September 26, 2024 • 16 mins
In this episode, Geriatric Clinical Pharmacist Sean Jeffrey discusses common interventions, strategies for communication and compensation for pharmacist driven fall prevention services.
Each month, APhA will release two, 10 to 15 minute podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Welcome to the First Fill.
My name is Katie Meyer,and I serve as the Senior Director
of Content Creation here at APhAand I'll be the host for this episode.
This month, we're trying something a little bitdifferent and we'll release two podcasts.
Today, during part two,I'm joined by a geriatric pharmacy
specialist, educator, colleague and a friendof mine, Sean Jeffrey, who will talk a little bit
about how he's optimized for preventionas part of his practice.
(00:26):
Welcome, Sean.
Why don't you introduce yourself
and tell listenersa little bit about your background and experience?
Thank you, Katie.
First and foremost, it's great to be hereand thank you so much for the invitation.
I guess my goal for this session is to not trip uptoo much in sharing recommendations
that I think every pharmacistscan hopefully feel comfortable making.
(00:47):
So as you said, Sean Jeffrey, I'm
a geriatric pharmacy specialistwith over 20 years of experience in the field.
I did my residency training in geriatricsat the Durham V.A.
and Duke Center for Agingand then spent 15 years as a consultant pharmacist
at VA, Connecticut,where I was sort of a jack of all trades.
I did a little bit of all things geriatrics.
(01:08):
This included being part of a home basedprimary care team
where I sawfirsthand the fall dangers in people's homes.
I was in the geriatric clinicwhere we struggled to mitigate fall risk.
I worked as part of a geriatric surgery teamto pre hab or pre
habilitation older adults before surgery to help
(01:29):
prevent post-operative complications like falls.
And I helped stand up or hospital'sinitial fall screening program.
Now, that was my time in the VA.
I currently practice within a large employedmedical group where I work closely with primary
care providers to optimize medication therapy,
especially in our older adult population.
(01:51):
And I'm particularly passionateabout fall prevention,
probablybecause I've lost count of the number of times
I had to pick myself upafter tripping over my own feet.
But all jokes aside, it's a critical areawhere pharmacists can make a real difference.
And I'm excited to share some insights today.
Thanks, Sean.
So today, as Sean mentioned, we're going to talka little bit about fall prevention.
(02:12):
But rather than discuss recent evidenceand literature, we'll discuss
some strategies and practice pearlsthat pharmacists can use to identify
and intervene to prevent falls and patientsthat they see that are at risk.
So just a little bit of backgroundbefore we get started.
As we've discussed in episode one,Falls are the leading cause of injury among adults
(02:33):
aged 65 years and older in the United Statesand caused an estimated 3 million ED visits,
more than 950,000 hospitalizationsor transfers to another facility
and approximately 32,000 deaths annually.
And these numbers are increasing.
One of the major contributorsto falls in older adults is increased
use of medications,which is where we as pharmacists can help.
(02:55):
So this brings me to my first question.
Sean, can you tell the listeners a little bitabout how the workflow is set up in your practice
setting, specifically as it relatesto identifying and intervening in patients
where at risk for falls?
Sure.
Again, so first things, I'mno longer that pharmacist in the VA.
I'm now the director of pharmacy at HartfordHealth Care's Integrated Care Partners.
(03:18):
So this is part of our Health Care systemsorganization
that's responsible for value basedcontracting population, health and oversight
of our payer partner relationships,especially in the Medicare Advantage space.
So my perspective ismaybe a little different here.
I work with over 400 primary care providers,
thousands of specialists,and we have about 350,000 attributed lives.
(03:42):
So that means I'm no longerthe individual pharmacist
conducting a lot of the one on one fall medicationreviews.
I need to be impacting practicesacross our state and system.
So the question is, how do we do this?
It starts with educating our care management team.
We have over 50 nurses and social workerswhere we have an integrated fall risk assessment
(04:02):
in their current routine medicationreviews for the members who have
perhaps experienced a transition of carealso known as a TOC,
or are being followed for complex care management,also known as CCM.
We start by identifying patientswho are 65 and older, who are either
on multiple medications or are taking any medsassociated with a higher risk of falls.
(04:26):
So in this case, think benzos,anti-depressants, antihypertensives.
And once identified our teamdoes the comprehensive med review,
which we affectionately call the fall sweep.
The team can then do one of two things.
They can either refer back to my pharmacy teamfor a more detailed fall risk
reduction consultation.
(04:46):
These are higher acuity, more complicated
patients, or if it's a lower acuity individual,
they will make a recommendation to the provideras part of their ongoing chronic care management.
And you know, just like that, we've turneda potential hazard into an opportunity
for better care.
A second way that we approach this as a system
(05:09):
is through the 4Ms age friendly health initiative.
And for those who may not be familiar with what
the 4Ms stand for, it's a program that began
with the American Geriatrics Society,and it stands for what matters most.
First M, mobility, mentation and medications.
(05:30):
So we have a geriatric councilthat is currently developing training materials
for these specific that we're going to bedisseminating to both clinicians and to patients.
And fall risk reduction
actually crosses all four of the M's.
It really matters to patientsbecause they're definitely afraid of falling.
It directly impacts mobility.
(05:51):
And mentation is often a key risk factorfor falling.
And medications drive the risk ofor declining mentation and mobility.
By focusing at this health system level
in raising awareness about the 4Msby leveraging our care management team,
it helps me to be able to extend the fall risk
(06:13):
screening and services
into our ambulatory providers.
On the hospital side, hospitalistsdo a very good job internally of having those fall
risk teams internally to help with all the safety
concerns around people falling in the hospital.
But the bigger opportunityis certainly in the ambulatory space.
(06:33):
Thanks, Sean so much for sharing a bitabout the really, quite frankly,
fascinating work that you're doingand reiterating the importance of the 4Ms as well.
You mentioned benzodiazepines, antidepressants.
So kind of along that same line,what would you say
are some of the most common medicationrelated recommendations or interventions
(06:53):
that the teams making to help support prevention?
And that's a great question, Katie.
And one of our most common recommendationsrevolve around deprescribing or dose adjustment.
So we often suggest tapering off
or switching off of benzodiazepines
or other sedatives to safer alternatives.
That is a big bucket of work, is trying to prevent
(07:15):
the ongoing use of benzodiazepineswhere they don't need to be used.
Another big one is addressing polypharmacy,
and we know that patients are sometimeson cocktails of antihypertensives
that can lead to orthostasisand that increases their fall risk.
We also emphasize on the prevention side,although it's maybe a little bit weaker,
the importance of vitamin D supplementation
(07:37):
not just for bone health,but also for the fall risk reduction.
And I would be remiss if I didn't
say we look for opportunitiesto reduce anticholinergic burden.
I can tell you
that trying to pry away somebody's diphenhydramine
or they're Ativan is sometimes harderthan getting a cat out of a tree.
So you really do have to have a relationship
(07:58):
and a dialog around getting back to those 4Ms.
What matters to that individual?
Yeah, So it's so funny
when I think back to my timepracticing as a geriatric clinical pharmacist,
patients love their oxybutyninand they love their diphenhydramine,
so reinforcingthe 4Ms is obviously very important.
(08:19):
But do you have any other tips or tricksthat you've found when addressing
patient or provider hesitancy when they kind ofare really hesitant to deprescribe?
So convincing somebody to give up that, quote,miracle cure
or their favorite pill can be quite challenging.
In this case, what matters most is importantfor framing the discussion on medications.
(08:42):
And any pharmacist can do this. For example,
if you have a
frail, older adultwho's using a walker and comes into your pharmacy,
take that extra step to review their medsfor any potential heavy hitters
that can cause falls,perhaps as too many hypertensive meds.
Or maybe they're at your pharmacy counterbuying an over-the-counter sleep aid.
(09:03):
This is a targetrich opportunity for you to prevent a fall.
When I'm doing the fall consults
and I have an opportunity to speak to the patient,I will sometimes ask
if you could stop a medication,which one would you stop first?
If I were to stop a medication.
Which one don't you want me to touch?
(09:25):
And this line of questioning helps me establish,
albeit crudely, the individual's mostand least important medications.
And from there, I might say,I know this medication helps you sleep,
but wouldn't it be greatif you could sleep and stay on your feet?
I also emphasize the risk
benefit ratio,making it clear that the risks may now outweigh
(09:47):
the benefits, especially as they ageand we providers.
I often highlight evidence from studiesthat are out there.
There's plenty of studies that both highlightthe risks and dangers of medications
by class or specific medicationsas causing fall risks.
There's the STEADIRx study.
So I use all of these thingsto try to back up my recommendations
and make sure that they know it's a team effort.
(10:10):
No one's trying to upend their treatment plan,
just refine it for the patients current needs
A little humor doesn't hurt as well.
I sometimes joke I'm not tryingto rain on anyone's medication parade,
but maybe we can dial it back to a drizzle.
There you go Seanand that's a great way to approach it.
Thanks so much for the tips and tricks.
(10:32):
All right.
Let's shiftgears a little bit from clinical to billing
and reimbursementbecause obviously that's very important as well.
So what are some tips or pearlsyou have for pharmacists to obtain payment
from payers for fall prevention services?
So billing is certainly everybody'sfavorite topic right now.
And I would say that there are
(10:53):
the key here is really to tie your fall
prevention servicesto existing billable activities.
So for instance, comprehensive medication reviewsor CMRs are often covered under Medicare Part D,
and you can document fall preventionas part of the CMR process.
Additionally, many Medicare Advantage plans offer
extra benefitsthat may cover fall prevention programs.
(11:14):
So it's also worthexploring value based care models
where improving fall ratescan contribute to shared savings.
And my tip is to make surethat you're documenting everything.
If it's not written down, it didn't happen.
If it didn't happen, you can't bill for it.
So I just want to take a little bit deeper,dive into those value based opportunities,
because I think that this is where we havepotentially the greatest future opportunity.
(11:39):
It's not fully realized now,but I can tell you in my world
where our system has contracts
that are what we call downsizerisk, where the medical group is at risk
for the total cost of care for the membersthat we're caring for.
That really gets people's attentionand it allows them to start thinking in creative
(12:02):
ways around resources
for populations that have downsize risk.
And fall prevention is one of those
easier things
to try to do upfront to then prevent somebody
from having the sequelae downstreamand the cost downstream.
So because you're in a downside risk environment,it allows you to have a greater
(12:27):
emphasis on preventive strategiesand putting resources where it matters most.
So that could be developing additional education
programs for clinic based practices.
It could be standing up for risk reduction clinics
because any time you prevent the E.R.
visit and you prevent the hip replacement,you're saving significant money to the system.
(12:53):
And that is going to get people's attention.
Absolutely. That's one of the biggest things.
The more hospitalizations
we can prevent, the more moneythat we're saving from a broader perspective.
So thanks, Sean, for that perspective.
All right.
So before we wrap up, I'mjust one final question for you today, Sean.
What is the biggest advicethat you would give listeners
(13:14):
that want to take a more active rolein fall prevention but just don't know
where to start in terms of implementationconsidering their competing priorities?
Yeah.
So biggest advice start small, but think big
and do as Yoda would say, right?
So don't let inertia keep you fromat least doing something,
(13:34):
even if all you do at first is identifyone or two high risk patients perhaps a week.
That's progress.
Or you could start withmaybe an educational campaign,
pick a medication a month and highlighthow this medication
or class of medicationscan increase someone's risk of falling.
That helps with that conversationto create cognitive dissonance
(13:56):
in the mind of the person taking the medicationthat, hey, maybe there's a concern here
and I have somebody who I can nowtalk to about this concern.
The key is really to integrate the fall prevention
into your existing workflowrather than seeing it as an additional task.
So you might want to start by adding a fall riskassessment question
(14:16):
to your standard medication reviewif you don't already do that.
If you're in a health systemwhere you have access to annual wellness visit
data, look for documentation of somebodywho's already had a potential fall risk.
And once you're comfortable with that,you gradually expand your efforts.
Remember, every fall you help preventis one less trip to the ER for your patients
(14:39):
and one more reasonfor them to be grateful for your care.
Plus, it's a great way to make a tangibledifference without having to reinvent the wheel.
All right. Thank you so much for that, Sean.
Let's summarize major takeaways from our time heretoday.
So falls are a major cause of morbidityand mortality in older adults, and pharmacists
like Sean are key in the fight against medicationrelated falls.
(15:01):
Some of the key medications to look out forand consider
deprescribing to help prevent fallsinclude benzodiazepines and other
sedatives, antidepressants and patientsthat are on multiple antihypertensives.
Also,don't forget about vitamin D supplementation.
If you come across a patient, a providerwho's hesitant
to make changes, it's important to approach themcollaboratively and professionally.
(15:24):
And keep in mindthe 4Ms and frame the recommendation
about the patient's goalsand what matters most to them.
And lastly, if you're looking to beginmore actively intervening for fall prevention,
explore tying your interventions to CMRs and valuebased payment models for reimbursement.
And start small but think big about the impactyou're making to patient care.
(15:45):
Thanks so much again, Sean for joining us today.
It's truly been a pleasure to have you.
And for folks on the line, if you haven't listenedto part one of this month's First Fill podcast
yet that released a week ago,I hosted APhA Executive Education Fellows, Nick
and Yara,and we reviewed the recent USPSTF statement
relevant to fall preventionand some other evidence based facts.
(16:06):
Definitelycheck it out for any BCGP credentialed pharmacists
we also recently released a case studyon fall prevention in our Learning library.
Check that out as well to earnand and a half hours of BCGP certification credit.
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your CPE for this month’s podcast.
(16:29):
We'd love to hear your feedbackabout how you like the new set up.
Thanks and take care.
Welcome to the First Fill.
My name is Katie Meyer,and I serve as the Senior Director
of Content Creation here at APhAand I'll be the host for this episode.
This month, we're trying something a little bitdifferent and we'll release two podcasts.
Today, during part two,I'm joined by a geriatric pharmacy
specialist, educator, colleague and a friendof mine, Sean Jeffrey, who will talk a little bit
about how he's optimized for preventionas part of his practice.
(00:26):
Welcome, Sean.
Why don't you introduce yourself
and tell listenersa little bit about your background and experience?
Thank you, Katie.
First and foremost, it's great to be hereand thank you so much for the invitation.
I guess my goal for this session is to not trip uptoo much in sharing recommendations
that I think every pharmacistscan hopefully feel comfortable making.
(00:47):
So as you said, Sean Jeffrey, I'm
a geriatric pharmacy specialistwith over 20 years of experience in the field.
I did my residency training in geriatricsat the Durham V.A.
and Duke Center for Agingand then spent 15 years as a consultant pharmacist
at VA, Connecticut,where I was sort of a jack of all trades.
I did a little bit of all things geriatrics.
(01:08):
This included being part of a home basedprimary care team
where I sawfirsthand the fall dangers in people's homes.
I was in the geriatric clinicwhere we struggled to mitigate fall risk.
I worked as part of a geriatric surgery teamto pre hab or pre
habilitation older adults before surgery to help
(01:29):
prevent post-operative complications like falls.
And I helped stand up or hospital'sinitial fall screening program.
Now, that was my time in the VA.
I currently practice within a large employedmedical group where I work closely with primary
care providers to optimize medication therapy,
especially in our older adult population.
(01:51):
And I'm particularly passionateabout fall prevention,
probablybecause I've lost count of the number of times
I had to pick myself upafter tripping over my own feet.
But all jokes aside, it's a critical areawhere pharmacists can make a real difference.
And I'm excited to share some insights today.
Thanks, Sean.
So today, as Sean mentioned, we're going to talka little bit about fall prevention.
(02:12):
But rather than discuss recent evidenceand literature, we'll discuss
some strategies and practice pearlsthat pharmacists can use to identify
and intervene to prevent falls and patientsthat they see that are at risk.
So just a little bit of backgroundbefore we get started.
As we've discussed in episode one,Falls are the leading cause of injury among adults
(02:33):
aged 65 years and older in the United Statesand caused an estimated 3 million ED visits,
more than 950,000 hospitalizationsor transfers to another facility
and approximately 32,000 deaths annually.
And these numbers are increasing.
One of the major contributorsto falls in older adults is increased
use of medications,which is where we as pharmacists can help.
(02:55):
So this brings me to my first question.
Sean, can you tell the listeners a little bitabout how the workflow is set up in your practice
setting, specifically as it relatesto identifying and intervening in patients
where at risk for falls?
Sure.
Again, so first things, I'mno longer that pharmacist in the VA.
I'm now the director of pharmacy at HartfordHealth Care's Integrated Care Partners.
(03:18):
So this is part of our Health Care systemsorganization
that's responsible for value basedcontracting population, health and oversight
of our payer partner relationships,especially in the Medicare Advantage space.
So my perspective ismaybe a little different here.
I work with over 400 primary care providers,
thousands of specialists,and we have about 350,000 attributed lives.
(03:42):
So that means I'm no longerthe individual pharmacist
conducting a lot of the one on one fall medicationreviews.
I need to be impacting practicesacross our state and system.
So the question is, how do we do this?
It starts with educating our care management team.
We have over 50 nurses and social workerswhere we have an integrated fall risk assessment
(04:02):
in their current routine medicationreviews for the members who have
perhaps experienced a transition of carealso known as a TOC,
or are being followed for complex care management,also known as CCM.
We start by identifying patientswho are 65 and older, who are either
on multiple medications or are taking any medsassociated with a higher risk of falls.
(04:26):
So in this case, think benzos,anti-depressants, antihypertensives.
And once identified our teamdoes the comprehensive med review,
which we affectionately call the fall sweep.
The team can then do one of two things.
They can either refer back to my pharmacy teamfor a more detailed fall risk
reduction consultation.
(04:46):
These are higher acuity, more complicated
patients, or if it's a lower acuity individual,
they will make a recommendation to the provideras part of their ongoing chronic care management.
And you know, just like that, we've turneda potential hazard into an opportunity
for better care.
A second way that we approach this as a system
(05:09):
is through the 4Ms age friendly health initiative.
And for those who may not be familiar with what
the 4Ms stand for, it's a program that began
with the American Geriatrics Society,and it stands for what matters most.
First M, mobility, mentation and medications.
(05:30):
So we have a geriatric councilthat is currently developing training materials
for these specific that we're going to bedisseminating to both clinicians and to patients.
And fall risk reduction
actually crosses all four of the M's.
It really matters to patientsbecause they're definitely afraid of falling.
It directly impacts mobility.
(05:51):
And mentation is often a key risk factorfor falling.
And medications drive the risk ofor declining mentation and mobility.
By focusing at this health system level
in raising awareness about the 4Msby leveraging our care management team,
it helps me to be able to extend the fall risk
(06:13):
screening and services
into our ambulatory providers.
On the hospital side, hospitalistsdo a very good job internally of having those fall
risk teams internally to help with all the safety
concerns around people falling in the hospital.
But the bigger opportunityis certainly in the ambulatory space.
(06:33):
Thanks, Sean so much for sharing a bitabout the really, quite frankly,
fascinating work that you're doingand reiterating the importance of the 4Ms as well.
You mentioned benzodiazepines, antidepressants.
So kind of along that same line,what would you say
are some of the most common medicationrelated recommendations or interventions
(06:53):
that the teams making to help support prevention?
And that's a great question, Katie.
And one of our most common recommendationsrevolve around deprescribing or dose adjustment.
So we often suggest tapering off
or switching off of benzodiazepines
or other sedatives to safer alternatives.
That is a big bucket of work, is trying to prevent
(07:15):
the ongoing use of benzodiazepineswhere they don't need to be used.
Another big one is addressing polypharmacy,
and we know that patients are sometimeson cocktails of antihypertensives
that can lead to orthostasisand that increases their fall risk.
We also emphasize on the prevention side,although it's maybe a little bit weaker,
the importance of vitamin D supplementation
(07:37):
not just for bone health,but also for the fall risk reduction.
And I would be remiss if I didn't
say we look for opportunitiesto reduce anticholinergic burden.
I can tell you
that trying to pry away somebody's diphenhydramine
or they're Ativan is sometimes harderthan getting a cat out of a tree.
So you really do have to have a relationship
(07:58):
and a dialog around getting back to those 4Ms.
What matters to that individual?
Yeah, So it's so funny
when I think back to my timepracticing as a geriatric clinical pharmacist,
patients love their oxybutyninand they love their diphenhydramine,
so reinforcingthe 4Ms is obviously very important.
(08:19):
But do you have any other tips or tricksthat you've found when addressing
patient or provider hesitancy when they kind ofare really hesitant to deprescribe?
So convincing somebody to give up that, quote,miracle cure
or their favorite pill can be quite challenging.
In this case, what matters most is importantfor framing the discussion on medications.
(08:42):
And any pharmacist can do this. For example,
if you have a
frail, older adultwho's using a walker and comes into your pharmacy,
take that extra step to review their medsfor any potential heavy hitters
that can cause falls,perhaps as too many hypertensive meds.
Or maybe they're at your pharmacy counterbuying an over-the-counter sleep aid.
(09:03):
This is a targetrich opportunity for you to prevent a fall.
When I'm doing the fall consults
and I have an opportunity to speak to the patient,I will sometimes ask
if you could stop a medication,which one would you stop first?
If I were to stop a medication.
Which one don't you want me to touch?
(09:25):
And this line of questioning helps me establish,
albeit crudely, the individual's mostand least important medications.
And from there, I might say,I know this medication helps you sleep,
but wouldn't it be greatif you could sleep and stay on your feet?
I also emphasize the risk
benefit ratio,making it clear that the risks may now outweigh
(09:47):
the benefits, especially as they ageand we providers.
I often highlight evidence from studiesthat are out there.
There's plenty of studies that both highlightthe risks and dangers of medications
by class or specific medicationsas causing fall risks.
There's the STEADIRx study.
So I use all of these thingsto try to back up my recommendations
and make sure that they know it's a team effort.
(10:10):
No one's trying to upend their treatment plan,
just refine it for the patients current needs
A little humor doesn't hurt as well.
I sometimes joke I'm not tryingto rain on anyone's medication parade,
but maybe we can dial it back to a drizzle.
There you go Seanand that's a great way to approach it.
Thanks so much for the tips and tricks.
(10:32):
All right.
Let's shiftgears a little bit from clinical to billing
and reimbursementbecause obviously that's very important as well.
So what are some tips or pearlsyou have for pharmacists to obtain payment
from payers for fall prevention services?
So billing is certainly everybody'sfavorite topic right now.
And I would say that there are
(10:53):
the key here is really to tie your fall
prevention servicesto existing billable activities.
So for instance, comprehensive medication reviewsor CMRs are often covered under Medicare Part D,
and you can document fall preventionas part of the CMR process.
Additionally, many Medicare Advantage plans offer
extra benefitsthat may cover fall prevention programs.
(11:14):
So it's also worthexploring value based care models
where improving fall ratescan contribute to shared savings.
And my tip is to make surethat you're documenting everything.
If it's not written down, it didn't happen.
If it didn't happen, you can't bill for it.
So I just want to take a little bit deeper,dive into those value based opportunities,
because I think that this is where we havepotentially the greatest future opportunity.
(11:39):
It's not fully realized now,but I can tell you in my world
where our system has contracts
that are what we call downsizerisk, where the medical group is at risk
for the total cost of care for the membersthat we're caring for.
That really gets people's attentionand it allows them to start thinking in creative
(12:02):
ways around resources
for populations that have downsize risk.
And fall prevention is one of those
easier things
to try to do upfront to then prevent somebody
from having the sequelae downstreamand the cost downstream.
So because you're in a downside risk environment,it allows you to have a greater
(12:27):
emphasis on preventive strategiesand putting resources where it matters most.
So that could be developing additional education
programs for clinic based practices.
It could be standing up for risk reduction clinics
because any time you prevent the E.R.
visit and you prevent the hip replacement,you're saving significant money to the system.
(12:53):
And that is going to get people's attention.
Absolutely. That's one of the biggest things.
The more hospitalizations
we can prevent, the more moneythat we're saving from a broader perspective.
So thanks, Sean, for that perspective.
All right.
So before we wrap up, I'mjust one final question for you today, Sean.
What is the biggest advicethat you would give listeners
(13:14):
that want to take a more active rolein fall prevention but just don't know
where to start in terms of implementationconsidering their competing priorities?
Yeah.
So biggest advice start small, but think big
and do as Yoda would say, right?
So don't let inertia keep you fromat least doing something,
(13:34):
even if all you do at first is identifyone or two high risk patients perhaps a week.
That's progress.
Or you could start withmaybe an educational campaign,
pick a medication a month and highlighthow this medication
or class of medicationscan increase someone's risk of falling.
That helps with that conversationto create cognitive dissonance
(13:56):
in the mind of the person taking the medicationthat, hey, maybe there's a concern here
and I have somebody who I can nowtalk to about this concern.
The key is really to integrate the fall prevention
into your existing workflowrather than seeing it as an additional task.
So you might want to start by adding a fall riskassessment question
(14:16):
to your standard medication reviewif you don't already do that.
If you're in a health systemwhere you have access to annual wellness visit
data, look for documentation of somebodywho's already had a potential fall risk.
And once you're comfortable with that,you gradually expand your efforts.
Remember, every fall you help preventis one less trip to the ER for your patients
(14:39):
and one more reasonfor them to be grateful for your care.
Plus, it's a great way to make a tangibledifference without having to reinvent the wheel.
All right. Thank you so much for that, Sean.
Let's summarize major takeaways from our time heretoday.
So falls are a major cause of morbidityand mortality in older adults, and pharmacists
like Sean are key in the fight against medicationrelated falls.
(15:01):
Some of the key medications to look out forand consider
deprescribing to help prevent fallsinclude benzodiazepines and other
sedatives, antidepressants and patientsthat are on multiple antihypertensives.
Also,don't forget about vitamin D supplementation.
If you come across a patient, a providerwho's hesitant
to make changes, it's important to approach themcollaboratively and professionally.
(15:24):
And keep in mindthe 4Ms and frame the recommendation
about the patient's goalsand what matters most to them.
And lastly, if you're looking to beginmore actively intervening for fall prevention,
explore tying your interventions to CMRs and valuebased payment models for reimbursement.
And start small but think big about the impactyou're making to patient care.
(15:45):
Thanks so much again, Sean for joining us today.
It's truly been a pleasure to have you.
And for folks on the line, if you haven't listenedto part one of this month's First Fill podcast
yet that released a week ago,I hosted APhA Executive Education Fellows, Nick
and Yara,and we reviewed the recent USPSTF statement
relevant to fall preventionand some other evidence based facts.
(16:06):
Definitelycheck it out for any BCGP credentialed pharmacists
we also recently released a case studyon fall prevention in our Learning library.
Check that out as well to earnand and a half hours of BCGP certification credit.
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your CPE for this month’s podcast.
(16:29):
We'd love to hear your feedbackabout how you like the new set up.
Thanks and take care.
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