794 STANDARDISED SOCIAL HISTORY DOCUMENTATION IN MEDICAL CLERKING IMPROVES IDENTIFICATION OF FRAILTY

Abstract

Abstract Background Thorough social history is a crucial component of a medical admission. Understanding a patient’s functional status enables better assessment of their Frailty and better decisions about aims of treatment, rehabilitation, appropriate escalation and ceilings of care. Introduction The Medical Unit at St John’s Hospital Livingston, Scotland admits approximately 11,280 patients per year, of whom 55% are aged ≥65 years. Following a medical clerk-in, all admissions aged ≥65 years are screened for Frailty by a dedicated Frailty Nursing team using the Clinical Frailty Score (CFS) based on information in their electronic casenotes. Methods We assessed the quality of social history documentation and the accuracy of CFS in 202 medical admissions ≥65 years clerked in by medical staff over a 2 week period from 14th to 31st December 2020. Patients at end of life and those reviewed by the Frailty Advanced Nurse Practitioner prior to medical clerk-in were excluded. 3 months later this was repeated for 188 medical admissions from 12th–26th March 2021 following interventions below. Interventions An education session was delivered to trainee doctors and consultants at the Medical Unit Meeting. A pre-populated proforma was added to the electronic medical clerking document containing these prompts • Accommodation • Mobility/use of aids • Activities of daily living • Support family, district nurses • Cognition A dedicated field for Clinical Frailty Score was also added. Results Following intervention, documentation of social history and CFS increased from 22% to 35%. The pre-populated proforma was used in 21% of patients. In these patients, 95% had all areas of social history documented enabling accurate classification of CFS. Conclusion Using the pre-populated proforma significantly improves social history documentation and accuracy of CFS scoring. A change of culture is required particularly amongst junior doctors on the importance of this information, so we can deliver better patient-centred care.