Remote monitoring, assessment and consultations have become more common since the COVID19 pandemic with a number of digital care Hubs established across the country. Current protocols in care homes without remote monitoring direct carers to contact 111 / 999 following a fall, and this frequently results in residents being conveyed to hospital.
As well as representing significant costs to the NHS, avoidable conveyances and admissions can be distressing and disorientating for care home residents. Providing care homes with access to a clinical Hub that is staffed by registered practitioners enables assessments of residents who have fallen. Falls are multifactorial and require a comprehensive assessment by experts within falls teams, which can take time to arrange and for plans to be put in place. Consultant pharmacist led medicines optimisation services have been added to develop the existing Airedale service from reactive to proactive.
Falls assessment templates within the Hub have been amended to include triage for STOPPFall medications, which includes antihypertensive, antidepressant, anticholinergic and sedating drugs. If identified an automatic referral for triage and medication review by a Hub clinical pharmacist is sent electronically on SytstemOne, which is the electronic patient record used across Bradford District and Craven. Airedale Digital Hub fall templates also prompt clinical assessors to arrange a check of orthostatic/ standing BP to identify any residents with postural BP drop.
The medicines optimisation service is developing and currently patients are referred directly to usual GP. This happens automatically by electronic notes transferred in real-time as the falls review case is closed. Advice and guidance to consider changes to regular medication aimed at reducing fall risk is provided. Airedale Digital Hub is working with SICBL stakeholders to co-design referral pathways to practice, PCN and Medicines Optimisation Care Home pharmacy teams to support targeting of structured medication reviews (SMRs) to care homes residents who have fallen. These referral pathways will reduce GP workload, make efficient use of PCN SMRs targeted for older patients most likely to benefit and assist places to achieve Investment Impact Fund (IIF) Targets on admission avoidance.
Preliminary evaluation is available which shows that:
• 75% (n=50) of Care Home Residents experiencing recurrent falls are prescribed STOPPFall medicines.
• Actioning STOPPfall medication review advice and guidance resulted in significant reduction in care home residents experiencing recurrent falls.
• Basing medicines optimisation pharmacists in a digital hubs handling falls emergency response is, at worst cost neutral and at best could generate a ten-fold return on investment.
• The human costs of recurrent falls is described in stakeholder engagement.
