Each year, millions older adults experience falls and fall-related injuries. Falls occur in all healthcare settings, in the home, and throughout the community. Falls often result in injuries that require emergent care, hospitalization, and short- and long-term skilled rehabilitation, costing Medicare over $30 billion annually. In 2012, the Centers for Disease Control and Prevention (CDC) developed and began promoting the Stopping Elderly Accidents, Deaths & Injuries (STEADI) Toolkit to healthcare providers, community-based organizations and consumers in an effort to address the growing public health problem of falls among older adults.

STEADI includes consumer educational materials and an algorithm for fall risk screening, assessment and intervention based on the American and British Geriatrics Societies Clinical Practice Guidelines for the Prevention of Falls in Older Persons. Many older adults identified to be at increased risk of falls through STEADI could benefit from more comprehensive assessment of their medications and medical conditions. In response to this need, the American Society of Consultant Pharmacists (ASCP) and the National Council on Aging (NCOA) began work in 2015 on an expanded assessment companion tool for pharmacists, physicians and other clinicians.

The ASCP-NCOA Falls Risk Reduction Toolkit is designed to focus on falls risk factors in older adults identified to be at increased risk using screening tools, such as STEADI. The ASCP-NCOA Toolkit guides the clinician through a more comprehensive assessment of falls risk inducing medications and medical conditions. Similar to STEADI, the ASCP-NCOA Falls Risk Reduction companion Toolkit conveys the importance of falls risk detection and management via an interprofessional approach. Given that medications and chronic conditions are often implicated as a risk factor for falling, the role of the pharmacist in falls risk reduction is emphasized.

Why is an expanded falls risk assessment tool focused on medical conditions and medications needed?

• The population at most risk of falling is rapidly growing.
• Many different risk factors contribute to falls.
• Medications are common contributors to falls.
• Medical conditions are common contributors to falls.
• Healthcare providers play an important role in reducing risk factors.
• A six-step, comprehensive falls assessment for those at highest risk could identify and potentially mitigate risks before a fall occurs.

How do I use the ASCP-NCOA Falls Risk Reduction Toolkit?

1. To begin, it is recommended that Toolkit users listen to the following two webinars that provide needed background on falls among older adults, national and state falls prevention efforts, medical conditions and medications as a risk factor for falls:
• A Collaborative Approach to Falls Prevention: Introduction to the ASCP-NCOA Toolkit
• National and State Efforts to Reduce Falls Among Older Adults
2. Familiarize yourself with each of the components in the ASCP-NCOA Toolkit as well as the components in the STEADI Toolkit.
3. Determine which components may work best and what falls risk reducing role you will assume, while taking into consideration your practice setting, patient population, interprofessional colleagues, and institutional or community resources.
4. Establish a process to help identify patients most in need of a more comprehensive falls risk assessment. Consider training technicians, frontend office workers, or in-the–field case managers to use basic falls screening tools such as the “Stay Independent” brochure or appropriate components of the check list in the STEADI toolkit.
5. Set up a means by which individuals with positive screens can be referred to you for a more comprehensive assessment. Take into consideration referral processes both internal and external to your practice setting. Determine what patient information should accompany the referral.
6. Start the comprehensive assessment by filling in what information you have for the patient on the ASCP-NCOA falls risk Checklist.
7. Interview patient/caregiver using ASCP-NCOA falls risk Checklist to finish gathering pertinent information.
8. Use materials available in STEADI to provide instruction for orthostasis, gait and balance assessments, or refer patient to other member of healthcare team for these assessments.
9. Prioritize, document and share your findings with patient/caregiver and other members of the patient’s healthcare team using communication sample in Toolkit.
10. Include in your documentation a plan to address findings, including alternative medications and/or non-pharmacologic strategies.
11. Use citations from the bibliography to support findings and alternative strategies, as necessary.
12. Provide additional educational materials from STEADI to patient/caregiver, when appropriate, to assist in conducting an in-home falls hazards assessment and to provide information on how to further reduce falls risk.
13. Develop your referral base for falls risk reduction services and refer patients based on individual needs to appropriate resources. Examples: neurologist, geriatrician, physical therapist, occupational therapist, contractor/handyman, community programs such as Stepping On and TaiChi.
14. Follow-up with patients on implementation of recommendations and improvement of falls status.

Authors:

Kathleen A. Cameron, BSPharm, MPH Senior Director, National Falls Prevention Resource Center National Council on Aging

Michelle A. Fritsch, PharmD, BCGP, BCACP Founder and President Meds MASH, LLC

Penny S. Shelton, PharmD, BCGP, FASCP Executive Director North Carolina Association of Pharmacists

ASCP and the authors would like to thank major contributors to the toolkit content and acknowledge the initial work of the ASCP Innovations 4 (Falls) Workgroup.

Contributors:

Kacey Carroll, PharmD Assistant Professor of Pharmacy Practice Shenandoah University

Nicole Henry, PharmD Candidate 2017 University of Arizona

Marsha Meyer, PharmD, BCGP, CGCM Clinical Pharmacist Independence at Home, division of SCAN health plan

Amy Russell, CPh, BCGP, MBA President Prescriptive Strategies

Acknowledgements:

This toolkit is based on the initial work of ASCP’s Innovations 4 (Falls) Workgroup

Jwalant Bhatt, PharmD Omnicare

Kathleen A. Cameron, BSPharm, MPH Senior Director, National Falls Prevention Resource Center National Council on Aging

Kacey Carroll, PharmD Assistant Professor of Pharmacy Practice Shenandoah University

Sharon Clackum, PharmD, CGP, FASCP President

Rx Answers LLC Nicole Henry, PharmD Candidate 2017 University of Arizona

Joanne Hirschfield President Pharmacy Solutions Consulting, LLC

Erin Laughlin Karara Innovations Lead UnitedHealth Group

Marsha Meyer, PharmD, BCGP, CGCM Clinical Pharmacist Independence at Home, division of SCAN health plan

Amy Russell, CPh, BCGP, MBA President Prescriptive Strategies

Penny S. Shelton, PharmD, BCGP, FASCP Executive Director North Carolina Association of Pharmacists

Jennifer Urso Director of LTC Pharmacy Servicies Guardian Elder Care

ASCP Staff Liaisons:

Cindy Porter, RPh Vice President, Education & Foundation Development

Joan Baird, PharmD, BCGP Director of Education and Clinical Affairs

© American Society of Consultant Pharmacists 2017