www.cdc.gov/steadi

 

 

STEADI-Rx

OLDER ADULT 

FALL PREVENTION

Guide for 

Community 

Pharmacists
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS 
 

 

 

 

 

 

 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS 

STEADI-Rx

OLDER ADULT

FALL PREVENTION

Guide for 

Community 

Pharmacists

By

Stefanie P. Ferreri, PharmD1 

Susan J. Blalock, MPH, PhD1 

Jessica M. Robinson, PharmD1,2 

Chelsea P. Renfro, PharmD3 

Jan Busby-Whitehead, MD4 

Elizabeth R. Burns, MPH5 

Yara Haddad, PharmD, MPH6 

1UNC Eshelman School of Pharmacy, 

University of North Carolina at Chapel Hill, 

Chapel Hill, North Carolina 

2East Tennessee State University, 

Bill Gatton College of Pharmacy, 

Johnson City, Tennesse 

3University of Tennessee 

Health Science Center College of Pharmacy, 

Memphis, Tennessee 

4UNC School of Medicine, 

University of North Carolina at Chapel Hill, 

Chapel Hill, North Carolina 

5Division of Injury Prevention, 

National Center for Injury Prevention and Control, 

Centers for Disease Control and Prevention, 

Atlanta, Georgia 

6TJFACT Pharmacist Consultant to the 

Centers for Disease Control and Prevention, 

Atlanta, Georgia 

2020 

33
4 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

This document is a publication of the
 

National Center for Injury Prevention and Control
 

of the Centers for Disease Control and Prevention:
 

Centers for Disease Control and Prevention 

Robert R. Redfield, MD, Director 

National Center for Injury Prevention and Control 

Debra Houry, MD, MPH, Director 

Division of Injury Prevention 

Judith R. Qualters, PhD, MPH, Director 

Applied Sciences Branch 

Ann Dellinger, PhD, MPH, Branch Chief 

Safety Promotion Team 

Robin Lee, PhD, MPH, Team Lead 

ACKNOWLEDGEMENTS 

We acknowledge and appreciate the important contributions of 

Tenley Brown, PharmD, Sarah Shockley, PharmD, Emma Feder, 

PharmD, and Pooja Shah for preparing and organizing the contents 

of this guide. 

Suggested Citation: Ferreri SP, Blalock SJ, Robinson JM, Renfro CP, 

Busby-Whitehead J, Burns ER, Haddad Y. STEADI-Rx Older Adult Fall 

Prevention Guide for Community Pharmacists. Atlanta, GA: National 

Center for Injury Prevention and Control, Centers for Disease Control 

and Prevention, 2020. 

Reference herein to any specific commercial products, programs, or services by trade 

name, trademark, manufacturer, or otherwise, does not necessarily constitute or imply its 

endorsement, recommendation, or favoring by the United States Government. 
5

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

 

6 Why Focus on Falls?

7 Getting Started

12 Best Practices

14 STEADI-Rx: Three Critical Steps

20 STEADI-Rx: Tools

30 References

Table of Contents

5
STEADI-RX STEADI-R OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS X OLDER ADUL OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

Why Focus on Falls? 

OLDER ADULT FALLS: 

AN OPPORTUNITY FOR PHARMACISTS 

Falls among adults aged 65 and older (older adults) are a growing and significant public health concern. More than 

one in four older adults falls each year,1 and falls cost an estimated $50 billion in annual medical costs.2 Older adults 

who fall often experience decreased mobility and loss of independence, which may increase future falls. Falls lead to 

serious injuries such as traumatic brain injuries, hip fractures, and even death.1 However, there are many evidencebased interventions that can reduce falls, including reducing medications that increase fall risk.3 

Pharmacists can play a role in fall prevention by assessing medication regimens and providing clinical 

recommendations to help reduce the risk of falls. Certain medication classes affect cognition and physical function, 

which contribute to fall risk.4-7 These are anticonvulsants, antidepressants, antihistamines, antihypertensives, 

antipsychotics, benzodiazepines, muscle relaxants, opioids, and sedative hypnotics. Reducing medications for which 

the potential risks outweigh the potential benefits may reduce falls by 39–66%.3,8 Pharmacists can use geriatric 

support tools such as The American Geriatrics Society (AGS) Beers Criteria,5 the Screening Tool of Older Persons’ 

Prescriptions (STOPP),6 or the anticholinergic burden indices,5,7 to identify potentially inappropriate medications used 

by older adults. 

The Centers for Disease Control and Prevention (CDC), in partnership with the University of North Carolina Eshelman 

School of Pharmacy and School of Medicine, developed STEADI-Rx to help pharmacists work with the healthcare 

team to promote safe medication use and healthy outcomes in older adults. 

STEADI-Rx 

STEADI-Rx is based on CDC’s Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative9 and incorporates 

the Joint Commission of Pharmacy Practitioners (JCPP) Pharmacists’ Patient Care Process.10 STEADI-Rx offers a 

3-step framework, or algorithm, for integrating fall screening and prevention into pharmaceutical care and a suite of 

tools that can be used to assist pharmacy staff in completing each step. It was developed by geriatric pharmacists, 

healthcare providers, and fall prevention experts committed to helping reduce fall injuries among older adults. 

This guide provides an overview of STEADI-Rx and how it can be personalized and implemented into a 

pharmaceutical practice. Copies of the tools are provided at the end of this guide and can also be downloaded on 

the STEADI-Rx website. 

HOW STEADI-Rx WORKS: 

STEP 1: 

Screen 

STEP 2: 

Assess 

STEP 3: 

Coordinate Care 

patients for fall risk 

in the pharmacy. 

modifiable risk 

factors. 

with primary care 

providers to reduce 

identified risk. 

6
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

Getting Started 

KEY CONSIDERATIONS FOR YOUR PHARMACY 

Older adults are a large percentage of many pharmacies’ patient population, and fall prevention is a service that 

pharmacies can offer to communities. Fall prevention activities like medication therapy management can easily 

be integrated into existing pharmacy services. Here are the key steps to help pharmacists implement a fall 

prevention program: 

• Identify a champion • Develop procedures 

• Conduct an environmental scan • Provide relevant training 

• Assess readiness • Promote services 

• Establish support • Identify staff roles 

• Gather resources 

IDENTIFY A CHAMPION 

Having a champion is key to a successful implementation. A pharmacist or a trained pharmacy technician may serve 

in this role. An engaged champion will ensure appropriate implementation, documentation, and follow-up. 

7
8

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

CONDUCT AN ENVIRONMENTAL SCAN

Plan for what your fall prevention program may include by identifying the portion of the patient population that will 

benefit from the service and how the service will fit into your existing workflow. An analysis of strengths, weaknesses, 

opportunities, and threats (SWOT) can identify internal and external factors that may impact implementation. 

FALL PREVENTION SERVICE SWOT ANALYSIS

STRENGTHS Internal factors that may support successful fall prevention services (e.g., resources available, staff 

already providing other services)

WEAKNESSES Internal factors that may hinder successful fall prevention services (e.g., poor workflow or 

documentation procedures)

OPPORTUNITIES External factors that may support successful fall prevention services (e.g., large older adult 

population, supportive providers, state laws allowing pharmacists provider status)

THREATS External factors that may hinder successful fall prevention services (e.g., nearby pharmacies with 

robust fall prevention services, lack of reimbursement)

ASSESS READINESS 

Assess your pharmacy’s readiness to provide fall 

prevention activities and determine steps needed 

to implement the service. Develop an action plan to 

optimize strengths and to mitigate weaknesses. 

A readiness assessment may include these questions: 

• What is the capacity of staff to add a program? 

• What resources and trainings are needed 

(e.g., tools, clinical resources and knowledge, 

technical skills)?

• Does the service have appropriate leadership 

support and staff buy-in?

• Does dispensing workflow accommodate 

service activities (screening, medication review, 

care coordination)?

• Does the pharmacy provide other enhanced 

services (e.g., medication therapy management, 

adherence packaging, point-of-care testing)?

• Are there methods in place to promote the 

service to patients and providers?

• Are there opportunities for collaboration (e.g., 

patient advocacy, other healthcare providers, 

community stakeholders)?
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

ESTABLISH SUPPORT 

Engage pharmacy staff and management to increase excitement around the new initiative. Present an outline of the 

service that includes an overview of the proposed goals, purpose, key steps, key personnel, and training and resource 

needs. Spark staff interest by showing how fall prevention can be an opportunity to improve patient outcomes and 

advance the role of pharmacists in patient care. Encourage staff participation by conducting appropriate training, 

showcasing new or existing tools that may improve workflow efficiency, and fostering ongoing leadership support. 

GATHER RESOURCES 

Gather tools and resources to conduct fall prevention activities. Resources may include a copy of the AGS Beers 

Criteria for Potentially Inappropriate Medications in Older Adults®, clinical resources such as UpToDate and 

Lexicomp, and the UNC High Risk Medication Recommendations. Visit CDC’s STEADI website to learn more about 

STEADI; print patient education materials, functional assessment tests and postural hypotension information; and to 

read the Coordinated Care Plan to Prevent Older Adult Falls for additional tips for implementing STEADI. 

DEVELOP PROCEDURES 

Develop procedures that efficiently incorporate fall prevention activities into existing pharmacy workflow. A fall 

prevention service may be driven by a pharmacy technician, with pharmacists participating in portions that require 

clinical judgement and expertise. 

There are five specific areas where the pharmacy can provide support: 

1.	 Patient identification: Develop a system for identifying patients who may be at risk for falls. This could include 

everyone aged 65 and older or those 65 and older with a history of polypharmacy. Pharmacies may use automatic, 

electronic alerts through the pharmacy dispensing software, or filtered reports, to identify eligible patients. Use 

electronic alerts within the workflow or at the point-of-sale to notify staff if patient is eligible for screening. 

2.	 Screening: Develop a procedure for how and when patients will be screened for fall risk. For example, decide 

whether you will combine screening with delivery of another service (e.g., prescription drop off/pick up, 

medication counseling, or in an appointment-based model, such as 

medication synchronization). Screening can be provided by any member of 

pharmacy staff. Develop procedures to determine how pharmacists will be 

alerted when patients screen at risk. 

 PHARMACY TIP 

3.	 Medication review: Develop a process for how medication lists will be 

gathered from pharmacy dispensing software, primary care providers, 

or the electronic health record (EHR) when available. The STEADI-Rx 

Follow-up 

Attempt to contact the 

patient three times. For 

hard-to-reach patients, 

ask for updated contact 

information at every 

pharmacy visit or contact 

known family members 

to identify an active 

phone number.

Community Pharmacy Fall Risk Checklist can be used to record information 

related to fall risk factors and potentially inappropriate medications. Also 

determine whether discussions with patients regarding their medications 

will be conducted by phone or face-to-face. 

4.	 Follow-up: Develop a process that outlines how often and when patient 

follow-up should occur. Determine whether a HIPAA-compliant electronic 

calendar or other reminder system will be used to ensure follow-ups occur 

as planned. 	

9 
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

5.	 Documentation: Develop a process for where and how patients’ answers 

to the screening questions, the medication review, concerns about postural 

hypotension, and any recommendations given to the patient and their 

providers will be documented. You can document in the patient’s EHR 

or eCare plan if it’s available. Document medication review for Medicaid 

billing if it’s applicable. 

PROVIDE RELEVANT TRAINING 

Successful implementation requires training and retraining. Onboard training 

for pharmacists should include review of clinical knowledge about falls and 

how medications can increase fall risk. There should also be comprehensive 

technical training on STEADI-Rx for all support staff (technicians, interns). All 

staff that will support the fall prevention program should understand the core 

clinical components of STEADI-Rx as well as the processes and procedures. 

Staff may benefit from motivational interviewing. For more on motivational 

interviewing, see the section on Best Practices. 

PROMOTE SERVICES 

Marketing directed to patients should be individualized and help patients 

and caregivers understand the risks associated with falling and inappropriate 

medication usage, as well as how pharmacists can help mitigate these risks. 

Consider whether events with national momentum like Falls Prevention 

Awareness Day (annually in September), Older Americans Month (annually 

in May), or American Pharmacists Month (annually in October) could help 

promote the pharmacy’s fall prevention program. Pharmacy messaging should 

highlight how fall prevention offers mutual benefits for patients, providers, and 

pharmacists through improved patient outcomes and adherence to performance 

measures. Promoting services to other healthcare providers and community/ 

public health stakeholders can increase your pharmacy’s referrals and can help 

create strong partnerships. The STEADI-Rx Provider Flyer and Fax Form are 

tools that can help inform providers about STEADI-Rx and how pharmacists and 

providers can work collaboratively to reduce older patients’ fall risk. 

Documentation 

Fall risk screening and 

medication review are 

components of fall-risk 

assessment, a quality 

performance measure 

for providers. By sharing 

information in a useful 

manner, pharmacists 

have an opportunity to 

assist providers and build 

sustainable models of 

collaboration. 

Motivational 

interviewing 

Try using motivational 

interviewing if the patient 

is reluctant to be screened 

or does not want to 

complete a medication 

review. Motivational 

interviewing can help 

the patient understand 

why fall prevention is 

beneficial. 

 PHARMACY TIP 

IDENTIFY STAFF ROLES 

Staff roles and responsibilities should be documented for everyone who will support the fall prevention program. This 

includes, but is not limited to, the roles and responsibilities of the technician, clerk, and pharmacist. Below is a list of 

roles and responsibilities to consider: 

In the program administration, identify who will: 

• Ensure staff are trained and retrained as needed 

• Be responsible for any promotions to patients and other healthcare providers 

• Be responsible for billing (if applicable) 

10 
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

 PHARMACY TIP 

During the screening process, identify who will: 

• Create and maintain a system to identify eligible patients 

• Screen patients and document the patient’s risk score 

For medication review, identify who will: 

• Gather patient health and medication information prior to medication review 

• Schedule patient appointments and make reminder calls 

• Conduct medication reviews (e.g., any pharmacist) 

• Document the medication reviews 

To support care coordination, identify who will: 

• Discuss the fall prevention care plan and provide recommendations to the patient 

• Follow up with the patient and healthcare provider 

• Document the care coordination activities 

A community pharmacy dispensing workflow is fast paced, leaving little time for staff development or provision 

of clinical services. It is often necessary for pharmacies to create ways of being more efficient in order to provide 

new services. This may mean using technical staff who traditionally do not have clinical support roles. For 

example, implementing services such as the appointment-based model for medication synchronization1 may 

help improve dispensing workflow while providing technician staff with the opportunity to be more involved in 

clinical follow-up. In this model, technicians conduct monthly telephone appointments with patients to assess 

adherence, medication changes, or recent health events. This provides a mechanism for technician-driven followup and collection of clinical information. By incorporating technicians, pharmacies create efficiency and offer 

opportunities for technicians to engage with patients and increase their skillset. 

1

www.aphafoundation.org/appointment-based-model

11 
12 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

Best Practices 

PATIENT COMMUNICATION 

Conversations about aging may be difficult for older adults and caregivers. Many older adults, caregivers, and 

healthcare providers may have a false belief that falls are a normal part of aging. Pharmacists can play a role in 

exploring misconceptions and focusing on patient empowerment. 

Motivational interviewing is a technique that helps guide healthcare providers in understanding how patients perceive 

and make sense of their conditions and experiences. It can help healthcare providers, including pharmacists, explore 

ways to improve partnership with the patient to influence behavior change and willingness to collaborate. Building 

rapport and gaining patient trust are essential before recommending medication or lifestyle changes. Be mindful of 

how you communicate using verbal, nonverbal, and written techniques: 

•	 Verbal: Is your language easy to understand? Do you convey empathy? Is your information devoid of 


medical jargon?
 

•	 Non-verbal: Does your expression and posture support your verbal communication? Do you appear 


open and empathetic?
 

•	 Written: Are your education materials written using health literacy techniques that make them easy to 

understand? Do you use education materials to guide patients to the most important information? 
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

CDC offers a simple guide to plain language health literacy techniques if you are creating your own patient education 

material. You can also read more about communicating health information to older patients on CDC's Older Adults 

Health Literacy page. 

PROVIDER COMMUNICATION 

It is important to recognize that healthcare providers face workflow challenges. Therefore, it may be helpful 

to contact primary care providers with whom you share patients to identify the most efficient method for 

communicating and sharing information. In addition, it may be useful to discuss whether the provider is collecting 

fall-related information and how the pharmacy can help provide additional information and insight. Request access to 

the office’s EHR if possible to limit the number of faxes, emails, or phone calls shared from the pharmacy. They may 

allow a member of your staff to visit the office to update patient information if they cannot provide you with remote 

access. Finally, when making medication recommendations, sharing a comprehensive recommendation that contains 

drug name, strength, dose, frequency, and number of refills is most helpful. 

When communicating with a provider consider the following: 

General communication 

• Develop trust with providers by sharing high-quality 

assessments and recommendations 

• Determine who within the office should be your point of contact 

• Determine the best way to communicate 

• Use pharmacy branding (i.e., logo) on external forms to build 

trust and brand recognition 

• Maintain open communication 

• Accept constructive criticism 

• Address miscommunication immediately 

Sharing recommendations 

• Determine what information is most valuable to the providers 

• Specify whether information was reported by the patient or observed by the pharmacist 

• Collect clinical information (i.e., medication risks) 

• Offer comprehensive recommendations (i.e., drug name, strength, dose, frequency, refills) 

• Prioritize recommendations 

• Support recommendation with appropriate and clear background information 

• Provide pharmacist’s contact information and availability 

• Use legible handwriting and avoid abbreviations

 PHARMACY TIP 

13 
STEADI-Rx

Stopping Elderly Accidents,

Deaths & Injuries

Community Pharmacy Algorithm for Fall Risk

Screening, Assessment, and Care Coordination

ASSESS patient’s

modifiable risk factors.

 Share answers to three key questions and education provided to 

 patient with the patient’s provider using the Provider Consult Form

Document answers to three key 

questions and education provided 

to patient

Reduce risk by recommending 

effective prevention strategies

•Educate patient on fall prevention

•Refer to community exercise or fall

prevention program

Refer to provider for an evaluation of gait, strength,

& balance using the Provider Consult Form

Share answers to three key questions 

with the patient’s primary care provider 

using the Provider Consult Form

Inquire about postural hypotension

•Symptoms of lightheadedness or

dizziness from lying to standing?

•Can assess for postural hypotension

by measuring blood pressure from

lying to standing

Share identified MTPs and recommendations with the patient’s

provider using the Provider Consult Form

•Medication information should include medication name,

strength, dose, and frequency

Document answers to three key

questions and education provided

to patient

•Educate patient on fall prevention

• Refer to community exercise or 

fall prevention program

•Reassess yearly or any time 

patient presents with an acute fall

COORDINATE CARE with primary care or prescribing

provider to reduce identified risk factors using

effective interventions.

Identify medications that

increase fall risk

• Schedule medication review

with patient

•Review medications utilizing the

Community Pharmacy Falls Risk

Checklist and a geriatric-specific

medication decision-support tool

(e.g., The UNC High Risk Medication

Recommendations or the Beers

Criteria)

• Identify any medication therapy

problems (MTPs) associated with

the use of high-risk medications

2019

PREVENT future risk by

recommending effective prevention

strategies.

2

3

Call provider’s office to verify 

they received the Provider 

Consult Form

Resend Provider Consult Form

if provider did not receive it

RESPONSE

NOT RECEIVED FROM

PROVIDER WITHIN 7 DAYS

RESPONSE RECEIVED

FROM PROVIDER

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

S for f ≥ ears ≥ 4 chronic medications or ≥ tion or 

an tien esents with an acute fall. ST

A E tient’s 

modifiable risk factors.

C

ovider to reduce identified risk factor 

effective interventions.

future risk by

rec effectiv evention 

strat

S for f ≥ ears ≥ 4 chronic medications or ≥ tion or 

an tien esents with an acute fall. ST

STEADI-Rx: 

Three Critical Steps 

STEADI-Rx 

Community Pharmacy Algorithm for Fall Risk 

Screening, Assessment, and Care Coordination 

1

 Share answers to three key questions and education provided to 

patient with the patient’s provider using the Provider Consult Form 

Document answers to three key 

questions and education provided 

to patient 

Reduce risk by recommending 

effective prevention strategies 

• Educate patient on fall prevention 

• Refer to community exercise or fall 

prevention program 

Refer to provider for an evaluation of gait, strength, 

& balance using the Provider Consult Form 

Share answers to three key questions 

with the patient’s primary care provider 

using the Provider Consult Form 

Inquire about postural hypotension 

• Symptoms of lightheadedness or 

dizziness from lying to standing? 

• Can assess for postural hypotension 

by measuring blood pressure from 

lying to standing 

Share identified MTPs and recommendations with the patient’s 

provider using the Provider Consult Form 

• Medication information should include medication name, 

strength, dose, and frequency 

Document answers to three key 

questions and education provided 

to patient 

• Educate patient on fall prevention 

• Refer to community exercise or 

fall prevention program 

• Reassess yearly or any time 

patient presents with an acute fall 

SCREENED NOT AT RISK SCREENED AT RISK

Identify medications that 

increase fall risk 

• Schedule medication review 

with patient 

• Review medications utilizing the 

Community Pharmacy Falls Risk 

Checklist and a geriatric-specific 

medication decision-support tool 

(e.g., The UNC High Risk Medication 

Recommendations or the Beers 

Criteria) 

• Identify any medication therapy 

problems (MTPs) associated with 

the use of high-risk medications 

1. Feels unsteady when standing or walking?

2. Worries about falling?

Three key questions to ask patients [at risk if YES to any question]:

3. Fell in the past year?

 > If YES ask, “How many times?” “Were you injured?”

2019

2 

3 

Call provider’s office to verify 

they received the Provider 

Consult Form 

Resend Provider Consult Form 

if provider did not receive it 

RESPONSE 

NOT RECEIVED FROM 

PROVIDER WITHIN 7 DAYS 

RESPONSE RECEIVED 

FROM PROVIDER 

Discuss ways to improve patient receptiveness to the patientprovider care plan and address barrier(s)

FOLLOW UP with patient in 30-90 days.

Stopping Elderly Accidents,

Deaths & Injuries

CREEN all risk yearly for older adults ( 65 y ) taking 1 high-risk medica 

y time pa t pr ART HERE 1 

SCREENED NOT AT RISK SCREENED AT RISK

1. Feels unsteady when standing or walking? 

2. Worries about falling? 

Three key questions to ask patients [at risk if YES to any question]: 

3. Fell in the past year?

 > If YES ask, “How many times?” “Were you injured?” 

In the previous section, we presented a series of steps that pharmacies can take 

to implement a STEADI-Rx based fall prevention program. This section reviews 

the core steps of the STEADI-Rx Algorithm. 

A successful pharmacy-based fall prevention program includes screening, 

conducting the assessment for patients who are at risk, and coordinating care 

to reduce falls among those who are at risk. For each step, we point out how 

the step aligns with the JCPP. 

SCREEN for fall risk yearly for older adults (≥ 65 years) taking ≥ 4 chronic medications or ≥ 1 high-risk medication or any 

time patient presents with an acute fall. START HERE 1 

1. Feels unsteady when standing or walking? 

2. Worries about falling? 

Three key questions to ask patients [at risk if YES to any question]: 

3. Fell in the past year?

 > If YES ask, “How many times?” “Were you injured?” 

SCREENED NOT AT RISK SCREENED AT RISK 

STEP ONE: SCREEN FOR FALL RISK 

In step one, older patients (age 65 and older) are screened for fall risk. This step is in line with the JCPP process 

referred to as collection. In this step, pharmacists collect information to better understand the patient’s relevant 

medical history and clinical status. 

Pharmacy staff should identify older patients who: 

• Take four or more chronic medications 

• Take one or more high-risk medications, or 

• Who present with an acute fall 

Pharmacy staff screen the patient for fall risk if any of these criteria are met. While there are many ways to screen 

for fall risk, CDC’s Three Key Questions can be a quick and easy way to assess risk. The patient is asked the 

following questions: 

1. Have you fallen in the past year? 

2. Do you feel unsteady when standing or walking? 

3. Are you worried about falling? 

14 

SCREEN for fall risk yearly for older adults (≥ 65 years) taking ≥ 4 chronic medications or ≥ 1 high-risk medication or 

any time patient presents with an acute fall.

COORDINATE CARE with primary care or prescribing

provider to reduce identified risk factors using 

effective interventions.

ASSESS patient’s 

modifiable risk factors.

PREVENT future risk by

recommending effective prevention 

strategies.

 START HERE
15

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

It’s important to document the patient’s answers to the Three Key Questions 

and to document whether the patient was given any educational material on 

fall prevention. The Community Pharmacy Fall Risk Checklist can be used to 

record this information for internal use. 

If the patient says yes to any of the questions, they are considered at risk 

for falling. Pharmacy staff are then encouraged to complete step two of the 

STEADI-Rx Algorithm.

If they say no to all questions, it’s important to reduce future risk by educating 

the patient about falls. CDC’s What You Can Do to Prevent Falls brochure and 

the Chair Rise Exercise both offer information on how to prevent future fall 

risk. Encourage patients to participate in home- or community-based exercise, 

especially those that focus on improving gait, strength, and balance, like Tai 

Chi. The National Council on Aging maintains a list of state falls prevention 

coalitions. State coalitions can help identity local programs for your patients. 

Rescreen patients annually for fall risk. 

1. Create alerts to notify 

pharmacy staff at 

point-of-dispensing or 

point-of-sale when a 

patient is eligible for 

fall risk screening. Use 

a STEADI-Rx Auxiliary 

Label if an electronic 

alert is not available.

2. Train technicians, clerks, 

students, and delivery 

drivers to screen 

patients.

3. Help patients 

understand why you 

are asking about their 

history of falls. Explain 

your role as a patient 

care champion and 

provide empowering 

education about falls 

prevention. 

4. Reduce pharmacy 

burden by combining 

screening with another 

service (e.g., medication 

therapy management).

Key Tips for 

Screening
STEADI-Rx

Stopping Elderly Accidents,

Deaths & Injuries

Community Pharmacy Algorithm for Fall Risk

Screening, Assessment, and Care Coordination

SCREEN for fall risk yearly for older adults (≥ 65 years) taking ≥ 4 chronic medications or ≥ 1 high-risk medication or 

any time patient presents with an acute fall. START HERE 1

 Share answers to three key questions and education provided to 

 patient with the patient’s provider using the Provider Consult Form

Refer to provider for an evaluation of gait, strength,

& balance using the Provider Consult Form

Share answers to three key questions 

with the patient’s primary care provider 

using the Provider Consult Form Share identified MTPs and recommendations with the patient’s

provider using the Provider Consult Form

•Medication information should include medication name,

strength, dose, and frequency

Document answers to three key

questions and education provided

to patient

•Educate patient on fall prevention

• Refer to community exercise or 

fall prevention program

•Reassess yearly or any time 

patient presents with an acute fall

SCREENED NOT AT RISK

COORDINATE CARE with primary care or prescribing

provider to reduce identified risk factors using

effective interventions.

1. Feels unsteady when standing or walking?

2. Worries about falling?

Three key questions to ask patients [at risk if YES to any question]:

3. Fell in the past year?

 > If YES ask, “How many times?” “Were you injured?”

2019

PREVENT future risk by

recommending effective prevention

strategies.

3

Call provider’s office to verify 

they received the Provider 

Consult Form

Resend Provider Consult Form

if provider did not receive it

RESPONSE

NOT RECEIVED FROM

PROVIDER WITHIN 7 DAYS

RESPONSE RECEIVED

FROM PROVIDER

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

S for f ≥ ears ≥ 4 chronic medications or ≥ tion or 

an tien esents with an acute fall. ST

A E tient’s 

modifiable risk factors.

C

ovider to reduce identified risk factor 

effective interventions.

future risk by 

rec effectiv evention 

strat

A E tient’s 

modifiable risk factors.

STEP TWO: ASSESS MODIFIABLE RISK FACTORS 

In step two, pharmacists assess medicationrelated fall risk factors. This step is in line with 

the JCPP process referred to as assess. In this 

step, pharmacists identify medications that may 

increase fall risk by: 

•	 Scheduling a medication review session 

with the patient 

•	 Reviewing medications utilizing the 

Community Pharmacy Fall Risk Checklist 

and a geriatric-specific medication 

decision-support tool (e.g., UNC High 

Risk Medication Recommendations or 

the AGS Beers Criteria®) 

•	 Identifying any medication therapy 

problems (MTPs) associated with the use 

of the identified high-risk medications 

When reviewing medications, pay special 

attention to medication classes that have 

been shown to increase fall risk. These include: 

•	 Anticonvulsants 

•	 Antidepressants 

•	 Antihypertensives 

•	 Antipsychotics 

•	 Antispasmodics 

•	 Benzodiazepines 

•	 Opioids 

The information below can help 

inform the medication review. 

• Medical history 

• Active medication list 

(prescription, over-the-counter, 

and herbal medications) 

• Socioeconomic factors 

• Functional status 

MEDICATION 

REVIEW: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discuss ways to improve patient receptiveness to the patientprovider care plan and address barrier(s)

FOLLOW UP with patient in 30-90 days.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When reviewing the patient’s medications, assess each 

potentially inappropriate medication for accurate dose, 

correct indication, efficacy and safety, possible adverse 

effects, and for the patient's adherence. The AGS Beers 

Criteria® for Potentially Inappropriate Medication Use in 

Older Adults and UNC High-Risk Medication 

Recommendation Guide11 provide guidance for stopping, 

switching, or reducing medications. 

It’s also important to inquire about postural hypotension, a 

risk factor for falls. Postural hypotension is defined as a drop 

in systolic blood pressure of ≥20 mm Hg, a diastolic blood 

pressure of ≥10 mm Hg, or experiencing lightheadedness or 

dizziness on changing positions (supine to sitting and sitting 

to standing).12-13 

16 

SCREEN for fall risk yearly for older adults (≥ 65 years) taking ≥ 4 chronic medications or ≥ 1 high-risk medication or 

any time patient presents with an acute fall. START HERE

PREVENT future risk by 

recommending effective prevention 

strategies.

ASSESS patient’s 

modifiable risk factors.

COORDINATE CARE with primary care or prescribing 

provider to reduce identified risk factors using 

effective interventions.
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

To assess for postural hypotension: 

1.	 Have the patient lie down for 5 minutes, then check blood pressure. 

2.	 Then, have the patient stand up for one minute, and repeat the blood 

pressure check. 

3.	 After the patient stands for 3 minutes, repeat the blood pressure check. 

Pharmacy staff can also reduce risk by recommending other prevention 

strategies. These strategies include educating patients on fall prevention and 

referring them to evidence-based community fall prevention programs. The 

National Council on Aging maintains a list of state falls prevention coalitions. 

State coalitions can help identify local programs in your area. 

With the information from step two, pharmacists can coordinate with primary 

care providers or other prescribing providers, as described in step three. 

Key Tips for

Assessing

Information 

1.	 Obtain information from 

multiple sources (e.g., 

patients, caregivers, 

dispensing profile, 

primary care provider, 

or controlled substance 

monitoring database). 

2.	 Use technicians 

to collect active 

medication list from 

dispensing profile or 

primary care provider 

prior to patient 

appointment. 

3.	 Schedule patients for 

telephone or face-toface appointments to 

conduct a medication 

review. 

4.	 Use the Community 

Pharmacy Fall Risk 

Checklist to help collect 

information related 

to fall risk factors, 

including medications 

that might increase 

fall risk. 

17 
18

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Discuss ways to improve patient receptiveness to the patientprovider care plan and address barrier(s)

FOLLOW UP with patient in 30-90 days.

STEP THREE: COORDINATE CARE

In step three, pharmacists 

coordinate care with primary care or 

other prescribers to reduce fall risk 

identified through the medication 

review. These actions align with the 

JCPP processes referred to as plan, 

implement, and follow-up.

When developing recommendations, 

document the identified 

medication therapy problems. This 

documentation should include the 

name of the medication, strength, 

dose, frequency, and remaining 

refills. Also provide any background 

information that could help 

providers understand the need for 

your recommended changes. Include 

answers to the patient’s Three Key 

Questions and a description of the 

fall prevention education you gave 

the patient.

Discuss ways to improve patient receptiveness to the patientprovider care plan and address barrier(s)

FOLLOW UP with patient in 30-90 days.

 Share answers to three key questions and education provided to 

 patient with the patient’s provider using the Provider Consult Form

 Refer to provider for an evaluation of gait, strength, 

 & balance using the Provider Consult Form

Share identified MTPs and recommendations with the patient’s 

 provider using the Provider Consult Form

• Medication information should include medication name, 

strength, dose, and frequency

COORDINATE CARE with primary care or prescribing 

provider to reduce identified risk factors using 

effective interventions.

3

Call provider’s office to verify 

they received the Provider 

Consult Form

Resend Provider Consult Form

if provider did not receive it

RESPONSE 

NOT RECEIVED FROM 

PROVIDER WITHIN 7 DAYS

RESPONSE RECEIVED 

FROM PROVIDER
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

The Provider Consult—Medication form was developed to help you document and share your identified medication 

therapy problems and recommendations with the provider. 

EXAMPLE PHARMACIST RECOMMENDATION: 

“Patient reports recently experiencing several injurious falls and reports 

symptoms of dizziness and sedation. Please consider switching from 

paroxetine to citalopram, if appropriate, which has a better safety profile 

in relation to falls. I recommend paroxetine taper and washout prior to 

switching to citalopram. In addition, please assess gait, balance, and 

strength at next visit. The patient was educated about the importance of 

proactive falls prevention and provided with educational resources.” 

Not all patients will need their medications modified. However, the AGS/BGS 

clinical guidelines on the prevention of falls among older adults recommend 

that ALL patients who screened at-risk should be assessed for additional risk 

factors. The Provider Consult—Fall Screening form offers a way to inform the 

provider that the patient screened at risk for falls and that additional fall risk 

assessment may be needed, even if medication changes are not. 

Healthcare provider offices may receive large quantities of daily faxes, leading 

to recommendations being lost or misplaced. Therefore, it is important to 

follow-up with providers. The Provider Flyer and Fax Form can be used to 

inform pharmacists and healthcare providers about STEADI-Rx. The Provider 

Flyer includes information on falls burden, a description of the STEADI-Rx 

initiative, and how STEADI-Rx works. The Fax Form includes information on 

STEADI-Rx and how the pharmacist can work collaboratively with the provider 

to reduce patients’ fall risk. 

When determining an appropriate time for following up with a patient 

consider the following: 

•	 When is follow-up needed? 

•	 What type of follow-up is required (e.g., face-to-face, phone, 


electronic)?
 

•	 Does follow-up need to be one time or ongoing? 

You may want to create alerts in your dispensing software to notify staff at 

point-of-dispensing or point-of-sale whether a patient is due for follow-up. If 

an alert is not available in either of these systems, a paper or HIPAA-compliant 

electronic calendar can be used. 

Key Tips for

Coordinating

Care 

1.	 Contact provider 

offices to determine 

if they would 

like to receive 

recommendations 

by fax, electronic 

messaging, or phone. 

Ask them if you 

can share a copy, 

even if they prefer 

phone, to ensure 

appropriate reciprocal 

documentation. 

2.	 Provide adequate 

background 

information to help 

providers understand 

the need for changes 

to therapy. 

19 
20 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

STEADI-Rx Tools 

In the previous section, we referred to STEADI-Rx tools that can be used to facilitate fall risk screening, assessment, 

and coordination of care between the pharmacy and healthcare providers. 

The STEADI-Rx Algorithm describes three steps pharmacists can take to reduce fall risk among their older patients: 

screen, assess, and coordinate care. Each step is in line with the JCPP. 

The Provider Flyer and Fax Form can be used to inform pharmacists and healthcare providers about STEADI-Rx. 

The Community Pharmacy Fall Risk Checklist offers a way to collect and document a patient’s fall risk factors and 

potentially inappropriate medications. This tool is for internal use only and should not be shared with patients or 

other providers. 

STEADI-Rx provides two forms that can be used to inform a healthcare provider that a patient screened “at risk” for 

falling. The Provider Consult—Fall Screening form is used when the patient is not currently taking any medications 

that could increase their fall risk, but additional fall risk assessment may be warranted given the screening results. 

The Provider Consult—Medication form is used to recommend changes to the patient’s medications based on the 

pharmacist’s medication review. 

The STEADI-Rx Auxiliary Labels can be affixed to medication bottles or bags. They can encourage communication 

about falls and fall prevention among pharmacy staff, older adults, and their caregivers. Labels can be printed on 

self-adhesive label paper where adhesives are 1.75 inches by 0.5 inches (80 labels per sheet). 

A copy of each tool is available in this guide and electronically on the STEADI-Rx website. 
21

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

STEADI-Rx ALGORITHM 

STEADI-Rx 

 

Community Pharmacy Algorithm for Fall Risk 

Screening, Assessment, and Care Coordination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2019

 

 

 

 

 

 

 

 

 

 

 

Discuss ways to improve patient receptiveness to the patientprovider care plan and address barrier(s)

FOLLOW UP with patient in 30-90 days.
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

PROVIDER FLYER 

STEADI-Rx 

What does this mean for your practice? 

STEADI-Rx is a pharmacy initiative to reduce the risk of falls in older adults through collaboration 

between healthcare providers and pharmacists. 

Community pharmacists will screen older adults using the three STEADI questions and review the 

patient’s profile to identify medications that may increase the risk of falls. 

Collaboration with a community pharmacist can help you meet quality metrics related to falls and 

high-risk medications and improve fall-related outcomes. 

More than 

8 MILLION 

of those falls require medical treatment 

or restrict activity for at least a day. 

1 in 4 older adults reports 

falling each year.

More than 

32,000 

older adults die each year because 

of a fall — that’s more than 88 older 

adults every day. 

How STEADI-Rx works: 

STEP 1: 

Patient screened for 

fall risk at pharmacy 

STEP 2: 

Pharmacist performs 

medication review 

STEP 3: 

Information shared with 

patient and provider 

STEP 4: 

Provider responds 

to recommendation 

2020

 

PREVENT FALLS 

Collaborate with Community Pharmacists 

22
 
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

23 

COMMUNITY PHARMACY FALL RISK CHECKLIST 

Patient:

Date of Birth: Date:

Community Pharmacy Fall Risk Checklist 

STEADI-Rx 

STEADI­Rx is a pharmacy initiative to reduce the risk of falls in older adults through 

collaboration between healthcare providers and pharmacists. It was developed 

by the University of North Carolina Eshelman School of Pharmacy and School of 

Medicine through a grant from the Centers for Disease Control and Prevention. 

Fall Risk Factor(s) Identified 

FALL HISTORY PRESENT? NOTES 

Any falls in the past year? Yes No

Worries about falling? Yes No

Feels unsteady when standing or walking? Yes No

POSTURAL HYPOTENSION 

Patient­reported symptoms of 

lightheadedness or dizziness from 

lying to standing? 

 Yes No

MEDICATION CLASSES 

WITH FALL RISK 

MEDICATION(S) 

Include medication name, dosage prescribed, and 

administration directions. 

PRESCRIBED BY: 

Anticonvulsants 

Antidepressants 

Antihypertensives 

Antipsychotics 

Antispasmodics 

Benzodiazepines 

Opioids 

Sedative hypnotics 

Tricyclic antidepressants 

Other (e.g., OTC agents) 

Notes: 

2019
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

24 

FAX FORM 

FAX FORM 

PREVENT FALLS 

Collaborate with Community Pharmacists 

Provider: Pharmacist: 

Fax: Fax: 

Phone: Phone: 

Subject: Fall Risk Medication Review Date: 

No. Pages: 

Comments: Contains Sensitive Patient Information 

What does this mean for  your practice? 

STEADI­Rx is a pharmacy initiative to reduce the risk of falls in older adults through collaboration 

between healthcare providers and pharmacists. It was developed by the University of North Carolina 

Eshelman School of Pharmacy and School of Medicine through a grant from the Centers for Disease 

Control and Prevention. 

Community pharmacists will screen older adults using the three STEADI questions and review the 

patient’s profile to identify medications that may increase the risk of falls. 

Collaboration with a community pharmacist can help you meet quality metrics related to falls and 

high­risk medications and improve fall­related outcomes. 

We request that you review the pharmacist’s recommendations and fax a response back to the 

pharmacy. Additional information is available at www.cdc.gov/steadi. 

STEADI-Rx 

2019

How STEADI-Rx works: 

STEP 1: 

Patient screened for 

fall risk at pharmacy 

STEP 2: 

Pharmacist performs 

medication review 

STEP 3: 

Information shared with 

patient and provider 

STEP 4: 

Provider responds 

to recommendation 
                                                                                                     

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

25 

PROVIDER CONSULT—FALL SCREENING 

Pharmacist: Pharmacy:

Available by Fax:  or Phone:  On:

Patient:

Date of Birth: Date:

Provider: Fax:

STEADI-Rx FORM 

Provider Consult - Fall Screening 

Date:

Fall Risk Factor(s) Identified FACTOR PRESENT? 

Any falls in the past year? Yes No

Worries about falling? Yes No

Feels unsteady when standing or walking? Yes No

Symptoms of lightheadedness or dizziness from lying to standing? Yes No

Taking 4+ chronic medica tions? Yes No

Taking 1+ high­risk medica tion(s)? Yes No

Evaluation of Gait, Strength, & Balance PLEASE INDICATE YOUR RESPONSE 

According to AGS/BGS 2010 Fall Prevention Guidelines, a patient may benefit from 

an evaluation of gait, strength, and balance when fall risk factors are present. Yes No

Provider Signature:

Please acknowledge your receipt of this information and return to the pharmacy: 

Fall screening and medication review results: 

The patient’s pharmacist has reviewed the patient’s fall­related risk factors and current medications. Based on information available to 

the pharmacy, this patient is not currently taking any prescription or non­prescription medications known to increase the risk of falling. 

Other fall risk factors are identified below. 

PLAN TO EVALUATE? 

STEADI­Rx is a pharmacy initiative to reduce the risk of falls in older adults through 

collaboration between healthcare providers and pharmacists. It was developed 

by the University of North Carolina Eshelman School of Pharmacy and School of 

Medicine through a grant from the Centers for Disease Control and Prevention. 2019
Pharmacist: Pharmacy:

Available by Fax: or Phone: On:

Accept

Decline

Plan to discuss with patient

Accept

Decline

Plan to discuss with patient

Accept

Decline

Plan to discuss with patient

Medication Therapy Problem Recommendation PLEASE INDICATE YOUR RESPONSE

Yes No

Evaluation of Gait, Strength, & Balance

According to AGS/BGS 2010 Fall Prevention Guidelines, a patient may benefit 

from an evaluation of gait, strength, and balance when fall risk factors are present.

PLEASE INDICATE YOUR RESPONSE

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

Fall Risk Factor(s) Identified FACTOR PRESENT?

Any falls in the past year?

Worries about falling?

Feels unsteady when standing or walking?

Symptoms of lightheadedness or dizziness from lying to standing?

Taking 4+ chronic medications?

Taking 1+ high-risk medication(s)?

Patient:

Date of Birth: Date:

Provider: Fax:

26

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

PROVIDER CONSULT—MEDICATION

Pharmacist: Pharmacy:

Available by Fax: or Phone: On:

Patient:

Date of Birth: Date:

Provider: Fax:

STEADI-Rx FORM 

Provider Consult - Medication

Date:

Fall Risk Factor(s) Identified FACTOR PRESENT?

Any falls in the past year?  Yes  No

Worries about falling?  Yes  No

Feels unsteady when standing or walking?  Yes  No

Symptoms of lightheadedness or dizziness from lying to standing?  Yes  No

Taking 4+ chronic medications?  Yes  No

Taking 1+ high-risk medication(s)?  Yes  No

Evaluation of Gait, Strength, & Balance PLEASE INDICATE YOUR RESPONSE

According to AGS/BGS 2010 Fall Prevention Guidelines, a patient may benefit 

from an evaluation of gait, strength, and balance when fall risk factors are present.  Yes  No

Medication Therapy Problem Recommendation PLEASE INDICATE YOUR RESPONSE

 Accept

 Decline

 Plan to discuss with patient

 Accept

 Decline

 Plan to discuss with patient

 Accept

 Decline

 Plan to discuss with patient

Provider Signature:

Please acknowledge your receipt of these recommendations and return to the pharmacy:

Fall screening and medication review results: 

After reviewing this patient’s fall-related risk factors and current medications, we have identified

medication(s) that may increase the patient’s risk for a fall. Please see recommendation(s) below.

PLAN TO EVALUATE?

STEADI-Rx is a pharmacy initiative to reduce the risk of falls in older adults through 

collaboration between healthcare providers and pharmacists. It was developed 

by the University of North Carolina Eshelman School of Pharmacy and School of 

Medicine through a grant from the Centers for Disease Control and Prevention. 2019
STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

PHARMACY AUXILIARY LABELS 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

27 
 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS 

CASE STUDY 

Carolina Booker Mrs. Booker is a 76-year-old woman who lives 

independently in her own home. She has 

come to the community pharmacy to pick up 

her medications. 

SCREEN FOR FALL RISK (STEADI-Rx STEP 1) 

Mrs. Booker is taking six medications, which may increase her fall risk. The pharmacy technician screens Mrs. Booker 

using the STEADI Three Key Questions before ringing up her prescriptions. Mrs. Booker says “yes” to the question, “I 

have fallen in the past year.” 

Mrs. Booker reports she fell the previous week. She was not hurt and did not seek medical attention. She was walking 

outdoors with a friend when she tripped over a crack in the sidewalk and fell. This was her first fall. 

ASSESS PATIENT'S MODIFIABLE RISK FACTORS 

(STEADI-Rx STEP 2) 

The technician alerts the pharmacist that Mrs. Booker screened positive for fall risk. The pharmacist performs a 

comprehensive medication review using the Community Pharmacy Fall Risk Checklist. 

Mrs. Booker takes the following medications: 

• Fluoxetine 40 mg by mouth daily 

• Lorazepam 0.5 mg–1 mg by mouth twice daily, as needed 

• Levothyroxine 75 mcg by mouth daily 

• Hydrochlorothiazide 25 mg by mouth daily (recently increased from 12.5 mg daily) 

• Docusate 200 mg by mouth daily 

• Acetaminophen 500 mg by mouth four times daily, as needed for pain 

Mrs. Booker reports using lorazepam 1–2 times per week. She reports taking it for many years with no problems. 

She takes acetaminophen 3–4 times per week. When asked about her adherence, she states that she might miss 

her fluoxetine once a month. She currently uses a pill box. The pharmacist asks Mrs. Booker if she has been dizzy or 

lightheaded upon sitting up or standing. Mrs. Booker states she often has dizziness when getting out of bed in the 

morning. It’s been going on for a few weeks. She reports the only change to her medicines is that she is now taking 

an increased dose of her blood pressure medication. 

Seated blood pressure measured in the pharmacy today was 100/67 mmHg. 

28 
29 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS

The pharmacist makes the following assessment: 

•	 Fluoxetine, lorazepam, and hydrochlorothiazide are potentially inappropriate medications. 

•	 Fluoxetine is a long-acting SSRI known to cause sleep disturbances and is a risk factor for falls. 

•	 Lorazepam is a benzodiazepine with excess risk of sedation and dizziness and a risk factor for falls. Although 

the patient reports taking it for years, lorazepam is not indicated for routine use in older adults. 

•	 Her blood pressure is low and she reports symptoms of dizziness when getting up from the bed in the 

morning, indicative of potential postural hypotension. 

•	 Hydrochlorothiazide was increased from 12.5 to 25 mg two weeks ago and is a likely cause of her 


postural hypotension. 


•	 She has fallen in the past year, which is a strong predictor for a recurrent fall. 

COORDINATE CARE (STEADI-Rx STEP 3) 

The pharmacist discusses the medication list and all potential medication therapy problems with Mrs. Booker. The 

pharmacist offers to initiate a conversation with Mrs. Booker’s primary care provider to make a recommendation for 

alternative therapies. 

Mrs. Booker agrees with the pharmacist and gives permission to discuss changes to her medications with her primary 

care doctor. 

The pharmacist then reviews the STEADI patient educational brochures What to Do to Prevent Falls and Check for 

Safety with the patient. The pharmacist explains to Mrs. Booker that due to her risk of falling, she is suggesting she 

follow-up with her primary care provider to assess other potential fall risk factors. 

Before ending the interview, the pharmacist sets up an appointment to follow up with Mrs. Booker in one month to 

assess medication changes, sleep, symptoms of dizziness, or any new symptoms that may have developed. 

After Mrs. Booker leaves, the pharmacist uses the Fax Form and Provider Consult Form—Medication to share 

screening results and medication recommendations with Mrs. Booker’s primary care provider. 
 

 

STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS 

References 

1.	 Moreland B, Kakara R, Henry A. Trends in Non-fatal Falls and Fall Injuries Among Adults Aged ≥65 years — United 

States 2012–2018. MMWR Morb Mortal Wkly Rep. 2020; In press. 

2.	 Florence CS, Bergen G, Atherly A, et al. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc. 

2018;66(4):693–698. 

3.	 Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for Preventing Falls in Older People Living in the 

Community. Cochrane Database Syst Rev. 2012;(9):CD007146. 

4.	 American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older 

Adults. J Am Geriatr Soc. 2019;67(4): 674-694. 

5.	 Dalleur O, Boland B, Losseau C, et al. Reduction of Potentially Inappropriate Medications Using the STOPP Criteria in 

Frail Older Inpatients: A Randomized Controlled Study. Drugs Aging. 2014; 31:291–298. 

6.	 Hilmer SN, Mager DE, Simonsick EM, et al. A Drug Burden Index to Define the Functional Burden of Medications in 

Older People. Arch of Intern Med. 2007; 167:781–787. 

7.	 Naples JG, Marcum ZA, Perera S, et al. Concordance Among Anticholinergic Burden Scales. J Am Geriatr Soc. 2015; 

63:2120–2124. 

8.	 Pit SW, Byles JE, Henry DA, et al. A Quality Use of Medicines Program for General Practitioners and Older People: A 

Cluster Randomised Controlled Trial. Med J Aust. 2007;187(1):23-30. 

9.	 Stevens JA, Phelan EA. Development of STEADI: A Fall Prevention Resource for Health Care Providers. Health 

Promot Pract. 2013;14(5):706–714. 

10.	 Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014. Available at: 

https://jcpp.net/wp-content/uploads/2016/03/PatientCareProcess-with-supporting-organizations.pdf. 

11.	 UNC High Risk Medication Recommendations. UNC Eshelman School of Pharmacy 2019. Available online at: 

https://pharmacy.unc.edu/research/centers/cmo/resources/. 

12.	 Gangavati A, Hajjar I, Quach L, et al. Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community 

Dwelling Elderly Population: The Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of 

Boston study. J Am Geriatr Soc. 2011;59(3):383–9. 

13.	 Mader SL. Identification and Management of Orthostatic Hypotension in Older and Medically Complex Patients. 

Expert Rev Cardiovasc Ther. 2012;10(3):387–95. 

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STEADI-RX OLDER ADULT FALL PREVENTION GUIDE FOR COMMUNITY PHARMACISTS 
 

www.cdc.gov/steadi