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Community Pharmacy Falls Prevention Service
Claire Thomas MSc
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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)
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Aim
Enable you to provide high quality falls prevention consultations
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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
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Falls
What is a fall?
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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
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Falls
What are the consequences of falling?
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Consequences of falling:
Serious injury: head injury/fracture
‘Long-lie’
Death
Psychological
Loss of mobility
Increased dependency & disability
Impact on family/carers
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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
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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
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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
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TBL: Falls Risk & Prevention
3 questions to discuss in groups
5 mins to agree group answer
5 mins for debate
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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
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Medication and Falls - Evidence
Use of multiple medicines
Anti-arrhythmics e.g. digoxin, amiodarone, beta-blockers, flecainide
Psychotropics i.e. antipsychotics, sedatives, benzodiazepines & antidepressants.
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Medicine Use in Older People
Ageing process - pharmacokinetic, pharmacodynamic & homeostatic changes:
Drug distribution
Altered receptor sensitivity
Reflex tachycardia
Balance
Thirst & hydration
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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
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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
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Falls Prevention Service
Patient recruitment
Inclusion criteria
Falls risk assessment
Referral to Specialist Falls Service
GP notification form
Payment
Monitoring/evaluation
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Patient Recruitment
Self referral
Presenting in pharmacy following a fall
Identified by dispensing staff
Identified by counter staff
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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
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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
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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
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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
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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
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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
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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
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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.
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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.
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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/