LRI Emergency Department Documents/Frailty... · This SOP outlines the procedure for scoring clinical frailty within the ED and to ensure that the effective and consistent procedures

Page 1 of 6 Frailty (including Clinical Frailty Score) UHL Emergency Department Guideline Approved by ED Guideline Committee

Trust Ref: C11/2018 Next Review 01 November 2019

LRI Emergency Department

Standard Operating Procedure for: Clinical Frailty Scoring

Staff groups SOP applies to:

All emergency department staff

Issue date: 10 January 2018

Version number: FINAL v1.3, 30/12/17

Supersedes: None

Review date: 01/11/2019

Author(s) Dr Jay Banerjee and Vicki Enright

Operationalising Clinical Frailty Score within the Emergency Department

Scope

This SOP covers responsibilities and daily routine tasks of the Emergency Department (ED) Clinical Teams in normal working practice.

This SOP does not cover clinical procedures. For these and all other clinical policies, guidelines and procedures refer to the Trust intranet http://insitetogether.xuhl- tr.nhs.uk/pag/Pages/default.aspx

This SOP outlines the procedure for scoring clinical frailty within the ED and to ensure that the effective and consistent procedures are adopted.

This SOP should be seen as an addendum to the ED SOP for the Assessment Zone, Emergency Room (ER), Majors, and Blue Zone.

Absolute Underlying Principles

• The Clinical Frailty Score (CFS) score will be calculated on Nervecentre as amandatory field on all attendees >65

• Every attempt will be made and evidenced to include older people, theircareers/ families and their GPs in the care management decisions. This canbe done face-to-face, on the phone or in writing (GP and Care Homes).

• The CFS score is not a tool to decide to withhold care.

• The CFS score is a tool to help decide on the ideal treatment and care thataddresses the older persons goals and avoids further harm through iatrogenicmeans.



Using the Clinical Frailty Score (CFS)

1) Use the CFS flash cards or your Smartphone download adobe document fromGoogle search “Rockwood frailty scale” or print off Appendix 1 click hereAppendix 1 CFS orsee:https://docs.wixstatic.com/ugd/2a1cfa_e5e2c60f3d3d4449bbdd5e85aeb915f3.pdf to identify the CFS score – do not use the photos from the CFS flashcardbut quiz the patient or seek corroborative information fromfamily/neighbor/GP/care home

2) The CFS to act on is based on what the person was like 2 weeks ago (so takesout the effect of acute reversible illness, such as acute heart failure, on functionalstate)

3) Involve the MDT (Primary Care Coordinator, Physiotherapist, OccupationalTherapist) to carry out a comprehensive holistic assessment of the older person,record date and time of referral on Nerve Centre and in patient records.

Suggested Pathway

Comprehensive Geriatric Assessment (CGA)



When you are selecting your frailty score to also remember your Clinical Frailty Outcomes and complete the required referrals:

Clinical Frailty Score

Care required and Plan

1 to 4 Follow usual care 5 to 6 Discuss with specialist, discuss care with patient and family

Score >5

Think about PCC involvement to reduce readmission risk

Score >6

Think about AMBER care bundle click https://www.ambercarebundle.org/homepage.aspx

7 to 9 Consider geriatric MDT, discuss with specialist, and discuss care with patient and family Is a care plan / DNACPR in place – check if enhanced summary care record available, if available check information from primary care. Think of EFU / AFU

REFERENCE: British Geriatrics Society “Fit for Frailty” http://www.bgs.org.uk/frailty-explained/resources/campaigns/fit-for-frailty/frailty-what- is-it;



CONSULTATION UNDERTAKEN:

Name Title/Responsibility Ratify (R)

Consulted (C)

Issue

Date Version

Dr Richard Wong /

Prof Simon Conroy /

Dr Vivek Pillai

Dr Jay Banerjee

Consulted December

2017

FINAL

1.3

APPROVALS REQUIRED:

This document has been approved by.

Name Issue

Date Version

Emergency Floor Guidelines Committee 10 January 2017 Final Version 1.3

30 November 2017

Review dates and owners

Reviewers Dr Jay Banerjee Vicki Enright

Review Date 01 November 2019

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Frailty (including Clinical Frailty Score) UHL Emergency Department Guideline Approved by ED Guideline Committee


Appendix 1 CFS

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Appendix 2 Frailty Proforma

Frailty (including Clinical Frailty Score) UHL Emergency Department Guideline Approved by ED Guideline Committee
