The project used a collaborative approach to undertake frailty reviews, aiming to reduce inappropriate hospital admissions. The reviews included discussing residents' preferred place of care and options in the event of deterioration, a Treatment Escalation Plan (TEP).
A collaborative was formed between care home managers, pharmacists and geriatricians to review frailty factors in residents over 65 years, excluding those with Learning Disabilities. Care homes with high risk of COVID-19 were prioritised. A Standard Operational Procedure was approved within one month. Using existing resources only, the project was delivered over 3 months. Communication was sent to GP practices, care homes and residents/families and consent was obtained. Templates were developed and education was delivered.
Results
Review outcomes were recorded electronically onto the GP clinical system. Care homes kept a copy and informed residents/families of the outcome. 595 residents were reviewed in 21 care homes.
Preliminary analysis for 247 residents reviewed May 2020 to April 2021 show:
• 137 survivors, 84 with severe frailty (CFS 7-9), 53 not severely frail (CFS<7). Out of total 70 residents with Treatment Escalation Plans( TEP) indicating avoidance of hospital admission, 55 residents achieved their wishes. 15 residents were admitted with acute complaints. 14 residents TEP included hospital management.
• 92 of the 110 deceased residents were severely frail. 91% died in their preferred place of death.
Conclusion
Clinical leadership demonstrated courage and capacity to challenge the status quo, improve organisational processes and innovate practice. This helped staff morale at a difficult time of immense pressure and positively enhanced care homes' profile and residents' experience.
