Download Preventing Falls, Helping Patients to Manage their Medicines

Preventing
Falls
Helping patients to manage
their medicines
Jayne Agnew Pharmacy SHSCT
Causes of falls
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There are many causes of falls.
Medicines can be a cause in a variety of ways
e.g. it may be an unwanted effect (side effect)
of the medicine.
Studies have shown that taking more than four
medicines can increase the risk of falls, no
matter what the medicines are.
Unwanted effects of medicines include:
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A sudden drop in blood pressure on standing
Poor balance
Confusion
Drowsiness
Dizziness
Blurred vision
Medicines that can cause falls
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Sleeping tablets and nerve tablets
e.g. temazepam, diazepam,
zopiclone, zimovane. These can
make people drowsy and clumsy.
Psychotropic medicines e.g.
chlorpromazine. These are used
in patients who can be very
agitated. These can cause
confusion and low blood
pressure.
Medicines that can cause falls
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Medicines that affect blood
pressure e.g. blood pressure
medicine, angina medicine.
Some antidepressants e.g.
fluoxetine, citalopram and
parkinsons medicines e.g.
Madopar can lower blood
pressure.
Medicines that can cause falls
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Some antidepressants can cause drowsiness
e.g. amitriptyline, dosulepin. These medicines
can also be used to treat nerve pain.
Epilepsy medicines can slow down reaction
times and increase risk of falls e.g. Tegretol®
(carbamazepine), Epilim® (sodium valproate).
Some epilepsy medicines can be used to treat
nerve pain e.g. Lyrica® (pregabalin).
Medicines that can cause falls
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Fluid or water tablets (diuretics) e.g.
furosemide. If taken late in the day
the patient may have to get up to
use the toilet during the night and
increase their risk of a fall.
Strong painkillers e.g. morphine,
codeine, tramadol, BuTrans®,
Transtec® – these can cause low
blood pressure and dizziness.
Alcohol
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Alcohol can cause drowsiness and
dizziness.
It interacts with many medicines and can
make unwanted effects of medicines worse.
What can patient’s do?
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Talk to their doctor or pharmacist
if they experience unwanted
effects from their medicines.
Ask their doctor or pharmacist to
review their medicines every six
to twelve months. This should
include medicines the patient
buys e.g. pain killers, herbal
medicines. Are they all needed?
Medication review
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Does the patient know why they are talking each of their
medicines?
Are all the medicines still needed?
Is the patient experiencing any side effects?
Are all the medicines still working?
Are any blood tests needed e.g. Kidney function?
Are the medicines the best medicines for the patient?
Could any of the medicines be changed to ones that will
work just as well but could save the NHS money (Northern
Ireland Formulary)
What can patient’s do?
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Patients should not stop or change the
dose of a medicine prescribed by a
doctor without talking to their doctor
first.
Know all the medicines they are taking:
– Why are they taking it
– What does it do
– How and when should they take it
– What possible unwanted effects could it
cause
What can patient’s do?
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Talk to their doctor or pharmacist
before adding any new medicines.
Carry an up to date list of all the
medicines that they are taking.
They can show this to their doctor
or pharmacist when they visit
them.
Never use another person’s
medicines.
What can patient’s do?
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Develop a system that helps them to take their
medicines as prescribed e.g. reminder charts, alarms.
Return any medicines they are no longer taking to their
community pharmacist.
If they are admitted to hospital they should check when
they are going home that they understand what
changes have been made to their medicines.
Drink enough water. Dehydration can cause dizziness.
Medicines used to strengthen
bones
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Calcium and vitamin D e.g.
Calceos, Natecal D3,
Adcal D3, Calcichew
Hormone replacement
therapy in women
Medicines used to strengthen
bones
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Patient’s with osteoporosis
will usually be prescribed a
bone tablet e.g. risedronate
(Actonel) or alendronic acid
(Fosamax) taken once a
week or Bonviva taken
once a month
Things to remember about
bone tablets
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Calcium tablets should not be taken at the same
time as risedronate or alendronic acid. Patient
should take their calcium at lunchtime on the day
they take their bone tablet.
Take your risedronate or alendronic acid should be
taken on an empty stomach at least 30 minutes
before breakfast. It should be taken with a glass of
water and the patient should stand or sit upright for
30 minutes after taking it.
Medication adherence support pilot
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Assessment tool
Simplify medication regimen
Medicine education
Encourage active family/caregiver involvement
Provision of Medication list
Provision of compliance aid
Reminder charts
Medication adherence support pilot
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Easy open containers
Synchronisation of medication quantities
Collection of medications/ delivery solution
Change to medication timing
Bespoke reminder system e.g. Text messages,
phone calls
Large print and audio labels
Audio patient information leaflets,t ranslations
Medication reminders
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Medication reminder watch
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Daily medication reminder
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Smartphone medication adherence Apps e.g.
Pill reminder App, Drugs.com Medication
Guide
Compliance aids
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Pill popper
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Pill cutter
Compliance aids
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Haleraid
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Opticare
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Turboaid
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Opticare artho
Compliance aids
Community pharmacists receive no payment to
supply these
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Reusable compliance
aids – family member or
patient can fill
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Non reusable compliance
aids
Compliance aids
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Clear print and large print labels
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Audio labels
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Talking label voice recorder
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Braille labels
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Tactile labels
Compliance aids
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Tablet crushers
Patients need to check if their medicine can
be crushed
Some medicines should never be crushed
e.g. modified release preparations, enteric
coated preparations
MUR (Medicines Use Review) service
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Service provided by most community pharmacies
Diabetic and respiratory patients on multiple medicines
Aim of MUR is to help patients use their medicines more
effectively
Establishes patient’s actual use, understanding and
experience of taking their medicines
Identifies, discusses and resolves poor or ineffective
medicine use e.g. ‘using preventer inhaler only if chest is bad’
Identifies side effects and drug interactions that may affect a
patient’s compliance with their medicines
Follow up consultation 4 weeks later if needed
Medicines Management Service
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Some local pharmacies
provide a medicines
management service
It is a service where the
community pharmacist will
do a detailed review of a
patient’s medicines and
answer any queries they
have about their medicines.