4THE INTRODUCTION OF AN ORTHOPAEDIC CLERKING PRO-FORMA FOR PATIENTS OVER 60 YEARS OF AGE TO IDENTIFY PATIENTS WITH A HIGH CLINICAL FRAILTY SCORE REQUIRING AN ORTHOGERIATRIC INTERVENTION

Abstract

Introduction: Older patients with fragility fractures are currently admitted under the care of the orthopaedic service in our hospital. Our prior work has shown the patients to be a similar cohort to those with a neck of femur fracture. Recent changes to the admission policy in our trust mean more fractures are being admitted under the sole care of the orthopaedic teams. Our current model of care does not allow the orthogeriatric team to review all patients. Previous attempts at the introduction of a pro-forma for falls assessment and comprehensive clerking of patients has failed. We aimed to introduce a system for targeted reviews with orthogeriatric intervention for the patients with the greatest need. Method(s): Co-designed new orthopaedic clerking pro-forma and post-take ward round sheet, introduced for all patients over 60 years, excluding patients with fracture neck of femur, in September 2018. This included a Clinical Frailty Scale (CFS), cognitive and falls assessments. Intervention(s): A series of PDSA cycles were undertaken to embed the use of the proforma over one month. Initial feedback highlighted some discrepancies in frailty scoring and these were addressed by a training session with an orthogeriatrician. Audit is ongoing to check correct use of pro-forma. Result(s): In total 63 patients (>60 years) were admitted to orthopaedic care. * 51 (81%) had completed orthopaedic clerking pro-forma (missed patients were reviewed daily for justification of omission). * 20 (39%) patients had a Rockwood Score of >=5. * 75% had a fall. * Mean Charlston Co-morbidity Score - 6.8. * Mean length of stay was 10 days. * Fractures: Spinal 4 (20%), Pelvis 4 (20%), Upper limb 3 (15%), Lower limb 3 (15%). * Non fractures: Infection 2 (10%), Hip pain 4 (20%). Conclusion(s): The clerking pro-forma was successfully introduced together with frailty scores and cognitive assessments. Falls assessment embedding is ongoing. This intervention will allow targeted review from the orthogeriatric team for all patients with a CFS Score >=5. Key Steps: * Co-design of the pro-forma - with active orthopaedic engagement in its design and implementation. * The role of the orthopaedic nurse to coordinate the data collection and feedback to team members on a daily basis (significantly increased the uptake in the use of the pro-forma). * The teaching session to the junior team to highlight the reasoning behind frailty assessments.