Frailsafe: A safety checklist for frail older patients entering acute hospital care Sheffield Teaching Hospitals NHS Foundation Trust

Contact: Paul Harriman

• Led by Sheffield Teaching Hospitals NHS Foundation Trust on behalf of the British Geriatrics Society.
• Run in 12 NHS trusts from across the UK.
• Aimed to improve quality of care for frail older patients admitted to NHS hospitals with medical emergencies.
• Used the Frailsafe safety checklist to improve communication and compliance with evidence-based interventions, and to reduce avoidable harm.

It has been shown that ‘the oldest old’ are disproportionately affected by patient safety incidents involving harm. Common issues that can result in harm to patients in the first few days of acute care include confusion, falls, pressure ulcers and reduced mobility.

This project aimed to improve the reliability and safety of care for older people admitted to acute hospital by learning how to implement a safety ‘check and challenge’ list.

The project was led by Sheffield Teaching Hospitals NHS Foundation Trust, working on behalf of the British Geriatrics Society, in partnership with the Collaboration for Leadership in Applied Health Research and Care Northwest London (CLAHRC NWL), Sheffield Hallam University Art and Design Research Centre, Age UK, NHS England Patient Safety, and the Royal College of Physicians.

Twelve trusts from across the UK took part in a 12-month Breakthrough Series Collaborative with the aim of learning how to implement Frailsafe: a checklist to ensure a small set of evidence-based interventions have been completed as soon as possible after hospital admission.

Evaluation of the project was carried out by CLARHC NWL and included analysis of data uploaded by participating sites – 7,021 Frailsafe checklists. Overall compliance with Frailsafe over the 12 months was 22.5% (all 11 elements delivered); compliance with individual elements ranged from 58.4% (medicines reconciliation) to 87.6% (pressure ulcer assessment).

This variability in compliance with Frailsafe indicated that where the conditions were right, Frailsafe could be used effectively. The successful sites demonstrated these conditions; the less successful ones were missing key conditions.

It was acknowledged from the start that there was no single method to implement Frailsafe and teams would need to find the best way to proceed within their clinical environment. A design team was integral to this, helping teams to tailor the checklist.

The implementation process highlighted deficiencies within local systems that may not have been apparent, indicating that Frailsafe can also be used as a tool to drive improvements.

Patient outcomes for falls, readmissions, mortality and length of stay were explored, where data were available. A reduction in length of stay was found in two of the sites, although it is difficult to attribute any changes to the initiative alone.

Barriers included difficulty engaging acute physicians; highlighting the importance of having key stakeholder representation in the improvement team.

Some of the teams are scaling up Frailsafe within their organisations, and the British Geriatrics Society is promoting the initiative nationally.