Abstract
Introduction
Patients with frailty at Tiree Medical Practice (TMP) are identified and managed by a Multi-Disciplinary Team. That team also provide out of hours and emergency care on the island meaning quick access to patient information is essential. The aim of this project was to improve frailty record keeping at TMP. It was intended that by 30 April 2025, a full Frailty Record (FR) would be held for at least 90% of patients identified as having frailty.
The process of determining the parameters of the FR was dynamic but the final definition was an entry containing:
- Identifying details
- Medical problems
- Care arrangements
- Recent developments
- Action points and
- Rockwood Clinical Frailty Scale Score (RCFS)
Plus, whether they had a:
- Do not attempt cardiopulmonary resuscitation form (DNACPR)
- Key information summary (KIS)
- Advance care plan (ACP) and
- Power of attorney (POA).
Method
A variety of Quality Improvement tools were used to understand the problem and involved the MDT, wider practice and patients. A plan-do-study-act (PDSA) approach was then used to implement, evaluate and amend three key change ideas throughout the course of the project with at least four PDSA cycles per change idea.
The change ideas were a template to standardise the FR; introduction of frailty scoring; and patient engagement.
Results
4% of patients had a full FR by the end date. In terms of the process measures 20% of the patient group had a recorded DNCPR, 60% a KIS, 40% a POA and 16% an ACP. 100% had an RCFS score.
Conclusion
The changes of introducing a template and an interactive frailty scoring session were particularly effective. There is scope for future changes in relation to patient engagement and a project improving patient uptake of elements such as POA and ACP.