Dataset Information

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project.

ABSTRACT:

Introduction

The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD.

Methods

A frailty screening programme, using the Clinical Frailty Scale (CFS), was introduced in September 2018. A Geriatric Assessment (GA) was offered to patients with CFS ≥ 5 and non-dialysis- or dialysis-dependent CKD. Renal Frailty Multidisciplinary Team (MDT) meetings were established to discuss needs identified and implement a person-centred management plan.

Results

A total of 450 outpatients were screened using the CFS. One hundred and fifty patients (33%) were screened as frail. Each point increase in the CFS score was independently associated with a hospitalisation hazard ratio of 1.35 (95% CI 1.20-1.53) and a mortality hazard ratio of 2.15 (95% CI 1.63-2.85). Thirty-five patients received a GA and were discussed at a MDT meeting. Patients experienced a median of 5.0 (IQR 3.0) problems, with 34 (97%) patients experiencing at least three problems.

Conclusions

This quality improvement project details an approach to the implementation of a frailty screening programme and GA service within a nephrology centre. Patients living with frailty and CKD at risk of adverse outcomes can be identified using the CFS. Furthermore, a GA can be used to identify problems and implement a person-centred management plan that aims to improve outcomes for this vulnerable group of patients.

SUBMITTER: Nixon AC

PROVIDER: S-EPMC8357770 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project.

Nixon Andrew C AC Brown Julie J Brotherton Ailsa A Harrison Mark M Todd Judith J Brannigan Dawn D Ashcroft Quinta Q So Beng B Pendleton Neil N Ebah Leonard L Mitra Sandip S Dhaygude Ajay P AP Brady Mark E ME

Journal of nephrology 20201010 4

<h4>Introduction</h4>The aims of this quality improvement project were to: (1) proactively identify people living with frailty and CKD; (2) introduce a practical assessment, using the principles of the comprehensive geriatric assessment (CGA), for people living with frailty and chronic kidney disease (CKD) able to identify problems; and (3) introduce person-centred management plans for people living with frailty and CKD.<h4>Methods</h4>A frailty screening programme, using the Clinical Frailty Sc ...[more]

PMID: 33040293

Similar Datasets

Project description:BackgroundGood hand hygiene is the most effective basic measure for preventing hospital-acquired infections. This research project, which originated from a project report on improving hand hygiene at a general hospital in Hangzhou, Zhejiang, China, aimed to investigate the effectiveness of hand hygiene improvement among the hospital staff.MethodsSince 2017, a hand hygiene improvement project involving the staff of a 2,500-bed general teaching hospital in Zhejiang, China, has been carried out. This study summarized the implementation and effectiveness of the project, which is based on the five factors of systematic evaluation. The research summary was divided into three phases: phase I (December 2017 to August 2018), phase 2 (September 2018 to April 2019), and phase 3 (May 2019 to December 2019). The data of hand hygiene compliance rates of different groups of professionals in the different research periods were statistically analyzed.ResultsThe results showed that continuous intervention led to a gradual increasing trend (Ptrend<0.001) in the hand hygiene implementation rate with as the intervention time and phases progressed. The hand hygiene compliance rates differed significantly during different phases (76.61%, 79.95%, and 83.34% in phases 1, 2, and 3, respectively, P<0.001). At the same time, the compliance rates of hand hygiene at each phase differed significantly between different professions (P<0.001, the compliance rate of hand hygiene among nurses was the highest and lowest among workers). The compliance rate of hand hygiene for different professions during the three phases were: nurses, 84.73%; doctors, 78.35%; interns, 77.62%; and other hospital workers, 72.79%.ConclusionsThe hand hygiene compliance rate was effectively improved among the hospital staff after the implementation of the hand hygiene improvement project. In this hospital, the project yielded remarkable results. Hand hygiene must be continuously practiced and improved to develop good habits. Effective and detailed planning as well as key factors, such as hand hygiene facilities, information monitoring, the active participation and response of employees, training and education, and supervision and feedback, could help to guarantee the effectiveness of the project.

Project description:Hypertension affects 29% of the adult U.S. population and is a leading cause of heart disease, stroke, and kidney failure. Despite numerous effective treatments, only 53% of people with hypertension are at goal blood pressure. The chronic care model suggests that blood pressure control can be achieved by improving how patients and physicians address patient self-care.This paper describes the protocol of a nested 2 x 2 randomized controlled trial to test the separate and combined effects on systolic blood pressure of a behavioral intervention for patients and a quality improvement-type intervention for physicians. Primary care practices were randomly assigned to the physician intervention or to the physician control condition. Physician randomization occurred at the clinic level. The physician intervention included training and performance monitoring. The training comprised 2 internet-based modules detailing both the JNC-7 hypertension guidelines and lifestyle modifications for hypertension. Performance data were collected for 18 months, and feedback was provided to physicians every 3 months. Patient participants in both intervention and control clinics were individually randomized to the patient intervention or to usual care. The patient intervention consisted of a 6-month behavioral intervention conducted by trained interventionists in 20 group sessions, followed by 12 monthly phone contacts by community health advisors. Follow-up measurements were performed at 6 and 18 months. The primary outcome was the mean change in systolic blood pressure at 6 months. Secondary outcomes were diastolic blood pressure and the proportion of patients with adequate blood pressure control at 6 and 18 months.Overall, 8 practices (4 per treatment group), 32 physicians (4 per practice; 16 per treatment group), and 574 patients (289 control and 285 intervention) were enrolled. Baseline characteristics of patients and providers and the challenges faced during study implementation are presented. The HIP interventions may improve blood pressure control and lower cardiovascular disease risk in a primary care practice setting by addressing key components of the chronic care model. The study design allows an assessment of the effectiveness and cost of physician and patient interventions separately, so that health care organizations can make informed decisions about implementation of 1 or both interventions in the context of local resources.ClinicalTrials.gov identifier NCT00201136.

Project description:BackgroundThe Geriatric Emergency Department (ED) Guidelines recommend screening older adults during their ED visit for delirium, fall risk/safe mobility, and home safety needs. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) tool for preimplementation planning.MethodsThe cross-sectional survey was conducted among ED nurses at an academic medical center. The survey was adapted from the CFIR Interview Guide Tool and consisted of 21 Likert scale questions based on four CFIR domains. Potential barriers identified by the survey were mapped to identify recommended implementation strategies using ERIC.ResultsForty-six of 160 potential participants (29%) responded. Intervention Characteristics: Nurses felt geriatric screening should be standard practice for all EDs (76.1% agreed some/very much) and that there was good evidence (67.4% agreed some/very much). Outer setting: The national and regional practices such as the existence of guidelines or similar practices in other hospitals were unknown to many (20.0%). Nurses did agree some/very much (64.4%) that the intervention was good for the hospital/health system. Inner Setting: 67.4% felt more staff or infrastructure and 63.0% felt more equipment were needed for the intervention. When asked to pick from a list of potential barriers, the most commonly chosen were motivational (I often do not remember (n = 27, 58.7%) and It is not a priority (n = 14, 30.4%)). The identified barriers were mapped using the ERIC tool to rate potential implementation strategies. Strategies to target culture change were identifying champions, improve adaptability, facilitate the nurses performing the intervention, and increase demand for the intervention.ConclusionCFIR domains and ERIC tools are applicable to an ED intervention for older adults. This preimplementation process could be replicated in other EDs considering implementing geriatric screening.

Dataset Information

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project.

Introduction

Methods

Results

Conclusions

Publications

Implementation of a frailty screening programme and Geriatric Assessment Service in a nephrology centre: a quality improvement project.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets