Abstract
Introduction: It’s estimated that 52% of elective vascular patients are frail, with predictions by 2030, one-fifth of surgical procedures will involve patients over 75. This project aimed to evaluate current practices around frailty recognition and documentation at the South-East Wales Vascular Network's regional surgical centre.
Objectives:
Assess the proportion of patients >65 years with documented frailty assessments using the Clinical Frailty Scale (CFS).
Assess healthcare workers' understanding of frailty and familiarity with the CFS. Identify barriers to recognising and undertaking frailty assessments.
Provide a frailty-focused educational intervention for the multidisciplinary team.
Methods: Data was collected prospectively for 22 patients >65 over two weeks in March 2024. The project team reviewed whether a CFS score was recorded on electronic workstation and independently completed a CFS score. Teaching sessions were organised for the multidisciplinary team on frailty recognition and CFS use. Pre- and post-teaching questionnaires gauged confidence levels in using the CFS.
Results: Out of 22 patients, 10 had recorded CFS scores, with 6 being accurate. For the 12 patients without recorded scores, 8 were classified as frail. The mean age was 76 years. The questionnaire revealed knowledge gaps: none of the nurses knew where to document a frailty score, and only 33% of physiotherapists and 60% of occupational therapists knew where to record a CFS score. Post-teaching, staff confidence in frailty recognition increased significantly.
Conclusions: Identifying frailty enables better perioperative risk assessment and surgical decision-making. Frailty documentation on Ward B2 is inadequate. Data collection highlighted nurses' lower awareness of frailty scoring, necessitating further improvement cycles. 73% of patients were frail, with 36% not previously identified as such. Improving frailty recognition will enhance care planning for frail patients undergoing vascular surgery. Designating a 'Frailty Champion' could improve frailty score documentation and ensure its routine inclusion in assessments on Ward B2 at UHW.