Establishing Frailty and Falls Risk Assessment Screening in an MSK Outpatient Physiotherapy Department

Purpose

To implement frailty and falls risk assessment screening as a core part of patient assessments following Trust objectives, NICE guidance and the NHS 10 year plan objective of helping people to age well, enabling us to identify those at risk and signpost to services appropriately.

Approach

NICE Falls guidelines, and local and national Frailty documents were researched, and current practice was reviewed and benchmarked against these. Further to this, liaison with the Trust Frailty Champion assisted in developing and implementing departmental frailty and falls screening. Staff were trained on the screening process which was then integrated into patient core assessment documentation. A baseline audit was carried out in 2019 (50 patient notes), and a further audit in 2020 (100 patient notes) to assess adherence to falls and frailty screening.

Outcomes

Results: Between 2019 and 2020, there was an improvement from 16% to 54% of patients having frailty assessments, and 30% to 44% having falls assessments. In the second audit, 53 out of 54 patients screened were not frail (Rockwood 1-3 or very fit, well or managing well). One patient scored 5 (mildly frail), and was also at risk of falls, but was not signposted to frailty or falls services. Three patients had their frailty scored incorrectly. 31 of those not screened for frailty were aged 65 or over. Eight of these were in their 80s and 90s. At baseline audit, two patients were identified as a falls risk, with one being referred to appropriate services. By 2020, 13 patients were identified as at risk of falls, but only three had this addressed. Of those not assessed for falls, 11 had increased risk of falls evidenced in their notes

Conclusion(s): The frailty and falls screening process delivers on the principles of Making Every Contact Count, and good progress has been made to make it a core part of our initial assessment. There was significant improvement in frailty screening between 2019 and 2020, though there were still missed opportunities to identify frailty. There was a significant improvement with falls screening. However, 44% compliance is low compared to the national guidance expectation of 100% screening for patients aged 65 or over. There is still a lack of knowledge and confidence with using the screening tools, and further training is needed. Whilst screening has improved, there is a lack of addressing issues identified and signposting to services for falls and frailty. Further research and training regarding local resources/ services is needed.

Impact: Introduction of frailty and falls screening shows alignment with our Trust objectives, national guidelines and the NHS 10 year plan. Addressing frailty and falls issues with our patients will impact on their health and well being and quality of life, and reduce healthcare costs.

Cost and savings

No costs

Implications

Introduction of frailty and falls screening shows alignment with our Trust objectives, national guidelines and the NHS 10 year plan. Addressing frailty and falls issues with our patients will impact on their health and well being and quality of life, and reduce healthcare costs.

Top three learning points

No further data 

Funding acknowledgements

Unfunded