Evaluation of Frailty and Advance Care Planning Documentation in Heart Failure Reviews: A Quality Improvement Project.

THE PROBLEM

This quality improvement (QI) project was a continuation of an audit completed in 2017, which found lack of standardization in the evaluation of heart failure (HF) patients. Therefore, a HF, frailty and end-of-life template was created to improve assessment of HF patients. The audit found several deficits in template usage by practice nurses, especially low recording of lifestyle advice and frailty. Therefore, this project aimed to further assess deficits in recording and increase utilization of at least the HF and frailty template.

MY APPROACH

The project was conducted at Pendleside Medical Practice in Clitheroe. Data was collected using the Egton Medical Information Systems (EMIS) software, from 70 patients identified as having chronic HF. Main parameters investigated were: Patients having New York Heart Association (NYHA) classification, Clinical Frailty Score (CFS or Rockwood score), electronic frailty index (EFI) score, advance care plan (ACP) and Do Not Attempt Resuscitation (DNACPR) recorded and the extent of template recording for each patient.

THE LEARNING

Areas needing improved recording was the HF template (41% had no questions filled), frailty template (76% had few questions filled), NYHA status (14% recorded), CFS (77% recorded), EFI (74% recorded) score, care plan discussion (50% recorded) and DNACPR discussion (50% recorded).

WHY IT MATTERS

The project demonstrated that frailty and end-of-life aspects required further recording and standardization, with regards to frailty scores, falls, care plan reviews and NYHA class. In addition, lifestyle and functional status recording needed improvement. Therefore, this project has significant implications for primary care. Frail and elderly individuals comprise a majority of HF patients, so inadequate documentation can cause reduced quality of management for many. In addition, not managing frailty and the needs of HF patients, inevitably leads to increased and prolonged hospital admissions, adverse quality of life and early mortality (Vitale et al, 2018).

PRESENTER Sushilkumar Keshav Jadhav, Universit of Central Lancashire email skjadhav@uclan.ac.uk and sushilkumarkjadhav@gmail.com)

Co-author Dr. Lucy Astle email: lastle@uclan.ac.uk and lucy.astle@nhs.net)

REFERENCES FOR ABSTRACT

Vitale, C., Spoletini, I., Rosano, G.M. (2018). Frailty in Heart Failure: Implications for Management. Cardiac Failure Reviews, 4(2), 102-104.