Implementing STOPP-FALL Criteria to Reduce Medication-Related Falls in Patients aged over 65 using the PDSA model

Introduction: Patients over 65 often have multiple comorbidities and complex polypharmacy regimens, many including falls-risk-increasing drugs (FRIDs). Falls are a leading cause of morbidity in this group and are frequently associated with polypharmacy. Using the STOPP-FALL criteria, we systematically identified and reviewed FRIDs during hospital stays to reduce falls and improve prescribing safety. The multidisciplinary team consisted of consultants, resident doctors, and nursing staff.

Methods: Cycle 1 data obtained for patients who were either admitted with a fall or had a history of falls, along with their current medications, showed that all of them were on at least one FRID. To facilitate the practical use of the STOPP-FALL tool, we developed a color-coded template for each category of FRID. We educated the ward team to review each patient’s medication regimen using the template and document this on the ward round entry.

Results: A re-audit was conducted under the PDSA model, one month after the intervention was implemented, reviewing a total of 35 patients. 69% were admitted with a fall or had a documented history of falls. Among these, 83% were prescribed one or more FRIDs. In 25% of these cases, it was considered clinically appropriate to deprescribe one or more FRIDs. The introduction of the STOPP-FALL tool led to a structured approach in identifying high-risk medications, which improved clinical awareness and accountability. Moreover, it promoted patient safety, leading to a potential reduction in future falls.

Conclusion: This project demonstrated that working closely as a team enabled us to effectively utilize the STOPP-FALL criteria in making prescribing safer for older patients. Future plans include expanding the use of the STOPP-Fall tool across other Health & Ageing wards, conducting large group teaching sessions, and further integrating it into electronic prescribing systems to ensure a consistent and sustainable practice across the Department of Clinical Gerontology at King’s College Hospital.