Abstract
Introduction
The British Geriatrics Society advocates for the development of local protocols to address frailty (1). A Cochrane Review on the use of Comprehensive Geriatric Assessment (CGA) resulted in higher survival rates at 3 months and fewer admissions to nursing homes at one year following hospital admission (2). Key components of CGA, including Treatment Escalation Plans (TEPs), Universal Care Plans (UCPs), Clinical Frailty Scores (CFS), and Abbreviated Mental Test (AMT) play pivotal roles in identifying frailty, establishing timely end-of-life care plans, preventing future inappropriate admissions, supporting early discharge and detecting cognitive impairment.
Methods
A retrospective analysis of documentation of 4 GCA parameters (TEP, UCPs, CFS, AMT) on admission to an Elderly Care ward over 2-weeks was conducted. An intervention was introduced which included the development of departmental posters; training medical staff and a frailty proforma, following which a second audit cycle was performed.
Results
Cycle one (N=34): Demonstrated poor documentation of CGA parameters. TEP completion 100 % (34/34), Day 2 TEP Completion 64% (19/34), UCP present 21% (7/34), CFS 12% (4/34), AMT completed 15% (5/34).
Cycle two (N=24). Documentation improved across all parameters. TEP completion 100 % (24/24), Day 2 TEP Completion 100% (24/24), UCP present 29% (7/24), CFS 58% (14/24), AMT completed 58 % (14/24). The proforma was used in 54% (13/24).
Conclusions
The use of a frailty proforma, visual aids and teaching is useful in improving documentation of frailty assessments. All parameters showed significant improvement in documentation when the proforma was used. This tool could be extended to include more data points in a CGA and would be useful to implement across the department to create uniformity, ease of access to information and improve management of elderly patients.
References:
1. British Geriatrics Society (2014). Fit for Frailty.
2. Ellisa et al. Cochrane Database Syst Rev. 2017 Sep 12;9(9):CD006211.