111 Tripper: Trying to Reduce Inappropriate Prescribing in Patients Who are Elderly and At Risk of Falls

Abstract

Background Falls in older adults are common, and a major cause of mortalityand morbidity. Polypharmacy is associated with a greater number of falls and is prevalent but preventable. The American GeriatricsSociety Beers Criteria for Potentially Inappropriate Medication(PIM) Use in Older Adults are used worldwide. This project focusedon Table 3 of the 2019 Beers Criteria which recommends anexplicit list of PIMs to be avoided in older adults with a history offalls. Aims To increase documented discussion about PIMs on dischargeletters for elderly patients at risk of falls over a 6-week period. Method A retrospective review was undertaken to define baseline data onfalls, PIMs and documented discussion of PIMs on dischargeletters. Stickers for Kardexes were introduced to highlight PIMsfor review. A table documenting discussion of PIMs wasincorporated to discharge letter templates. Data was then collectedon falls, PIMs and documented discussion of PIMs on dischargeletters over a 6-week period. Results: Of patients discharged over10 weeks, 44% had a history of falls. Of patients with a history offalls, 73% were taking at least one PIM pre-admission. Followingintervention, the median percentage of discharge letters withdocumented discussion of PIMs increased from 4% to 30%.Following intervention, there was a greater average reduction inprescribed PIMs on discharge in patients with a history of falls. Discussion We confirmed a significant burden of falls and PIMs in our patientpopulation. QIP intervention increased documentation of PIMdiscussion and reduced the volume of PIMs prescribed ondischarge. Communicating PIM discussion on discharge lettersencourages deprescribing; informs primary care and futureadmissions; and promotes patient centred decision-making inthis important risk area. Further work includes collecting feedbackfrom primary care and introducing a PIMs review table todischarge letter templates throughout the hospital.