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Use of standard risk screening and assessment forms to prevent harm to older people in Australian hospitals: a mixed methods study
  1. Bernice Redley1,2,
  2. Michelle Raggatt1
  1. 1School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
  2. 2Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
  1. Correspondence to Dr Bernice Redley, School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3125 Australia; bernice.redley{at}deakin.edu.au

Abstract

Background Standard risk screening and assessment forms are frequently used in strategies to prevent harm to older people in hospitals. Little is known about good practices for their use.

Objective Scope the preventable harms addressed by standard forms used to screen and assess older people and how standard forms are operationalised in hospitals across Victoria, Australia.

Methods Mixed methods study: (1) cross-sectional audit of the standard risk screening and assessment forms used to assess older people at 11 health services in 2015; (2) nine focus groups with a purposive sample of 69 participants at 9 health services. Descriptive analysis examined the number of items on forms, preventable harms assessed and sources of duplication. Qualitative thematic analysis of focus group data identified themes explaining issues commonly affecting how health services used the forms.

Results 152 standard assessment forms from 11 Victorian health services included over 3700 items with 17% duplicated across multiple forms. Assessments of skin integrity and mobility loss (including falls) were consistently included in forms; however, nutrition, cognitive state, pain and medication risks were inconsistent; and continence, venous thromboembolism risk and hospital acquired infection from invasive devices were infrequent. Qualitative analyses revealed five themes explaining issues associated with current use of assessment forms: (1) comprehensive assessment of preventable harms; (2) burden on staff and the older person, (3) interprofessional collaboration, (4) flexibility to individualise care and (5) information management. Examples of good practice were identified.

Conclusions Current use of standard risk screening and assessment forms is associated with a high burden and gaps in assessment of several common preventable harms that can increase risk to older people in hospital. Improvement should focus on streamlining forms, increased guidance on interventions to prevent harm and facilitating front-line staff to manage complex decisions.

  • Patient safety
  • Risk management
  • Healthcare quality improvement
  • Health services research

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Footnotes

  • Contributors All authors had full access to all of the data (including reports and tables) in the study. BR conceptualised the study, data were collected and analysed by MR and BR, MR drafted the paper, BR edited the manuscript. Both authors approved the final manuscript.

  • Funding This study was funded by the Victorian Department of Health and Human Services. The researchers were independent from the funder.

  • Competing interests None declared.

  • Ethics approval Low Risk Human Research Ethics Committees (or equivalent) at each site.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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