Improving ReSPECT Documentation and Clinical Frailty Assessment to Enhance Patient Safety and Shared Decision-Making

Introduction

Older people >65 years admitted to acute medical services may receive care inconsistent with their preferences when emergency treatment plans are incomplete. ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) supports personalised emergency care planning and shared decision-making. We identified inconsistent ReSPECT and Clinical Frailty Scale (CFS) documentation and aimed to improve completion and quality to ensure elderly patients admitted must have a ReSPECT plan and CFS in place in case of emergency situations.

Methods

Baseline data were collected over 2 months for patients >65 years admitted following clerking and post-take review before transfer to a General Medical Ward. Completion of ReSPECT form sections, including patient details, clinical information, mental capacity, senior clinician signature, resuscitation decisions, clinical recommendations and emergency contacts, was recorded. Fishbone analysis and a driver diagram identified barriers and change ideas. Two PDSA cycles (1.5 and 2.5 months) introduced targeted interventions including poster reminders, reinforcement during nursing/clinical handovers, consultant emphasis during post-take rounds, education sessions, journal club teaching and a clinical survey exploring ReSPECT/CFS knowledge. Outcome measures were completion of ReSPECT plans and CFS documentation. Data was analysed and projected graphically.

Results

Among 104 baseline patients >65yrs (mean age 71 years), only 41% had a ReSPECT form. While patient details, clinical information, mental capacity and senior signatures were documented in >75% of forms, clinical recommendations were completed in only 25%, with poor CPR, escalation and treatment-priority documentation; emergency contacts were recorded in 18%. Key barriers included workload/time pressure, unclear responsibility, no system prompts and knowledge gaps. ReSPECT completion increased from 41% at baseline to 49% by PDSA2, while full completion of Respect Forms (includes all Respect form sections) increased from 14% to 30%. ReSPECT discussion documentation increased from 28% in PDSA1 to 61% in PDSA2 post interventions. CFS documentation remained suboptimal (54% to 36%).

Conclusion

A multifaceted QI approach improved ReSPECT completion, full documentation and discussion recording. Persistent CFS gaps highlight the need for sustained education, clear ownership and electronic prompts to embed personalised care planning and frailty assessment.