Mercy Health Center has 12-point guideline to prevent falls

Mercy Health Center of Oklahoma City, OK, has an award-winning falls prevention program that was developed with extensive assistance from the hospital's pharmacy. The health center's fall prevention tools include guidelines for assessing fall risk.

The guidelines can be useful in training pharmacists in falls risk assessment and in training pharmacy students, says Burl Beasley, RPh, MPH, medication safety coordinator at Mercy Health Center.

Beasley shares the guidelines below.

Pharmacy Fall Prevention

Program Fall Risk Rounds

  1. Check patient age (60-65 years old and older).
  2. Check admit date (generally only within the last 2 days).
  3. Compare pharmacy and nursing scores:
    1. Pharmacy: 6 = high
    2. Nursing: 8 = high (depends on nursing fall scale used)
      1. Morse, CPG, etc.
  4. Check list of meds for those that need to be discontinued:
    1. Darvocet®
    2. Meperidine
  5. Check list for meds that require monitoring:
    1. Digoxin
    2. Phenytoin
    3. Fosfenytoin
  6. Check that sleeping agents are at lowest possible dose:
    1. Recommend change to HS PRN (not scheduled every HS)
    2. Without therapeutic duplication:
      1. Zolpidem, Zolpidem CR
      2. Temazepam
      3. Trazodone
  7. Review patient's home meds for those agents that may be discontinued or dose reductions (sleeping agents, pain meds, and antidepressants) as you may not want to adjust home medications.
  8. Review all medications for appropriate dose for age and renal function, and make recommendations to decrease medication doses based on dosing guidelines for geriatrics, etc.
  9. Complete Interdisciplinary Team Request for Consideration of Additional Services (ITRCAS, or pink sheet) on those medications that need recommendations.
    1. Include any supportive material that may be available:
      1. Beers Criteria
      2. FDA MedWatch
      3. Micromedex info
  10. Place the ITRCAS form in Progress Notes section of patient chart (this is NOT a permanent part of the patient record).
  11. Locate nurses of those patients whose nursing scores may be low to inform them of any discrepancies with pharmacy so that you may obtain a reassessment or confirmation that the patient truly is not at great risk of fall.
  12. Log all interventions made for the day and follow up on any previous interventions possible.