STANDARD RISK SCREENING AND ASSESSMENT TOOLS USED TO PREVENT HARM TO OLDER PEOPLE IN HOSPITALS

Objectives: Describe the use of standard risk screening and assessment tools used to prevent harm to older people in hospitals and identify good practice examples to guide ongoing quality improvement. Methods: A descriptive cross-sectional audit of 11 health services guided by six draft standards for good practice. Data collection included the standard risk screening and assessment tools used to assess older people in hospital and focus group discussions with key stakeholders. Results: 152 standard assessment tools from 11 health services were examined; 69 staff from 9 hospitals participated in focus groups. The 152 forms had over 3,700 items; 2,428 were on standard forms used universally,for every patient; 1,283 were on forms used selectively. Hospitals use multiple standard assessment forms (median 11, range 8-27) that collect up to 586 individual data items (median 345, range 150-586) from each patient. Approximately 17% of data are duplicated across multiple forms. Assessments of skin integrity, mobility (incl. falls) and medical risks (e.g. vital signs, concurrent high risk medical conditions) were consistently included in forms used universally at all health services. Variability across health services related to assessment of nutrition, cognition (including delirium), pain, medication and discharge. Assessment of continence and medical risks such venous thromboembolism (VTE) and hospital acquired infection (HAI) (e.g. related to invasive devices) and high risk patient characteristics (e.g. pre-existing cognitive impairment, self-care ability or substance abuse) were infrequent. Thematic analyses of focus groups discussions revealed two major themes and a number of sub-themes describing the use of standard risk screening and assessment tools in hospitals. Most prominent was the “burden on staff and the older person”; subthemes related to “workload burden” and “cognitive burden” due to the high number of standard forms, time taken to complete the forms and the high volume of information collected. Three sub-themes related to the theme "using standard forms to prevent harm during hospitalisation" these were; “interprofessional collaboration” that recognised disciplines need to share and work collaboratively but tend to work in silos; “flexibility to individualise care”, highlights the challenges involved with ensuring the best mix of interventions are also aligned individual preferences, particularly for those with complex risk profiles; and “information management” revealed the challenges of maintaining accessible, accurate, reliable and contemporaneous information to monitor progress, detect change early and inform clinical decision making. Conclusion: The multiple standard risk and assessment forms used in hospitals inconsistently capture some common preventable harms of hospitalisation and are burdensome for staff and patients. Recommendations include: 1. Explore use of ‘global triggers’ to reduce delays to interventions; 2. Reduce burdens on patient and staff; 3. Build resilience in frontline clinical governance to prevent harm.