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IN-DEPTH: FRAILTY


Frailty facts: what all clinical staff need to know


“Patients with frailty are in all of our hospital departments,” said Dr Susannah Long, consultant geriatrician. “They have multiple health concerns and need caring for in a way that takes into account all their medical and non-medical issues. “The most important step is identifying patients with frailty as soon as possible, giving them a specialist assessment. We can then ensure they are cared for on the right ward by staff with the appropriate skills.” Currently, many frail patients who need urgent care are triaged in A&E. Although some patients will be looked after in special beds for elderly patients, others will be cared for in other areas of the hospitals. When the wrong decision is made about where to admit or move a frail patient, it can add 5.5 days to their length of stay in hospital – and cause them unintended harm.


To improve the way frail older people are identified, the Trust has launched a raft of initiatives including adopting the ‘Rockwood frailty score’


discharged, they become reliant on community services having lost the ability to perform everyday tasks: “A patient’s world is suddenly much smaller, they can no longer climb stairs, walk to the shops or go out and see friends,” added Annabel. “Physically, they are weaker, more prone to confusion or falls, and sometimes have to be readmitted to hospital.”


To reverse the effects hospital care can have, Annabel is encouraging patients to keep to the same sleep / wake cycle they have at home. “No-one should be eating in bed if that’s not normal for them, “said Annabel, “Every patient should be sat up, dressed and out of bed where possible, and be supported to use the toilet as they do at home.”


FOR MORE INFORMATION


For more information on deconditioning contact: a.rule@nhs.net or


Sarah.Montgomery3@nhs.net Winter 2017/2018 Pulse/ 11


which assesses how frail a patient is and the support they need. “We want to enable all clinicians to identify frailty and understand the basic principles behind caring for this patient group,” continued Susannah. “Our aim is that all frail patients have a comprehensive geriatric assessment, initiated by a multi- disciplinary team, within 24 hours of admission so we can plan their care and bring in the right professionals. “For example, we know for patients with delirium or acute confusion, we need to minimise ward moves, familiarise them with the ward environment and potentially involve dementia specialists early in their care.” The frailty team is running a number of education events open to all clinicians at the Trust. Dr Claire Solomon, consultant geriatrician at Charing Cross Hospital said: “Looking after older people appropriately and effectively is really part of everyone’s job at the Trust now – so it’s really important staff take the time to learn about this critical group who have very distinct needs.”


The gold standard for caring for patients with frailty


1 2 3


Clinical advice for staff members or GPs:


IDENTIFY: use the frailty score to identify frail patients in emergency departments and on the wards


ASSESS: conduct a comprehensive geriatric assessment (CGA) as part of a multi-disciplinary team


TREAT: make a plan for the patient to receive ongoing, specialist care in the right environment, by the right staff


• Email: ICHC-tr.adviceelderlymedicine-imperial@nhs.net or Dr Suneil Shukla


or 077 8961 8954 for Dr Rosie Belcher


For education and training opportunities contact: karen.richards9@.nhs.net or cheryl-ann.carr@nhs.net


•Charing Cross Hospital: call 020 3311 5162 and speak to Dr Claire Solomon •St Mary’s Hospital: call 020 3312 6666 and ask for Dr Susannah Long


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