Use of a fall risk evaluation in a community-based pharmacy

Abstract Background Falls are a serious public health concern that increase health care expenditures and account for over $30 billion in direct medical costs. Medication-related problems can contribute to fall risk, and community-based pharmacists are well positioned to intervene given their role in monitoring ongoing medications. Objectives To evaluate integration of a fall risk screening assessment (i.e., STEADI) into community pharmacy practice and to report targeted medication management interventions that pharmacists made for patients aged 50-years and older with fall risk potential. Setting Service-oriented independent pharmacy in the Midwest U.S. that uses an in-house clinical software to perform prospective drug utilization review and document clinical interventions. Intervention A 3-item STEADI (Stop Elderly Accidents, Death, and Injuries) fall risk screening assessment was administered from October 15, 2018 to January 31, 2019 to 311 pharmacy patrons aged 50-years and older taking high-risk medications. For those with a positive screen for fall risk, the 12-item STEADI fall risk assessment was administered. A pharmacist performed a comprehensive targeted medication review (CMR) for these patients. Education and medication recommendations were provided. Evaluation Fifty-three patients (17%) responded "Yes" to at least one pre-screening question. The mean total STEADI fall risk score was 5.7 out of 12. The most commonly reported STEADI item was a worry about falling (75.5%) and sometimes feeling unsteady when walking (67.9%). While education about falls was provided to all receiving the study CMR, only 6 medication changes were made to prescribers of which 4 were accepted. Conclusions The STEADI assessment was useful in identifying patients who were potentially at risk for falls. More work appears needed pertaining to deprescribing high-risk medications for at risk patients.