Can a Self‑Assessment Tool Identify Unmet Therapy and Pharmacy Needs in Older Adults With Frailty on an Ambulatory Unit?

Introduction 

Unmet needs of those living with frailty significantly contribute to hospital admissions. The Ambulatory Assessment Unit (AAU) is a high-turnover, same-day emergency care unit with 40% of patients aged ≥65. Aligned with the 10 Year Health Plan shift from sickness to prevention, this Quality Improvement (QI) project aimed to better identify patients in AAU with unmet therapy and pharmacy needs using the Edmonton Frail Scale Acute Care (EFS-AC).

Methods 

The project received Trust governance approval (ULYSSES No.9934). 

Existing practice of referring to physiotherapy/pharmacy practitioners combines doctor referrals, note screening and Clinical Frailty Scale (CFS) score. The EFS-AC was selected as a valid and reliable self-assessment tool (approval received from developers). Over 3 PDSA cycles, EFS-AC forms were provided to patients ≥65 years and collected for analysis. Data collected included: CFS scores, EFS-AC scores, existing referrals to physiotherapy/pharmacy and readmission rate. Patients likely to need therapy input (high EFS-AC scores in functional independence and functional performance) and pharmacy input (EFS-AC scores highlighting compliance difficulties or polypharmacy) were identified. 

Results

34/37 (92%) eligible patients completed the EFS-AC form compared with 18/34 (53%) with CFS documented. 3/34 (9%) patients were classified as frail according to CFS (≥5) compared with 11/34 (32%) according to EFS-AC score (≥6). One patient was reviewed by therapy, compared with 13 patients with likely need according to EFS-AC score. No patients were reviewed by pharmacy regarding polypharmacy and compliance issues, compared to 12 with likely need according to EFS-AC score. One patient re-presented within 2 weeks with a frailty-related complaint. 

Conclusions

EFS-AC was completed with greater compliance, identified more patients with frailty and more patients who could have benefitted from pharmacy and therapy input compared with existing practice. Next steps involve validating referral criteria, creating a referral pathway using EFS-AC scores and evaluating long-term efficacy and sustainability.