Implementation of a Post-Fall Medication Reconciliation Assessment Tool

Abstract

Older adult patients are often prescribed potentially inappropriate medications (PIMs) in the acute care hospital setting. Reducing falls in older adults requires a multi-faceted approach, including thoughtful consideration of medication regimens in this at-risk population. Two medical units in a Charlotte-area hospital experienced a combined 47 falls in older adult patients out of 97 total falls in 2019. Without a process to address PIMs, the Doctor of Nursing Practice project team developed the Post-Fall Medication Reconciliation Assessment Tool. The tool was used specifically for patients 65 and older who fell on Unit A or Unit B to evaluate for PIMs administered within 24 hours of their falls, based on comparing their medication records with the 2019 Beers Criteria. After identification, the nurses were instructed to communicate with the patient’s physician to consider PIM discontinuation. During the 11-week implementation phase, 11 falls occurred on the two units, and only 10% of the tools were fully completed. However, for each patient that fell, they were administered an average of 2.4 medications that matched the Beers Criteria. Only one tool indicated a conversation occurred between a nurse and physician. While the project did not directly eliminate PIMs in these older adult patients, there is evidence in the literature that reducing PIMs can improve patient outcomes, reduce health care expenditures, and enhance patient care.