Reducing unwarranted variation in medication reviews following a fall: a closed-loop audit in primary care.

Abstract (English)

BACKGROUND: Falls in adults ≥65 are common, costly and preventable. Around one-third fall each year and 5-10% sustain serious injury; hip fractures carry 20-30% one-year mortality and falls cost the NHS ~£2.3bn annually. Polypharmacy and high-risk drugs (e.g. benzodiazepines, anticholinergics, antihypertensives) increase risk. NICE CG161/NG5 and NHS England guidance recommend timely, structured post-fall medication reviews, yet local data suggested unwarranted variation in documentation and follow-up. AIM: To increase guideline-concordant documentation of medication reviews within 4 weeks after a fall to 100%. METHOD: Retrospective closed-loop audit in a UK GP surgery. INCLUSION: patients ≥65 with a recorded fall. Cycle 1 (Apr-Jun 2024, n=63) established baseline; interventions comprised clinician education on NICE guidance, SystmOne prompts, and weekly MDT fall reviews; Cycle 2 (Jan-Mar 2025, n=70) re-audited performance against a 100% standard. Data were obtained from routine clinical records. PRIMARY OUTCOME: documented review within 4 weeks; secondary: evidence of deprescribing/medication optimisation. RESULTS: Documentation improved from 22% (14/63) at baseline to 94% (66/70) post-intervention. Reviews led to more appropriate deprescribing and optimisation, particularly of benzodiazepines, anticholinergics and antihypertensives, with qualitative MDT feedback indicating better continuity and timelier follow-up. These changes align with evidence that structured reviews reduce fall-related harm. CONCLUSION: Simple, scalable system changes, education, prompts and routine MDT oversight markedly reduced unwarranted variation and embedded safer prescribing after falls. The model is feasible for wider rollout across primary care; planned next steps include extending to care homes, sharing SystmOne prompt templates regionally, and annual re-audit to sustain gains.