Small Fix Could Yield Big Benefits by Reducing Falls in Hospitalized Seniors

Touro College of Pharmacy Professor Presents Her Research at Touro College Research Day

April 28, 2015

A simple change to a hospital's drug ordering system reduces the risk that older people will receive dangerously high doses of medication, according to a poster presented here at Touro College Research Day.

Organized by the Touro Research Collaborative, Touro College Research Day is being held from 11:30 a.m. to 5 p.m. on Tuesday, April 28, at the Touro College of Osteopathic Medicine and the Touro College of Pharmacy campus at 230 West 125th Street in Harlem.

Falls are common among hospitalized older patients, and medications are often the culprit, according to Rebecca Salbu, Pharm.D., CGP, an associate professor at Touro College of Pharmacy, who led the new study with the assistance of Dr. Rosanne Leipzig. Some drugs are not recommended for older people at all because they can increase the risk of falls, while others need to be given at lower doses in order to be safe.

“Many elderly people can be on quite a number of medications that may be unnecessary, and may be interacting with each other to cause adverse effects,” Dr. Salbu added. These drugs can make people feel dizzy, drowsy and weak, she added, putting them at risk of falls.

When a physician orders a medication for a hospitalized patient, an “order set” embedded into the medical record will suggest a default dosage for that drug that may or may not be appropriate for that patient depending on patient specific factors. In the new study, Dr. Salbu and her team investigated the effect of adjusting these default doses to geriatric-appropriate dosing for patients 65 and older for seven medications that are known to increase the risk of falls.

Over two hundred medication orders were assessed. During the three months before the order-set changes, medications were prescribed appropriately 23% of the time. During the following three months, the rate of appropriate prescribing increased to 40%. And after the order-set change, doctors were less likely to prescribe the fall-linked drugs at any dose to older people. “They may have just become more aware altogether of overprescribing in the elderly population, and that perhaps the medications were not needed,” Dr. Salbu said.

She and her colleagues are expanding their study to other units of the hospital. “Our next step is then to see if there was an overall reduction in falls as a result of these changes in order sets,” Dr. Salbu said.

The Touro Research Collaborative, a dedicated group of faculty who pursue research in the medical and health sciences, founded the Research Day—now in its fourth year—to foster collaborations among faculty and students.