Medication review aims to reduce falls
| Medication reviews brings many benefits
when they are carried out at home. Debbie Andalo reports |
Debbie Andalo is
a freelance journalist
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A woman visited her elderly mother every day to ensure
that she was taking her medicines appropriately. She separated the
daily medication
into two piles — one to be taken in the morning, the other in the
evening. However, it was not until a pharmacist visited the pensioner
in her own home to carry out a medication review that it was discovered
that she was not taking them properly. Some of the tablets should have
been taken three times a day.
  Pharmacist Sharron Patrick who carried out the review admitted: “One
of the advantages of a medicines review in the patient’s home is
that you see the whole picture. You might discover, for example, that
they are keeping their tablets in a cold damp cupboard or on top of the
fire.”
The home-based medicines review programme, centred on a sheltered housing
scheme in Peterborough, was introduced as part of a Medicines Management
Services Collaborative project to reduce the number of falls by the elderly.
The initiative was set up following the publication of the National Service
Framework for Older People that set a standard for the NHS, in partnership
with local councils, to take action to prevent falls in the elderly.
An elderly patient on four or more medicines — particularly those
for sedation or lowering blood pressure — is at risk of a fall,
the NSF points out.
Chas Ryan, Medicines Management Services project facilitator for the
Greater Peterborough Primary Care Partnership — which includes
the city’s two primary care trusts— explained that the scheme has been set up in partnership with local GPs,
the city council and the PCTs. The national falls collaborative, an initiative
to reduce the number of elderly falls set up by the Government’s
National Primary Care Development Team is also involved.
The council designed a falls tool kit that helps identify people who
are at risk of falling. These people are then offered a 30-minute medicines
review in their own home carried out by a pharmacist. The pharmacist,
who has access to the patient’s medication record, carries out
the review, working to a protocol drawn up by the local GPs.
Mr Ryan said: “The kind of things the pharmacist is allowed to
do
includes switching from brand to generic drugs and changing formulations
(eg, a cream to an ointment) as well as dose optimisation. The pharmacist
can also recommend the GP
reviews the medication if it hasn’t been done for a while.”
After the review the pharmacist
discusses the findings and any recommendations for change with the patient’s
GP. “This pilot scheme means that this group of patients may be
more compliant — using their medicines as advised. We are also
able to set in place a system so that these
patients can be reviewed again by the pharmacist in six months’ or
a year’s time. The intention is that these
patients will be dose optimised and using their medicines well and so
reduce their risk of falls.”
The home visits are being carried out by Mrs Patrick, medicines management
and prescribing manager for Greater Peterborough Primary Care Partnership,
who identified the benefits of seeing patients in their own homes. She
said: “If I visit patients in their own homes then I think they
are more keen to co-operate. If you expect them to come and see you then
it
requires more of an effort and they may not want to go out if it’s
raining or they don’t feel well.”
As part of the visit the pharmacist is also expected to discuss the risks
of a fall and how the risks can be reduced. Mr Ryan added: “The
pharmacist is also in a position, because they are in the patient’s
own home, to assess the risk the patient has of a fall.”
Brian Rigg, a council sheltered team manager who is involved in the falls
initiative, said the falls tool kit points out that tenants need to be
asked whether they are on four or more medicines, including OTC medicines.
He said: “I think this scheme is a great idea. As a local authority
we are obliged to produce a support plan for every tenant in a sheltered
housing scheme and we are using a lot of information from the falls initiative
for individual support plans.
“Having a home visit from a pharmacist helps tenants who are immobile
and, because somebody is coming into their home, they are more likely
to co-operate. It also takes pressure off local GPs because they are
not having to do a full-blown review in the practice and at the same
time it enhances the reputation of the local pharmacist.”
The Peterborough initiative was welcomed by Professor Alison Blenkinsopp,
professor of the practice of pharmacy at the department of medicines
management at Keele University. Professor Blenkinsopp, author of the
medicines management guide to the NSF for older people, said: “It
seems that Peterborough, by working in partnership, is taking the right
approach to looking at how to reduce falls in the elderly.”
She added: “The pharmacist, as part of the review, should also
be giving the elderly advice about regular exercise and what they can
do to improve their balance.” She suggested that community pharmacists
could also help reduce falls by giving elderly patients advice in the
pharmacy and issue information leaflets about falls prevention.
Hospital pharmacists could also help by discussing falls prevention with
patients admitted after a fall, she added. The Peterborough pharmacists
plan to use the experience of the falls project to launch a city-wide
medicines review of all 20,000 patients aged over 75. Mr Ryan said: “The
falls pilot will provide us with useful evidence for that programme and
means we will be able to meet the NSF target of reviewing all our over-75s
by 2004. I am convinced that the work we are doing with falls prevention
is making an impact in Peterborough and that we can make a difference
particularly in the care of elderly patients.”
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