Community Pharmacy Falls Prevention Service

Claire Thomas MSc

Agenda

Update on the recommissioning of the service – key changes

Team Based Learning approach to improve knowledge of falls risk & prevention

Update from Age UK Doncaster

Advice on service delivery

Training for Level 2 pilot service (8 pharmacists only)

Aim

Enable you to provide high quality falls prevention consultations

By the end of this session you will be able to: Understand key changes to the service Define a fall Describe the risk factors for falling Discuss how medication can lead to falls List ‘culprit/high risk’ medicines Provide advice to people to reduce their risk of

falls Provide a falls prevention service

Falls

What is a fall?

A fall is defined as:

‘an event whereby an individual comes to rest on the ground or another lower level with or without loss of consciousness’2

Falls

What are the consequences of falling?

Consequences of falling:

Serious injury: head injury/fracture

‘Long-lie’

Death

Psychological

Loss of mobility

Increased dependency & disability

Impact on family/carers

Why provide this service?

Nationally:

Cost to NHS >£2.3 billion annually1

86,000 hip fractures annually2

In Doncaster between Sept 2014 & Aug 2015 there were:

2,597 falls

1,935 admissions for fractures

£4,168,646 total cost of fractures

Key Changes to the Service

New Fee structure (tiered service)

Level 1 Basic Falls Risk Assessment

Level 2 (Pilot) Meds Optimisation

Electronic data recording

Prepopulation of referral forms

Option for domiciliary consultations

Patient aged 65+ on 3+meds/high risk medsagrees to Falls Prevention consultation (Level 1 service)

Leaflet and advice

Complex patient (4+ meds)

invited for & agrees to Medication

Optimisation Review Level 2 (Pilot

Scheme)See next slide for

detail

Fall in last 12 months?

Referral to SFS + GP notified + advice &

leaflet

Non-complex patient.

Other risk factors (e.g. continence/vision/bala

nce problem)

Does patient meet SFS referral criteria?

Signpost/refer to appropriate services or referred to GP +

advice & leaflet

Patient agrees to SFS referral

Advice & leaflet

Notify GP

No Yes

Yes

NoYes

Yes

No

No

TBL: Falls Risk & Prevention

3 questions to discuss in groups

5 mins to agree group answer

5 mins for debate

Falls Risk Factors

Falls history Gait/balance deficit Mobility impairment e.g. arthritis, PD. Fear Visual impairment Cognitive impairment Urinary incontinence Home hazards Medication Certain medical conditions

Medication and Falls - Evidence

Use of multiple medicines

Anti-arrhythmics e.g. digoxin, amiodarone, beta-blockers, flecainide

Psychotropics i.e. antipsychotics, sedatives, benzodiazepines & antidepressants.

Medicine Use in Older People

Ageing process - pharmacokinetic, pharmacodynamic & homeostatic changes:

Drug distribution

Altered receptor sensitivity

Reflex tachycardia

Balance

Thirst & hydration

Advice for Patients

Adequate calcium & vitamin D intake Bone-protective medication adherence Stop smoking Avoid alcohol Regular exercise Minimize home hazards Well fitting footwear & clothing Regular eye tests Use of hand rails/walking aids What to do in the event of a fall

Falls Prevention Service Level 1

Basic Falls Risk Assessment

Identify patients at risk & provide interventions to prevent their first fall/fracture (primary prevention)

Identify patients who have already fallen & refer to SFS

Falls Prevention Service

Patient recruitment

Inclusion criteria

Falls risk assessment

Referral to Specialist Falls Service

GP notification form

Payment

Monitoring/evaluation

Patient Recruitment

Self referral

Presenting in pharmacy following a fall

Identified by dispensing staff

Identified by counter staff

Inclusion Criteria

≥ 65yrs on 3 or more medicines

≥ 65yrs & have fallen/been frightened of falling in the past 12 months

≥ 65yrs & prescribed a ‘culprit/high risk’ medicine

Patients referred to the pharmacy by another healthcare professional

Falls Prevention Consultation

Register patient on PharmOutcomes

Complete Falls Risk Assessment checklist on PharmOutcomes

Provide lifestyle advice & leaflet

Print SFS referral form or GP notifcation where appropriate

Specialist Falls Service Referral

Refer patients who:

Have had a fall in the past year

That is not a one off accidental slip/trip

Fax referral form with copy of checklist

GP Notification Form

Types of issues appropriate to include:

Frequent side effects

Sign posted to optician

Continence problems

Balance/gait problems

Previous fragility fracture but no bone protection

Compliance issues with bone protection medication

Pharmacist Interventions

Advice on managing side effects

Patients who have fallen referred

Patients with vision problems sign posted

Identification of & support with compliance issues to bone protection therapy

Falls and fracture prevention advice

Payment & Monitoring

£17.50 per consultation

Additional £56 if domiciliary service

Paid monthly for number of consultations undertaken

Claims generated through PharmOutcomes

Activity/performance monitored by commissioners using PharmOutcomes

Tips for providing the service

Engage your pharmacy team

Engage with local GP practices

Use the checklist

Remember to ask about OTC medicines

Provide prevention advice & leaflet

Encourage patients to inform family, carers & HPs if they do fall

Summary

Falls & fall-related injuries are a common, serious, costly & often preventable problem.

By providing this service you can help improve the primary prevention of falls in Doncaster and help your patients live independently for longer.

References

1. National Institute for Health & Care Excellence. Clinical Practice Guideline 161 Falls: assessment & preventtion of falls in older people. London: 2013

2. National Institute for Clinical Excellence. Clinical Practice Guideline for the assessment and prevention of falls in older people. Clinical Practice Guidelines. London: Royal College of Nursing 2004.

Additional Resources

Falls: assessment and prevention in older people. NICE guideline 161 available at: http://www.nice.org.uk/guidance/cg161

Age UK www.ageuk.org.uk

Doncaster LPC: http://psnc.org.uk/doncaster-lpc/