Living and Dying Well with Frailty Collaborative – Learning Session One

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On 19 September 2019, 21 teams  taking part in the Living and Dying Well with Frailty Collaborative came together for the first learning session where they learned how to test their ideas using a range of improvement methods, and how to measure their activities and the impact they make. They also heard from each other about the frailty work being undertaken in the various Health and Social Care Partnerships and GP practices, and had time as a team to look at their project charter and develop their plans for their next test of change during the learning session action period.

Living with Frailty

People are at the heart of what we do, so we started the day by hearing from those living with frailty. We heard about the experience of Mr Lucas, who featured in our video. He spoke about how the support that he receives from services and family helps him to live independently with frailty. Mr Lucas is one of Dr Paul Baughan’s patients, the Living Well in Communities (LWiC) National Clinical Lead for Palliative and End of Life Care and GP at Dollar Health Centre.

(In order to make this video accessible we are editing a final version with subtitles so this will be made available when this has been done).

 

twitter-logo (2)“I hope I’m as able as Mr Lucas when I have moderate frailty. I love how it was the carers, reading and music that helped him live well with frailty.”

 

We also had Hugh Donaghy join us for the day. Mr Donaghy is a carer for his mother and spoke to Professor Graham Ellis, the LWiC National Clinical Lead for Older People and Frailty, about his experience of providing care to someone living with frailty. Hugh discussed how technology is helping him to support his mother in her home, the blurred line between being a carer and a relative, and the challenges of hospital stays: each time his mother comes out of hospital, her frailty increases.

 

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“Carer experience of mum with long term conditions going in to hospital ‘each time she comes home she’s that bit frailer’ – how can we build resilience when someone comes back home?”

 

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I want to be involved in the Frailty Collaborative because…

Alec Murray, Associate Improvement Advisor, led a short ice breaker with the teams using Slido to ask the teams how they felt about being involved in the collaborative, creating the word cloud below…

LS1 Word Cloud

It was great to see people and care at the centre.

Throughout the day there were a number of questions asked on Slido. We didn’t have the opportunity to respond to all of these on the day, so we’ve pulled together our answers in this form: Slido Questions and Answers

Learning about Improvement

The teams then had the opportunity to learn about Quality Improvement Methods and Measurement for Improvement, led by the Living Well in Communities Improvement Advisors and Associate Improvement Advisors (Nathan Devereux, Scott Purdie, Dianne Foster, Tom McCarthy and Michelle Church).

Quality Improvement Methods

When we designed this session we wanted to explore with the teams a range of Quality Improvement concepts and tools. We held an introductory WebEx where we polled the teams to find out how much knowledge and experience everyone had in using QI tools. The teams told us that there was a real mix of skills and experiences in the room, and the results indicated that we should spend a little bit more time on the change package. Therefore the session was designed to give everyone a flavour of some of the approaches that might help teams in the action period.

At the end of the session, the teams were asked for their lightbulb moments:

“Build on existing practice and evidence with data”

 

“Small steps to improvement are better than a leap of faith”

 

“Even failed attempts are learning and a critical part of improvement”

 

“Don’t reinvent the wheel – SHARE”

 

“In order to spread change, you need to explain to others why it’s important, how it works and have a narrative”

 

Measurement for Improvement

As this was the first session we aimed to get everyone on the same level, so that teams were prepared for the first action period. We covered some of the practical elements of measurement for this collaborative, including the data collection method.

The collaborative is focused on three core measures, which represent an increase in involving people in conversations about their needs and care, and also a shift to more planned activity.

In the session we introduced the measurement plan tool designed to help teams collect this data and also provided time for teams to consider what their measurement priorities are, including local priorities and measures which take account of interventions (such as polypharmacy).

It was great to discuss measurement of the collaborative at the first learning session and particularly to hear the views of teams about how best to approach what can be one of the trickiest parts of improvement – measuring whether you make a difference.

Learning from Across Scotland

We had 15 teams and national organisation representatives host tables where they presented on what work they have undertaken on frailty in their area. This was ‘world café’ style, where everyone had an opportunity to go to three tables and hear about work in other areas and ask questions.

There were some great discussions, and the feedback we received indicated this was a very popular session. It was beneficial for them to hear about what is happening in other areas and have the chance to discuss challenges faced, as well as successes.

For example, Rebecca McLaren and Eileen Downham from the Angus team presented work on their Enhanced Community Service and community multidisciplinary team (MDT) meetings. The challenge faced in Angus is that a person can be registered to any of eight GP practices because practice boundaries overlap. The group were particularly interested that a medicine for the elderly consultant from hospital attends the community MDT meetings.​ If a consultant can’t attend then an advanced nurse practitioner attends in their place.

North Lanarkshire HSCP has been working with hospital at home and 30 GP practices to test MDTs. They found the challenges were around data and how home visits can be recorded. Also whether it is possible to measure the quality of ACPs, and creating an infrastructure to support people wishing to stay at home.

For a full list of these topics please click here. For more information about anything which was discussed, please get in touch via email – hcis.livingwell@nhs.net – and we can put you in touch with the relevant team.

Team planning

Teams were then given time to work together on their project charter and action planning for the first action period of the collaborative.

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If you are undertaking similar improvement work you may find the below resources helpful:

National Change Package

Project Charter Template

RACI Action Plan

 

twitter-logo (2)“Fantastic reasons to be at #LWiCFrailty today. But “a goal without a plan is just a wish” so now time for action! Thanks for a useful day of sharing & learning @LWiC_QI @eFI_Midlothian”

 

What next?

Away teams will share their learning with the Home Teams and begin their tests of change, or continue with any tests already underway. They will be documenting their progress and recording data over time, with the support of the Improvement Advisors and Associate Improvement Advisors who are area leads for each of the teams.

For more information about the collaborative please visit https://ihub.scot/improvement-programmes/living-well-in-communities/our-programmes/living-and-dying-well-with-frailty/

For the PowerPoint slides from the day from all sessions, please click here.

Frailty, palliative care and me

by Tim Warren, Policy Lead for Palliative and End of Life Care, Scottish Government

Tim's mumMy mum lives eight hours away, within earshot of Glastonbury (if only her hearing was a little better). Her frailty is a pressing reality. All of the issues which press in at work – frail older people, most with a host of health issues, increasingly lacking capacity, exhausted family carers, stretched paid carers, the role of GPs, district nurses; it all feels very personal.

As the policy lead for palliative and end of life care at the Scottish Government, I frequently have to answer questions about what I do. I usually begin with how ignorant I was when I took on this role, when I mistakenly thought palliative care was basically about hospices and cancer. Of course, I now appreciate that the lion’s share of palliative care is about supporting frail older people like my mum.

When does care become palliative?

So, good care, provided to people at any stage of their care pathway, becomes palliative with hindsight when the person dies. Specialist palliative care, provided in any setting is clearly ‘palliative’. From this perspective, good care, provided in care homes, or by informal carers, supported by district nurses and GPs, and encompassing the spiritual, social and psycho-emotional and the physical, is also ‘palliative care’.

The strategic framework for action on palliative and end of life care (SFA) starts with support for identifying people who stand to benefit from a holistic palliative approach, highlights the importance of conversations with those people (and those who care about and for them), and then aims to provide coordinated care across all settings.

So, who might benefit from a palliative approach?

At what point does support for people with long term conditions become early palliative care? I have come to think about this in two ways. Firstly, thanks to Kirsty Boyd, consultant in palliative care at Royal Infirmary of Edinburgh, I possess the mental metaphor of “umbrella conversations” – conversations to be carried on, not just when it’s raining, but when it might rain. Such conversations might be initiated with a question like, “If you were to get more unwell, what would it be important for us to know about”. Not having these sorts of conversations early, and recording them in a sharable way, can rob people of care and dignity at the end of life. And, although the National Digital Service will in due course enable such information sharing, at the moment the only available mechanism for reliable sharing across settings is the Key Information Summary.

Secondly, another way of looking at who might benefit is by employing “20:20 hindsight”, and reviewing the profiles and care pathways of those who have died over the most recent available year. In 2017 almost 58,000 people died. Around 16,000 of those died suddenly. Of the remainder around 20,000 died with dementia. This gives an additional significance to having those conversations early.

Why early conversations matter

As a policy team we get to see the letters people send to ministers about the care their loved ones receive. One haunts me. It recounts the last months of the writer’s father’s life, in which he experienced increasing frailty, repeated hospital admissions and disjointed care (along with some examples of kind, warm and compassionate staff). He underwent several operations, repeated burst stoma-bags, unmanaged pain and broken promises of ‘fast-tracked care’. The family said it had seemed like a dreadful rollercoaster, which could have been prevented had they just had a realistic conversation about his likely trajectory, and what mattered to him.

Although not all care pathways are like those of this man, all of those who died expectedly should have benefited from conversations about what mattered to them. Paul Baughan, a GP and the Healthcare Improvement Scotland clinical lead for palliative care, led the development of a new palliative care Directed Enhanced Service, to provide some financial support for identifying those who may be moving towards death. (We worked together on the diagram below). It aims to increase the proportion of those with a KIS at the end of life, but especially people with frailty, who have more often been overlooked.

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Diagram of the Directed Enhanced Service

And it is brilliant to see a focus on ensuring that people in care homes get to benefit from this approach; the work in Edinburgh and Glasgow comes to mind. There is lots still to do, but the support of colleagues in primary care in doing this, and supporting them to do so feels like a key element in making sure that everyone gets the palliative care they need by 2021.

Introducing our Living and Dying Well with Frailty Collaborative

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Thomas Monaghan, our Portfolio Lead, discusses our Living and Dying Well with Frailty Collaborative

People in Scotland are living longer than ever before, which is to be celebrated. This means that we all get to spend more time with our loved ones. However, people are not just living longer: they are living longer with more complex health needs and conditions, such as frailty. While we welcome spending more time with our loved ones, we also recognise that it can increase pressure on families, on carers and on our health and social care services to support people to have the best possible quality of life.

Improving care for people with frailty

Supporting people with frailty to have the best possible quality of life is becoming increasingly difficult, as there are growing numbers of older people in Scotland who need support: there will be 25% more people age 65 or over by 2029, and almost 80% more people age 75 or over by 2041.

If we want every older person in Scotland to have the best possible quality of life, then we need to start changing how we support people with frailty to live well in their community.

Our support

At Healthcare Improvement Scotland we want to help health and social care services to make changes so more people with frailty can have a better quality of life in their community. This will help to avoid crises that can lead to poor outcomes and increase pressure on families, carers and health and social care services.

We can do this by helping health and social care services to use evidence and quality improvement methods to:

  • find people who are becoming frail before they reach crisis point
  • have anticipatory care planning conversations with people with frailty to understand their wishes for future care, and
  • work with a range of health, social care, third sector, independent sector and housing providers in local areas to support people with frailty to achieve what they want for their future.

Our Living and Dying Well with Frailty Collaborative

If you want to work with us to help people with frailty to have a better quality of life and reduce pressures on individuals and services, then get in touch. We can talk about how you could be part of our Living and Dying Well in Communities improvement collaborative.

To find out more, get in touch by emailing us at hcis.livingwell@nhs.net, calling us on 0131 314 1232 or tweeting us @LWiC_QI.

Looking forward to hearing from you!

What works in care co-ordination in palliative and end of life care

PEOLC evidence bundle coverWe have recently published a resource that reviews the evidence on continuity and care coordination in palliative and end of life care. This blog post gives an overview of the document and its features.

Why focus on care coordination?

Good care co-ordination can help to improve people’s quality of life, right up to the end of life.

The Living Well in Communities team has been working with test sites in Dundee, East Ayrshire, Fife, Glasgow City, and Renfrewshire Health and Social Care Partnerships to deliver Commitment 1 from the Scottish Government’s Strategic Framework for Action on Palliative and End of Life Care:

We will support Healthcare Improvement Scotland in providing Health and Social Care Partnerships with expertise in testing and implementing improvements to identify those who can benefit from palliative and end of life care and in the co-ordination of their care.”

This work is coming to a close in March 2019.

Exploring the evidence on different approaches

Drawing on the priority practices outlined in the World Health Organization practice brief on continuity and co-ordination of care, we identified six key approaches to continuity and care co-ordination in palliative and end of life care:

  • Early integrated palliative care
  • Collaborative planning of care and shared decision making
  • Case management for people with palliative and end of life care needs
  • Intermediate palliative care at home
  • Technology to support continuity and care coordination
  • Building workforce capacity

Working with the Evidence and Evaluation for Improvement Team, we summarised the available systematic-review level evidence on these approaches.

Presenting the evidence visually

As with our Living Well in Communities with Frailty evidence review, we produced visual summaries for each of the approaches. These provide key information on the different approaches to care coordination, and an introduction to the more detailed evidence summaries. The visual summaries include

  • a brief description of each approach,
  • the rationale behind them,
  • the potential benefits,
  • enablers,
  • brief commentary on the quality of the evidence, and
  • links to further reading and examples of local good practice.

 

Visual summary
Early integrated palliative care visual summary
Case mgmt summary
Case management evidence summary

 

We hope that this document will provide a useful overview of the systematic review-level evidence on key approaches to care co-ordination in palliative and end of life care, and highlight the potential benefits of these approaches.

You can access the review, Continuity and Co-ordination in Palliative and End of Life Care: evidence for what works by clicking on the document image below:

PEOLC evidence bundle cover

 

The community-based interventions that can make a difference for people with frailty

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We have recently published a resource that summarises the evidence for different community-based frailty interventions. This blog post gives an overview of the document and its features.

Why focus on frailty?

A person with frailty can experience serious adverse consequences following even a relatively minor illness. Its impact can be very significant in terms of consequent disability or admission to a nursing home.

If frailty is identified at an early stage and individuals are targeted with evidence-based interventions that can manage frailty, or reverse it, this can improve people’s quality of life and wellbeing. This reduces the likelihood that they will need to access unplanned services due to a crisis, which, in turn, reduces the use of expensive, unscheduled care.

The community-based interventions that can make a difference

The literature on frailty is vast. For the purposes of our resource we focused on interventions in frailty that are community-based, focused on the prevention of harms or poor outcomes, and supported by relatively high-level evidence. The Evidence and Evaluation for Improvement Team carried out literature searches and produced evidence summaries for the following topics:

  • Exercise interventions and physical activity
  • Polypharmacy review
  • Immunisation
  • Primary care interventions
  • Community geriatric services
  • Lifestyle factors: physical activity diet, obesity, smoking alcohol and their relation to frailty
  • Nutritional interventions for the prevention and treatment of frailty
  • Hospital at home: admission prevention and early discharge
  • Reablement (including rehabilitation)
  • Bed-based intermediate care
  • Anticipatory care planning

Making the evidence accessible

We then created visual abstracts for each topic, which allow readers to compare the different interventions at a glance, and provide a route into the more detailed evidence summaries and further reading. The visual abstracts include information on the potential benefits of each intervention, evidence quality, costs, and frailty level:

Reablement visual abstract
Reablement visual abstract
Reablement summary
Reablement evidence summary

 

We hope that this document will help Health and Social Care Partnerships to compare different interventions for frailty and the evidence behind them, and to consider which interventions could make a difference for people with frailty in their local areas.

You can access the report, Living Well in Communities with Frailty: evidence for what works by clicking on the document image below:

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Working together to make a difference for people with frailty in Oban

Oban

by Laura Dobie, Knowledge and Information Skills Specialist

In December 2017 some of our team went to Oban to learn about how partnership working and a focus on prevention and early intervention is having a positive impact on outcomes for frail older people.

The Oban multidisciplinary team

It is 20th December, and the meeting room at Lorn Medical Centre is packed with colleagues from across health, social care and the third sector. This is what it is like every Wednesday morning, except for the festive touch of the mince pies on the table. It is amazing to see the turnout for this frailty multidisciplinary team meeting, and to learn more about people’s backgrounds, and the skills and knowledge that they bring to the table.

The team meets every Wednesday morning to discuss patients with mild, moderate and severe frailty, and this work is bottom-up and clinician-led. The team is truly multidisciplinary, with representation from social care and the third sector: in addition to GPs, nurses, physiotherapists, occupational therapists, pharmacists and dietitians, a social worker, an exercise professional and the centre manager from North Argyll Carers Centre join the weekly meetings. The team are also supported by an administrative assistant and the practice manager, who runs the electronic frailty index (eFI) on the Vision system. They have also been looking at SPARRA and high health gain data.

The team reported that they get together every week to share information in this way because they find it valuable, not because they have been told to work in this way.

‘The hour spent is much more valuable time spent than the previous way of working where it could take you all week to get in touch with someone.  Now you can have that face-to-face conversation and many issues are solved more quickly.  It has prevented duplication of referrals and assessments.’

Reablement project

Derek Laidler, Physiotherapy Team Lead, gave us an overview of the Oban reablement project.

Reablement services in Oban are delivered by Healthy Options, a social enterprise. Healthy Options offer interventions for people who are pre-frail. People who are at risk are referred to Healthy Options, and the aim is to build resilience and support the person to prevent decline. The project was a response to funding constraints in primary care and the pressures of increasingly complex patients and an ageing population. It is a demand-reducing model, rather than capacity-increasing.

Healthy Options used to be very much based in Atlantis Leisure Centre. However, there are now classes in villages that people are able to attend. The support offered is both physical and social, and deals with the whole person. This collaboration with the third sector has been in place in the area for a number of years.

Staff use the eFI and the Edmonton Frail Scale to identify people with frailty and direct them towards appropriate support. 100 people have been identified through case finding, and people are referred into the project through clinician concern.

The Oban Living Well initiative is a mild frailty rehabilitation and reablement approach, and the Active and Independent Living Programme has been a driver for the programme.

Derek explained that most physiotherapy referrals are made at a crisis point, which is reactive, and that the benefits are not as long lasting as intervening at an earlier stage: if people go on an exercise programme to maintain the ability to walk 400m, they retain this ability for two and a half years, whereas the benefits of intervening at a later stage and helping people to regain the ability to transfer themselves from the toilet only last six to eight weeks.

The project staff consider that we should be intervening before people are on the Lifecurve, and have produced a list of activities above the Lifecurve, where people should be targeted with early interventions.

Lifecurve slide

Healthy Options would intervene when people are struggling to run half a mile, or run to catch a bus, and physios would intervene when people are having difficulties climbing stairs and getting up from the floor. There is still a role for Healthy Options with very frail patients, but it is limited. However, they can make people who are mildly frail better.

Derek presented some case studies, which demonstrated how exercise programmes delivered by Healthy Options are reversing people’s frailty scores and improving their health and wellbeing. One older gentleman has regained the ability to take the bus independently and engage in social activities again, while an older lady who was afraid of falling now has increased confidence and improved gait and posture after completing a 12-week exercise programme and attending strength and balance classes.

Lianne McInally from the team visited a lady who had been though the programme recently.  The lady had a one-to-one assessment by a specialist physiotherapist and support from an exercise instructor to complete a home exercise programme based on OTAGO. The lady reported that she had made improvements in her strength and balance and noted a difference getting in and out of her chair. She also reported increased confidence walking further distances, and has agreed to attend the local leisure exercise class now that she was more confident to go outdoors. A buddy system exists, whereby the individual is paired with someone else from the class. Motivation to attend classes can be poor, particularly when a person is not comfortable initiating conversation, and the buddy system appears to make a difference, encouraging people to attend.

Moderate frailty project

Pauline Jespersen, Advanced GP Nurse, described the moderate/severe frailty project, which is running from October 2017 to March 2018. It is being delivered by four GPs (three qualified GP trainers). The project lead is a district nurse, and a physio, OT and pharmacist are also involved in the project. So far they have scanned 80 patients.

Their referral pathway takes a whole-system approach:

  • Edmonton frail scale score 0-5 – Healthy Options
  • Edmonton 6-7 vulnerable, 8-9 mild frailty – physio, Lorn and Islands Hospital reablement team
  • Edmonton 10-11 moderate frailty – Lorn Medical Centre.

The team are aware of all the options in the third sector and can pass on a referral, where appropriate. Their assessment form records people’s conditions, social circumstances and medication, and they are also using the DeJong Gierveld Loneliness Scale as part of the assessment process.

They have a meeting at 9am on a Wednesday, where they discuss the patients that were identified the week before. The frailty team then have a huddle to allocate work. The team double up to mentor staff and support them with enhanced assessment. Visits for enhanced assessment are an hour minimum.

In the afternoon they have a feedback huddle. In some cases they may need to do de-prescribing, and pharmacy assistants help to manage the change and take away old medication. They have been carrying out evaluation with patients and staff. There have been clinical and MDT tutorials, and nurses are doing formal educational modules. Oban has lost a lot of advanced nurses in recent years, so upskilling staff has been an important part of the project.

The process is as follows:

  1. Advanced clinical assessment
  2. Edmonton frail scale
  3. Polypharmacy review
  4. Loneliness questionnaire
  5. Checking ACP and DNACPR are in place
  6. MDT discussion of findings
  7. Interventions
  8. Evaluation

Although the team have seen 80 patients so far, they reported that there have been a lot more than 80 contacts. The initial assessment that is conducted is accepted by everyone – they do not have different groups of professionals coming in and conducting their own assessments. Secondary care is involved in the management of moderate and severe frailty, and advanced nurses work across primary and secondary care. There is an emphasis on home care and avoiding hospital admission.

Healthy Options

We then went on to visit Healthy Options to learn more about their work. This social enterprise clearly demonstrates how a community-owned resource can meet public health needs. In addition to supporting the reablement programme, they also support other initiatives within the community.

Roy Clunie, one of the directors, observed that there is a growing number of people with chronic conditions, and many of these people’s conditions could be managed or improved through a change to a healthy lifestyle.

Healthy Options was established by the community, and staff are drawn from the health, business, fitness and community sectors. A public health dietitian, Jacqualin Barron is seconded to them one day a week. Healthy Options, Atlantis Leisure Centre and health professionals all work in partnership. The Healthy Options staff are highly qualified, and are entitled to attend NHS training courses.

We went on a short walk from the Healthy Options offices to Atlantis Leisure Centre, where we were able to see some of their staff working with clients. One older gentleman was working on the treadmill and cross trainer in the gym, under the instruction of trainer Kirsty, while two ladies were doing a seated exercise class in the dance studio. All of them were very enthusiastic about the support that they were receiving, and the beneficial impact that it has had on their health.

Healthy Options have worked with Atlantis Leisure Centre to make the gym more welcoming for people who are not typical gym goers. The centre manager removed some of the exercise bikes from the gym to create more space and make it easier for people with a high BMI to use the facilities. The consultation process is co-produced, and people can choose the activities that interest them, whether this is swimming, classes or going on the rowing machine. They offer supervised gym sessions and a healthy living outreach programme at the MS Centre.

In addition to delivering a reablement programme and self-management support, Healthy Options is also working with vulnerable social housing tenants, and they have a part-time health liaison officer. They are also working with partners on a healthy village pilot in Taynuilt, with falls prevention, Healthy Options exercise and classes, tai chi and a self-management class.

An example to develop in other areas?

It is clear that the Oban frailty project’s prevention and early intervention approach is having a positive impact on people with frailty, helping them to maintain their independence and keep up with all the activities that they enjoy, from singing in the choir to walking football. By working together across the whole system in a genuine partnership, and involving a third sector partner that is able to offer tailored support for people in the early stages of frailty, Oban is meeting the challenges of population ageing head on, improving the health of its inhabitants, and supporting people to live as well as they can at home, for as long as they can.

Testing the eFI in Scotland: focus on Midlock GP practice

 

Some members of the Living Well in Communities and Midlock teams at the NHSScotland event

The Living Well in Communities team is working with Health and Social Care Partnerships in Glasgow City, West Dunbartonshire and Midlothian to test the electronic frailty index (eFI) to identify people over 65 who are living with frailty in the community. The Living Well in Communities team have developed an assets-based approach to support evidence-based interventions that are tailored to the individual. This article looks at the work to date with Midlock GP practice in Glasgow.

The testing in Midlock GP practice

The eFI uses GP read codes to calculate an individual’s degree of frailty and stratifies them into fit, mildly frail, moderately frail and severely frail. The tool has been validated in England. The purpose of testing at Midlock GP practice was to determine if the tool was accurate in a Scottish context. We have been working with a GP and other members of Glasgow City HSCP, including housing and the voluntary sector. The testing involved stratification of the GP population for frailty and reviewing case scenarios to determine if the eFI tool fits with a Scottish population. Continue reading “Testing the eFI in Scotland: focus on Midlock GP practice”

Using a population screening tool to identify people with frailty in the community: the e-frailty index

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by Laura Dobie, Knowledge and Information Skills Specialist

The Challenge

A person with frailty can experience serious adverse outcomes following even a relatively minor illness. Timely identification of frailty can help to reduce the likelihood of a poor outcome following an intervention (or eliminate the need for an intervention entirely) and support the long-term management of people’s health needs.

If we can identify people with frailty in the community, we can offer preventative support that could improve their quality of life and reduce the risk of unscheduled admissions.

There are a number of tools which professionals can use to screen people for frailty (see the British Geriatric Society’s Fit for Frailty guidance). However, many of these tools are based on questionnaires that require practitioners to have direct contact with individuals and can only be used to assess people who are actively engaged with services.  It would be resource-intensive and challenging for services to screen large population groups for frailty using these individual assessments.

The risk stratification tool, Scottish Patients at Risk of Re-admissions or Admissions (SPARRA) identifies individuals within the whole population at risk of hospital admission based on nationally-collected data on acute admissions and community prescribing.  However, it does not discriminate frailty from other high-risk population groups and can only identify individuals who are known to services, as they have had recent acute admissions or have been prescribed high-risk medications.  Alternative population screening tools are needed to identify people with frailty living in the community. Continue reading “Using a population screening tool to identify people with frailty in the community: the e-frailty index”

How care homes in Argyll and Bute are working to reduce falls

By Laura Dobie, Knowledge and Information Skills Specialist, Healthcare Improvement Scotland

On 5th December I went along to the Argyll and Bute Care Homes Quality Improvement for Falls Prevention event. It was a really interesting day, and it was great to hear about the work that care home staff are doing to reduce falls and improve quality of life for their residents.

PDSAs and data

Dr Christine McArthur, Project Lead, introduced the day and Sheila Morris, Occupational Therapy Care Home Lead, gave an overview of Plan Do Study Act cycles and the role of data in improvement. She emphasised the importance of carrying out small tests of change and having a clear plan.

The project participants then had the opportunity to discuss a case study of a 72-year-old lady who had had a number of falls, considering risk factors such as polypharmacy and multiple complex conditions, and reviewing the data in the falls diary to identify whether there was a pattern to her falls.

The care home staff observed that people are increasingly coming in to care homes with more mobility problems and multiple conditions and co-morbidities. Sheila commented that everyone in the care home sector is at risk of falling and should have a multifactorial falls assessmentContinue reading “How care homes in Argyll and Bute are working to reduce falls”

Scottish Ambulance Service Falls and Frailty Pathways Action Group first meeting

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On 25th November 2016 the Living Well in Communities team from Healthcare Improvement Scotland’s Improvement Hub (ihub) supported the first meeting of the Active and Independent Living Improvement Programme (AILIP) and Scottish Ambulance Service Falls and Frailty Action Group. This Storify summarises the discussions from the day. Presentations and other resources can be accessed on the Falls and Bone Health Community site.