794 STANDARDISED SOCIAL HISTORY DOCUMENTATION IN MEDICAL CLERKING IMPROVES IDENTIFICATION OF FRAILTY

Abstract

Background: Thorough social history is a crucial component of a medical admission. Understanding a patient's functional status enables better assessment of their Frailty and better decisions about aims of treatment, rehabilitation, appropriate escalation and ceilings of care. Introduction: The Medical Unit at St John's Hospital Livingston, Scotland admits approximately 11,280 patients per year, of whom 55% are aged >=65 years. Following a medical clerk-in, all admissions aged>=65 years are screened for Frailty by a dedicated Frailty Nursing team using the Clinical Frailty Score (CFS) based on information in their electronic casenotes. Method(s): We assessed the quality of social history documentation and the accuracy of CFS in 202 medical admissions >=65 years clerked in by medical staff over a 2 week period from 14th to 31st December 2020. Patients at end of life and those reviewed by the Frailty Advanced Nurse Practitioner prior to medical clerk-in were excluded. 3 months later this was repeated for 188 medical admissions from 12th-26th March 2021 following interventions below. Interventions An education session was delivered to trainee doctors and consultants at the Medical Unit Meeting. A pre-populated proforma was added to the electronic medical clerking document containing these prompts * Accommodation * Mobility/use of aids * Activities of daily living * Support family, district nurses * Cognition A dedicated field for Clinical Frailty Score was also added. Result(s): Following intervention, documentation of social history and CFS increased from 22% to 35%. The pre-populated proforma was used in 21% of patients. In these patients, 95% had all areas of social history documented enabling accurate classification of CFS. Conclusion(s): Using the pre-populated proforma significantly improves social history documentation and accuracy of CFS scoring. A change of culture is required particularly amongst junior doctors on the importance of this information, so we can deliver better patient-centred care.