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Identifying patients at high risk of having a fall

People aged 65 years and over have the highest risk of falling, with 30% of people aged over 65 years and 50% of people aged over 80 years falling at least once a year. Falls and fall-related injuries are a common and serious problem for older people. Falling has an impact not only on quality of life and health, but also healthcare costs. The costs to the NHS are estimated at more than £2.3bn per year.

The Centre for Medicines Optimisation at Keele University and the Medicines Management team at Walsall Clinical Commissioning Group have developed a falls risk assessment tool (FRAT) that uses a new EMIS web protocol and template to help prescribers identify the patients on their list who are most likely to have a fall.

Many falls are preventable. Interventions including the removal of falling hazards, addressing deterioration in muscle strength, balance and vision, and a medication review of psychotropic medicines will reduce a person’s risk of falling. The challenge, as is often the case for doctors in primary care, is finding the time for structured review when there are so many competing acute issues to be dealt with. This tool, by virtue of being EMIS integrated and focused in approach, helps meet that challenge by identifying patients at risk of falls in a prompt and systematic manner, which would then encourage a review of these at-risk patients.

Because time is so critical in general practice, the FRAT will initially identify only the small number of patients at highest risk. In this way we avoid overburdening the prescriber with an extensive list of medium-risk patients that would be onerous to deal with and difficult to action.

The FRAT identify patients aged over 65 years who may benefit from a medication review, falls assessment and signposting to local falls prevention services. It will provide prompt background alerts to identify at-risk patients systematically, using the predictors of falls risk recommended by the National Institute for Health and Care Excellence.

As part of the protocol, the FRAT will review high-risk psychotropic medicines that can contribute to falls and, by utilising read codes, ensures there is a robust audit trail.

The tool has already been piloted in general practice and found to be easy to use, intuitive and focused on high-risk patients. The toolkit was estimated to identify approximately 300 at-risk patients in a clinical commissioning group of 280,000 patients (figures based on testing across a sample of local practices).

UK healthcare professionals now have free access to the FRAT EMIS web protocol and template at We hope that, by using this tool, we can reduce the risk of falls and alleviate the distress, pain, injury, loss of confidence, loss of independence and number of deaths that come with falling.

Stephen Chapman

Head of Medicines Optimisation

School of Pharmacy

Keele University

Bharat Patel

Head of Medicines Management, Primary Care

Walsall Clinical Commissioning Group


Declaration of interest: the FRAT was developed using an unrestricted educational grant from Flynn Pharmaceuticals.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2016.20201031

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