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STANDARD RISK SCREENING AND ASSESSMENT TOOLS USED TO PREVENT HARM TO OLDER PEOPLE IN HOSPITALS
conference contribution
posted on 2016-10-14, 00:00 authored by Bernice RedleyObjectives: 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.
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.
