Improving patient safety for older people in acute admissions: implementation of the Frailsafe checklist in 12 hospitals across the UK

• DOI: 10.1093/ageing/afx194
• Publication Date: 2017-12-03T04:08:12Z
• Authors: Chrysanthi Papoutsi; Alan Poots; Jake Clements; Zoe Wyrko; Natalie Offord; Julie E Reed
• Keywords: Health Knowledge, Attitudes, Practice; Attitude of Health Personnel; Health Services for the Aged; 610; Interviews as Topic; 03 medical and health sciences; Patient Admission; 0302 clinical medicine; Humans; Geriatric Assessment; Qualitative Research; Aged; Quality Indicators, Health Care; Aged, 80 and over; Patient Care Team; 2. Zero hunger; Frailty; 1103 Clinical Sciences; Quality Improvement; United Kingdom; Checklist; Group Processes; 3. Good health; 1117 Public Health And Health Services; 1701 Psychology; Geriatrics; Patient Safety

checklists are increasingly proposed as a means to enhance safety and quality of care. However, their use has been met with variable levels of success. The Frailsafe project focused on introducing a checklist with the aim to increase completion of key clinical assessments and to facilitate communication for the care of older patients in acute admissions.to examine the use of the Frailsafe checklist, including potential to contribute to improved safety, quality and reliability of care.110 qualitative interviews and group discussions with healthcare professionals and other specialties, 172 h of ethnographic observation in 12 UK hospitals and reporting of high-level process data (completion of checklist and relevant frailty assessments). Qualitative analysis followed a thematic and theory-driven approach.through use of the checklist, hospital teams identified limitations in their existing assessments (e.g. absence of delirium protocols) and practices (e.g. unnecessary catheter use). This contributed to hospitals reporting just 24.0% of sampled patients as having received all clinical assessments across key domains for this population for the duration of the project (1,687/7,021 checklists as fully completed). Staff perceptions and experiences of using the checklist varied significantly, primarily driven by the extent to which the aims of this quality improvement project aligned with local service priorities and pre-existing team communications styles.the Frailsafe checklist highlighted limitations with frailty assessment in acute care and motivated teams to review routine practices. Further work is needed to understand whether and how checklists can be embedded in complex, multidisciplinary care.