3059 Collaborative reviews of anticholinergic burden (ACB) scores in primary care following discharge from secondary care after a fall

Abstract

Background Older adults with multimorbidity are prescribed medicines to manage chronic conditions. Some of these cause anticholinergic side effects which can lead to falls. Introduction This work originated from the West Yorkshire ACB Task and Finish Group and involved pharmacists in secondary and primary care working collaboratively. The aims were: To raise awareness of ACB across all sectors. To calculate the ACB scores for patients admitted with falls on acute elderly admission wards in two hospitals and refer to primary care for review on discharge if the score is 3 or more (clinically significant). Method On admission, the pharmacist calculated the ACB score using an online ACB calculator. Medicines contributing to ACB were reviewed throughout the hospital stay reducing doses and stopping medicines where appropriate following discussion with patients and carers. Any ACB score still ≥3 on discharge was documented in the discharge letter with a request to review and deprescribe anticholinergic medicines in primary care. Consent to access SystmOne was obtained so patient records could be checked in secondary care 6 weeks post discharge. Results Over one hundred ACB scores were calculated during the 4-week data collection period. After reduction of ACB scores in secondary care, 15 patients still scored 3 or more on discharge and were referred to primary care for review. 66.67% (10/15) of patients referred received a primary care review. 70% (7/10) of primary care reviews resulted in reduced ACB scores. Conclusion Awareness of ACB in secondary care was raised through routine calculation of ACB scores on admission. A high proportion of referrals were actioned in primary care. By reducing ACB scores patients were subjected to less side effects and a potentially reduced falls risk. This project was identified by NHSE in a national scoping exercise and analysed in a medicine safety scoping review.