Background
Until this service review and development project, there had been no analysis into the role of Physiotherapy and frailty at Liverpool Hospital. Previous quality improvement projects had established the need for frailty screening as part of standard care, however this had not been implemented. This project looked to ensure evidence based practice was being implemented including using a validated frailty screening tool and referring to a progressive individualised physical activity program that contains a resistance training component.
Implemented Change
As a result of this gap analysis between Physiotherapy standard practice and evidence based practice/ clinical practice guidelines, the vast discrepancies were evident. As a result there was a multi-modal approach taken to change practice. These practice changes included:
- incorporating the FRAIL scale into pre-completed documentation for Physiotherapists in Geriatrics in both an inpatient and community setting
- A student led project that produced a Residential Aged Care Facility database of local facilities detailing frequency and modality of Physiotherapy provided to residents and a frailty literature review
- A multidisciplinary education brochure about frailty to facilitate patient education
- A pre- completed template for resistance based exercise programs was created and kept in accessible gym space to improve exercise prescription
- A formal reciprocal Dietician and Physiotherapy referral pathway for patients screened with weight loss/frailty as part of the FRAIL scale
Key Learnings
This service development initiative is an excellent example of how applying a core body of evidence to a patient population group, such a frail older adults can have a significant impact and change practice.
Including key stakeholders, in particular the entire multidisciplinary team is pivotal when managing older adults, as they have many concurrent challenges, and a holistic approach to their care continually proves to be the most clinically effective and well supported in the literature.
This service development project that spanned a number of years demonstrated that a gap analysis is a key tool in establishing current practice and using a number of quality improvements projects to implement a multi-modal approach can bridge the research to practice gap and overall improve patient care.