community pharmacy falls prevention service claire thomas msc
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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/
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