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

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