that effort, actually looking at patients in the fall evaluations," he says. "You usually have nurses and physicians involved in assessing fall risk at admission, but that’s also where the pharmacist should get involved. I don’t think that happens enough."