Frailsafe: A new checklist for the acute care of frail older people

Professor Tom Downes is  consultant geriatrician and has expertise in the design of acute interface geriatric care. He is the Clinical Lead for Quality Improvement at Sheffield Teaching Hospitals. Saira Ghafur is a Quality Improvement and Leadership Fellow and Respiratory Registrar at Sheffield Teaching Hospitals NHS Foundation Trust. Reblogged from the British Geriatrics Society blog.

‘Something as mundane as a checklist can be a powerful tool for simplifying the complexity of the world and, in the context of medical procedures, save lives’ Atul Gawande 2010

FrailSafe

International studies have indicated that approximately 10% of all patients who are admitted to hospital suffer some form of adverse event (AE)- defined as an unintended harm to a patient resulting in injury, death or a prolonged admission.  Older people are more likely to suffer AEs and the consequences of these are often more severe in frail, older patients.

Data from the UK has shown that currently people over 65 years account for 60% of acute hospital admissions and 70% of bed days in NHS hospitals.all patients who are admitted to hospital suffer some form of adverse event (AE)- defined as an unintended harm to a patient resulting in injury, death or a prolonged admission. Older people are more likely to suffer AEs and the consequences of these are often more severe in frail, older patients.

So, in our acute hospitals, we have large numbers of frail older patients at high risk of harm. This is where FRAILsafe comes in…

The FRAILsafe project has identified the most common and highest impact issues which can result in harm to frail older patients in the first few days of acute care.

These harms include:

  • Confusion (identifying delirium and underlying dementia)
  • Equipment related
  • Reduced mobility (risk of venous thromboembolism)
  • Falls
  • Pressure ulcers
  • Poor advanced care planning
  • Medication: adverse drug reactions

The potential of the humble checklist lies in its simplicity, low cost and scalability to allow widespread use. As healthcare becomes more complex, the purpose of the checklist is to ensure that people are applying their knowledge and expertise on a consistent basis. This reduces variation, increases reliability and potentially helps us to deliver safer care.

One of the key consequences of the checklist is encouraging a ‘check and challenge’ mentality between professionals, triggering better communication and interprofessional team working.

Experience from the WHO Safer Surgery Checklist has demonstrated it to be an effective tool significantly reducing the number of post-operative complications and deaths.

FRAILsafe is currently being piloted in twelve hospitals across the UK. We have submitted a bid for The Health Foundation’s ‘Closing the Gap in Patient Safety’ grants. If successful, this will allow us to pilot further, collect outcome data and refine the implementation of the checklist prior to launching it nationally.

Along with the BGS, the bid is being supported by The Royal College of Physicians, NHS England Patient Safety and Age UK.

We aim to demonstrate that using this tool will reduce the rate of harm, mortality and length of stay in frail older patients. This simple, yet powerful tool can potentially help us improve the quality of care of frail older people.

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