An interview with Liz Butterfield, Immedicare Specialist Pharmacist…
Why is the prevention of falls so important for older people?
Falls are the leading cause of emergency hospital admissions for older people1,2 and during the pandemic, there was a clear and urgent need to protect care home residents from falling and being hospitalised as a result. By preventing an emergency hospital admission, the elderly care home resident is also protected from the risk of hospital-related complications and infections, including COVID-19 and other hospital-acquired infections.
Why are pharmacists well placed to help tackle the issue of falls?
It is well known that some medications and combinations of treatments can contribute to an older person’s risk of falling. If a resident falls, but does not require hospital admission, there is a risk that their medications are left unassessed and a future fall may occur again and result in greater harm.3-5
Integrating pharmacists into the care pathway is also a critical part of NHS England’s strategy to increase primary care support, as it would enable medication reviews via telephone or video and supporting care homes with medicines queries.6
What is the aim of pilot that you are involved in?
Immedicare*, a clinical and technology partnership between Involve Visual Collaboration Ltd and Airedale NHS Foundation Trust (ANHSFT), provide telehealth support to care homes, and data from the service revealed a significant unmet need in Bradford District and Craven. From 125 care homes in the area, falls are the most frequent reason for care homes to contact the telehealth clinical assessors and between March 2020 and February 2021, the service received 1,420 calls relating to falls.7
To proactively address this issue, Immedicare launched a pilot in the local area to reduce the risk of falls recurring in elderly care home residents. By providing proactive medication reviews, the pilot aims to reduce the risk of falls and the negative impact they have on the resident and local health services.
What is your role within the pilot and how do you integrate into the existing care pathway?
When a resident falls in one of the 690 UK care homes where Immedicare is in place, they receive an immediate virtual clinical assessment from a highly skilled, multidisciplinary team of specialist nurses based at ANHSFT. It is then determined whether the resident stays in their place of care or needs to be admitted to hospital.
This is where my unique role in the pilot comes in as it is my job to assess residents that remain in their place of care following a fall and identify those that are at a high risk of falling again. I then work directly with local GPs and care home pharmacists to optimise their medication and reduce their risk of a second, potentially more damaging, fall.
What impact might the pilot have now and in the future?
The potential value of a pharmacist’s intervention at the time of a fall is huge and has significant benefits for the resident and local healthcare system. For the resident, it adds additional protection for them from a stressful, disorienting hospital visit and reducing the risk of hospital-related complications and infections. For the local health system, it means reducing ambulance conveyances and emergency admissions.
The approach is also fantastic for local care home and pharmacy communities, as it seeks to change the way they respond to their residents’ falls and ensure that a pharmacist’s input is a key component of the clinical assessment and rehabilitation plan.
While the pilot is in its infancy, early feedback from care homes, GPs and local pharmacists has been extremely positive and impact data is being collected on medication reviews and treatment adjustments.
*Immedicare is a secure, video-enabled, clinical healthcare service linking care homes to the NHS with 24-hour access to a highly skilled, multidisciplinary clinical team based at Airedale NHS Foundation Trust. The service has been adopted by 690 UK care homes to date.