Designing safer systems of care delivery for older patients

A new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, identified incidents when poor communication between secondary and primary care and failures within primary care led to patient harm and highlights how improved communications systems could help protect older patients from harm. Timely electronic transfer of information with standardised formats could reduce medication and clinical decision-making incidents. Electronic alerts and expanded use of bar-coding are examples of systems which could tackle drug administration incidents.

Older adults are frequent users of primary healthcare services and account for half of all 340 million general practice consultations in the United Kingdom each year.  The study was conducted by researchers at Cardiff University School of Medicine and examined 1,591 patient safety reports relating to patients aged over 65 in England and Wales over an eight year period. Continue reading

How can we use quality data to make Care Homes safer?

Safety In Care HomesDr Adam Gordon is Clinical Associate Professor in Medicine of Older People at The University of Nottingham and an Honorary Consultant Geriatrician at Derby Teaching Hospitals NHS Trust; he tweets @adamgordon1978. Here he describes a project to benchmark and report the prevalence of care problems in UK care homes.

Care homes do a lot of good work. There are almost three times as many beds in UK care homes as there are in National Health Service hospitals. Care home residents are amongst the most vulnerable members of our society.

Up to 80% have cognitive impairment, some two thirds have behavioural symptoms, all need help with their activities of daily living and many are approaching the ends of their lives. Much of the excellent care that takes place to care for these very vulnerable citizens in the 320,000 UK care home beds goes unreported. When things go wrong, however, the media are quick to respond.

Continue reading

Open (Nearly) All Hours

1419565616_fbafd085a4_oThis year Heart of England NHS Foundation Trust became one of the first to introduce open visiting.  Dr Helen Chamberlain, a Consultant Geriatrician at Good Hope Hospital (one of the three sites run by the Trust), shares her experience of this innovation.

One of the drivers for our recent change in visiting hours was John’s Campaign.  This was started by Observer journalist Nicci Gerrard in November 2014 after death of her father Dr John Gerrard.  He had dementia, but during his admission for infected leg ulcers declined badly.  Nicci felt that had his family been allowed to visit as often as they wished, he would have been less distressed.

Continue reading

Popular treatments for lower urinary symptoms may be doing more harm than good

aaA new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, has revealed that many of the drugs commonly prescribed for older people with lower urinary tract symptoms may be doing more harm than good, and should either be used with caution or avoided altogether.

Researchers from the University of Heidelberg and an international rater team analysed data from 25 different clinical trials and other available evidence. Of the 16 drugs included in the study, only three were classified as beneficial for older people.

The majority were rated as questionable, meaning they should be avoided where possible, especially when patients are receiving other drugs at the same time. Five drugs were rated as “avoid”, with the authors recommending that they should not be used for older patients at all.

Drugs for the treatment of lower urinary tract symptoms rank amongst the most frequently prescribed medications for older people, and yet this new research is the first systematic comparative study looking at their appropriateness for older patients.

Speaking on behalf of the British Geriatrics Society, Professor Adam Gordon said:

“Lower urinary tract symptoms are common in older patients and can be a source of considerable distress. There is increasing recognition that many of the drugs prescribed for lower urinary tract symptoms may have harmful side-effects, particularly related to memory and thinking. 

Against that background, this study is a timely reminder that there is limited evidence of benefit in older patients for many drugs used. This has a number of implications. 

Firstly, drugs should only be used where non-drug treatments have been shown not to work. Secondly, they should be used with careful attention as to what side-effects they may be causing. Thirdly, more research is required to understand what combination of medications will achieve the best outcomes in older patients with lower urinary tract symptoms.”

Martin Wehling, corresponding author of the study said:

“The FORTA (Fit fOR The Aged) system – a simple approach to label drugs to be used in older people from A (indispensable), B (beneficial), C (questionable) to D (avoid) – was applied here to separate beneficial from less favourable drugs.

It is meant to provide guidance at a glance to improve often complex medication schemes which are all too common and carry considerable risk in this important age group. The respective FORTA list classifies drugs to treat major indications, with a new chapter on those used for lower urinary tract symptoms now added.”

Calling all geriatricians… FRAILsafe needs you!!

Zoe Wyrko is pleased to announce the next phase of FRAILsafe, a new checklist for the acute care of frail older people.your country needs you

Would you like to be involved in a national project which will change the way care is delivered to all frail older people, not just those who are able to be looked after by geriatricians on our specialist wards? Would you like to be part of work that will lead to improvements in the skills of all healthcare professionals who encounter vulnerable people in hospital? Would you like to see a reduction in the inadvertent harm caused when a frail older person needs to be admitted to hospital? If so …. read on. Continue reading

FallSafe: are culture clashes good for us?

Frances Healey was clinical co-lead of the FallSafe project and is currently Senior Head of Patient Safety Intelligence, Research and Evaluation at NHS England. She tweets at @FrancesHealey

FrostReportClassSketchThis week the extended evaluation of FallSafe is available online in Ageing and Ageing. FallSafe was generously funded by the Health Foundation as part of its Closing the Gap programme, and at the programme’s closing celebration I was asked to present on what we had learned. The essence of my answer was ‘culture clashes are good for us’ – something that, with further time for reflection, I still believe. Continue reading