A CPPE online workshop e-Book 1

Falls prevention

A CPPE online workshop

EW/FALLSPREV21/PWFebruary 2021

e-Book 1

Falls prevention – e-book 1

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CPPE programme developerReena Sharma, education supervisor, Yorkshire and Humber

ReviewersDr Parul Shah, consultant in elderly medicine, Northampton General Hospital NHS TrustDr Nicola Wilson, clinical fellow in elderly medicine, Northampton General Hospital NHS Trust

CPPE reviewersCaroline Barraclough, regional managerKristeen Turner, educational supervisorSusan Weatherhead, education supervisor

Piloted byPaul Jenks, local tutorCatherine Tucker, event tutor

AcknowledgementsCPPE would like to acknowledge all developers of the original Falls Prevention face-to-face workshop, first published in September 2018.

DisclaimerWe have developed this learning programme to support your practice in this topic area. We recommend that you use it in combination with other established reference sources. If you are using it significantly after the date of initial publication, then you should refer to current published evidence. CPPE does not accept responsibility for any errors or omissions.

External websitesCPPE is not responsible for the content of any non-CPPE websites mentioned in this programme or for the accuracy of any information to be found there.

All web links in this resource were accessed on 22 February 2021.

Published in February 2021, originally published in September 2018 by the Centre for Pharmacy Postgraduate Education, Division of Pharmacy and Optometry, The University of Manchester, Oxford Road, Manchester, M13 9PT. www.cppe.ac.uk

ProductionThis workshop has been developed by CPPE following a local, commissioned workshop funded by the Royal Society for the Prevention of Accidents (RoSPA).

Design and artwork by Gemini West Ltd

© Copyright controller HMSO 2021


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Contents

Learning with CPPE 4

About this CPPE workshop resource 6

Learning objectives 7

Useful resources 8

Section 1 – Pre-workshop tasks 10

Further reading 13

Checklist for action 14

Section 2 – Online workshop activities 15

Activity 1 – case study Paul Johnson 16

Activity 2 – Identifying causes of falls 20


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Learning with CPPEThe Centre for Pharmacy Postgraduate Education (CPPE) offers a wide range of learning opportunities in a variety of formats for pharmacy professionals from all sectors of practice. We are funded by Health Education England to offer continuing professional development for all pharmacists and pharmacy technicians providing NHS services in England. For further information about our learning portfolio, visit: www.cppe.ac.uk

We recognise that people have different levels of knowledge and not every CPPE programme is suitable for every pharmacist or pharmacy technician. We have created three categories of learning to cater for these differing needs:

Core learning (limited expectation of prior knowledge)

Application of knowledge (assumes prior learning)

Supporting specialties (CPPE may not be the provider and will direct you to other appropriate learning providers).

This is a 1 learning programme and assumes that you already have some knowledge of the topic area.

RevalidationYou can use this programme to support revalidation and your continuing professional development (CPD). Consider what your learning needs are in this area. For more information about revalidation and to record your entries, visit: www.mygphc.org

Programme guardians CPPE has a quality assurance process called programme guardians. A programme guardian is a recognised expert in an area relevant to the content of a learning programme who reviews the programme every six to eight months. Following the regular programme guardian review we develop an update to inform you of any necessary corrections, additions, deletions or further supporting materials. We recommend that you check you have the most recent update if you are using a programme more than six months after its initial publication date.

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FeedbackWe hope you find this learning programme useful for your practice. Please help us to assess its value and effectiveness by visiting your learning record in the My CPPE section on our website: www.cppe.ac.uk/mycppe/record

Alternatively, please email us at: [email protected]


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About this CPPE workshop resourceOverall aimThe overall aim of this programme is to develop your knowledge and skills to help you manage and optimise care for patients who are at risk of having a fall.

There are three parts to this CPPE programme, all of which must be completed in order to achieve the learning objectives:

This e-Book 1, which includes reading, information searches and tasks that you need to complete before you attend the online workshop (you will also need access to e-Book 1 during the online workshop).

The workshop itself, which is focused on the knowledge, skills and attitudes which will help you manage and optimise care for patients.

e-Book 2, which will be emailed to you after the online workshop and contains suggested discussion points for each of the scenarios discussed during the online workshop.

This book gets you started. It provides key information and tasks to help you meet the learning objectives, but it also encourages you to identify your own learning needs. It then challenges you to relate what you have learnt to your own practice and professional development. We have included tasks to stimulate your thinking and we will refer to these again at the workshop, so please ensure you complete them before attending the online workshop.

We estimate it will take you up to two hours to complete the tasks in this book.

A note about web links

Where we think it will be helpful we have provided web links to take you directly to an article or specific part of a website. However, we are aware that web links can change. If you have difficulty accessing any web links we provide, please go to the organisation’s home page or your preferred internet search engine and use appropriate key words to search for the relevant item.

Make sure you have completed Sections 1 of this book before your event. You will also find it helpful to read the activities in Section 2, which will be discussed at the online workshop.


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Learning objectivesYou can use our programmes to support you in building the evidence that you need for the different competency frameworks that apply across your career. These will include building evidence for your Foundation pharmacy framework (FPF) and supporting your progression through the membership stages of the Royal Pharmaceutical Society (RPS) Faculty.

As you work through the programme consider which competencies you are meeting and the level at which you meet these.

What extra steps could you take to extend your learning in these key areas?

After completing all aspects of this programme, you should be able to:

n describe the role of pharmacy professionals in prevention of falls

n identify the factors that contribute to the increased risk of falls

n identify people at risk of falls and provide solutions to reduce this risk through lifestyle and medicine interventions

n explain how you can utilise your knowledge in falls prevention to better support your patients

n provide educational advice on promoting good bone health and medicines for osteoporosis.


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Useful resourcesHaving a fall can have devastating and far reaching consequences. Falls are a major public health issue and can happen to anyone, but a fall does not have to be an inevitable outcome and measures can be taken to help prevent a fall from occurring.

We have selected some resources that you can use to familiarise yourself with the impact of falls on healthcare services and the role of pharmacy professionals in assessing the risks and prevention of falls.

National Institute for Health and Care Excellence. Clinical guideline CG161 – Falls in older people: assessing risk and prevention. 2013. www.nice.org.uk/guidance/cg161

National Institute for Health and Care Excellence. Quality standard QS86 – Falls in older people. 2015. www.nice.org.uk/guidance/QS86

World Health Organization. Falls – Key facts. 2018. www.who.int/en/news-room/fact-sheets/detail/falls

Public Health England. Falls: applying All Our Health. 2018. www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health

Public Health England. Public health matters blog – The human cost of falls. 2014. https://publichealthmatters.blog.gov.uk/2014/07/17/the-human-cost-of-falls/

Age UK. Falls Prevention Exercise – following the evidence 2013 www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/health--wellbeing/rb_2013_falls_prevention_guide.pdf

ACB Calculators www.acbcalc.com

National Osteoporosis Guidance Group (NOGG) Guidance www.sheffield.ac.uk/NOGG/downloads.html


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Before attending the CPPE workshop you need to complete the tasks set out below.

The workshop is a practical learning session, and you will take part in medicine optimisation activities to build on your knowledge and skills to identify and support people at risk of a fall.


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Notes

Section 1 – Pre-workshop tasksTask 1 – Patient perspective

A fall can affect a person more than just the physical injury.

Gloria, who lives in Northampton, shares her personal experience in the video link below and guides you through her thoughts on what you could do to prevent falls.

Consider what are you currently doing in your pharmacy teams to support people like Gloria? How could you improve this support?

Watch the video on the Northamptonshire County Council web page from Gloria: www.youtube.com/watch?time_continue=1&v=JMNHzDjpQJA


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Notes

Task 2 – Assessing risk

Read and become familiar with the NICE guidance CG161 on falls prevention – Falls in older people: assessing risk and prevention – available at: www.nice.org.uk/guidance/cg161

Reflect on which assessment tools you can use in your practice to help identify patients at risk of a fall and prevent a fall.


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Task 3 – Anticholinergic medicines role in falls

Medicines with anticholinergic side effects can increase the risk of a person having a fall.

Look at some of the prescriptions that you see in your practice for patients taking more than five medicines. Consider how many medicines each patient is taking and what their anticholinergic burden is. How would this contribute towards a potential fall? How could you potentially help reduce this burden?

Notes


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Further readingn CPPE Polypharmacy distance learning programme

www.cppe.ac.uk/programmes/l/polypharm-p-01

n CPPE Older people distance learning programme www.cppe.ac.uk/programmes/l/older-p-03

n National Institute for Health and Care Excellence. Clinical Knowledge Summaries – Falls - risk assessment https://cks.nice.org.uk/falls-risk-assessment#!scenario##

n Prescqipp Bulletin www.prescqipp.info/our-resources/bulletins/bulletin-87-care-homes-medication-and-falls/


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Checklist for actionNow that you have worked through the pre-workshop tasks, take a moment to run through this checklist to make sure you are well prepared for the online e-workshop.

Actions I completed this on:

I have looked at the appropriate websites and resources.

I have completed tasks 1-3 in the pre-workshop section.

Signed: Date:

You will need access to your notes and this book during the online workshop.

Enjoy your learning.


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Section 2 – Online Workshop activitiesBefore participating in this online workshop, you will have already completed Section 1 pre-workshop tasks to help you identify your own learning needs, read the key information and then related it to your own area of practice and professional development.

Please note that you do not need to complete this section of the book prior to the online workshop. However, you will find it helpful to read the following activities and think about the issues each raises.

You will work through the activities in this section with your professional colleagues at the online workshop. This will help you apply what you have learnt so far and encourage you to measure the changes in your practice. We will supply some suggested areas for discussion after the online workshop.


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Activity 1Case study: Paul Johnson

Paul Johnson, 78 years old has come to see you. Paul recently attended the emergency department following a fall, and he left with a big bag of medicines. He feels he is taking too many medicines and he would like your advice.

He has had four emergency department attendances in the last year, but does not appear to have been admitted. On one occasion, he sustained a fractured left distal radius.

He lives alone in a house, his wife died 18 months ago and he has no formal package of care, but his daughter lives nearby. He gets around using a walking frame.

Past medical history includes hypertension, type 2 diabetes, benign prostatic hypertrophy (BPH), age-related macular degeneration and osteoarthritis.

From Paul’s records, you can see he has been prescribed the following medicines:

Medicine Dose

Amlodipine 5 mg One daily

Amitriptyline 10 mg One at night

Codeine 60 mg One four times daily

Bendroflumethiazide 2.5 mg One daily

Finasteride 5 mg One daily

Furosemide 20 mg One twice a day

Gliclazide 80 mg One twice a day

Morphine sulphate oral 2.5 ml every four hoursw solution 5 mg when required

Omeprazole 20 mg One daily

Paracetamol 500 mg Two tablets four times daily when required

Ramipril 5 mg One daily

Sertraline 100 mg One daily

Simvastatin 40 mg One at night


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Medicine cont. Dose cont.

Tamsulosin 400 micrograms One at night

Zopiclone 3.75 mg One at night

Question 1

How would you define a fall?

When speaking to Paul about his medicines, he tells you he takes his medicines as prescribed.

Question 2

Which of the above medicines could contribute to Paul’s falls risk?


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Question 3

By what mechanism could each of these medicines precipitate a fall?

Paul would like to reduce the number of medicines he takes every day.

Question 4

Which medicines would you want to review?

Consider:

What questions would you ask Paul?

How would you discuss this with Paul?


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Question 5

Would there be any other changes or additions to Paul’s medicines that could help prevent a fall?


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Activity 2Identifying causes of falls

This activity will allow you to work in your groups to discuss and explore each of the following patients’ falls risk, as well as actions you can take in your sector of practice to help prevent a fall or how you can support the patient.

For each of the patients you will consider the same four questions.

1. Frank Alling is 81 years old and lives alone in a dormer bungalow. His family do not live locally and don’t have much opportunity to visit. He currently has no formal care package in place.

Medicine Dose

Co-beneldopa 125 mg one capsule four times a day

Paracetamol 500 mg two tablets four times a day when required

Ramipril 2.5 mg one tablet daily

Question 1

What clues does Frank’s prescription give you about his falls risk?


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Question 2

What medicine(s) would you be concerned about supplying?

Question 3

What key things would you discuss with Frank to establish the extent of the risk?

Would there be any other changes or additions to Paul’s medicines that could help prevent a fall?


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Question 4

What recommendations might you discuss with the prescriber?


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Question 4


2. Violet Swallow is 79 years old. Violet is a retired teacher and lives with her husband. They have lived in the family house for the last 40 years. Violet’s husband cares for her and there is no package of care in place.

Medicine Dose

Digoxin 250 mcg one tablet daily

Furosemide 20 mg one tablet twice a day

Bisoprolol 5 mg once tablet daily

Question 1

What clues does Violet’s prescription give you about her falls risk?

Question 2



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Question 3

What key things would you discuss with Violet to establish the extent of the risk?

Question 4



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3. Albert Stone is 93 years old and lives alone in a warden-controlled flat. His son visits regularly and Albert is moderately active and enjoys completing crosswords.

Medicine Dose

Gliclazide 80 mg one tablet daily

Metformin 500 mg one tablet twice daily

Insulin glargin ten units twice daily

Question 1

What clues does Albert’s prescription give you about his falls risk?

Question 2



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Question 3

What key things would you discuss with Albert to establish the extent of the risk?

Question 4


Notes


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Contacting CPPEFor information on your orders or bookings, or any general enquiries, please contact us by email, telephone or post. A member of our customer services team will be happy to help you with your enquiry.

Email [email protected]

Telephone 0161 778 4000

By post Centre for Pharmacy Postgraduate Education (CPPE)Manchester Pharmacy School1st Floor, Stopford BuildingThe University of ManchesterOxford RoadManchester M13 9PT

For information on all our programmes and events: visit our website www.cppe.ac.uk

Share your learning experience with us:email us at [email protected]

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A CPPE online workshop e-Book 1

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Transcript of A CPPE online workshop e-Book 1