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784 / Preventing functional loss in frail elderly hospital patients

NETHERLANDS
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Patient falls
Other There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Hospital stay comes with a lot of risks for frail elderly. Many frail elderly experience loss of function and/or cognition after a hospital stay. By applying the screening tool that detects (risks for) malnutrition, falls, functional loss and delirium, this PSP aims to prevent functional loss in elderly.
Description of the Patient Safety Practice
 
The intervention consists of a screening tool, by means of four simple questions, (risk for) malnutrition, falls, delirium and functional loss are detected. Coupled with the screening tool are advices on how to treat elderly who are at risk.
Goal of the intervention is to prevent functional loss or complications in frail elderly during hospital stay. This goal is evaluated by means of a process indicator: the number of elderly who have been sreened by menas of the screening bundle. Another process indicator is: the number of elderly who suffered from functional loss (measures by means of Katz-ADL score).
Implementation was conducted in all hospitals in the Netherlands, and was assisted by the national patient safety program. Especially for the sub-theme delirium, an e-learning module was developed and implemented in 18 hospitals in the Netherlands.
Evaluation was done by means of a longitudinal prospective stepped wedge evaluation study, using patient record review as method for evaluation.

The study design for the sub-theme delirium has been published as: Lotte Van de Steeg, Maaike Langelaan, Roelie Ijkema and Cordula Wagner. 2012.
http://www.implementationscience.com/content/7/1/13
Attachment of relevant written information and/or photos, as appropriate
There is no specified text here
There is no specified text here
There is no specified text here
There is no specified text here
Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
First results will be published in Dutch by the end of April 2013.
The study design for the sub-theme delirium has been published as:
Lotte Van de Steeg, Maaike Langelaan, Roelie Ijkema and Cordula Wagner. 2012. The effect of a complementary e-learning course on implementation of a quality improvement
project regarding care for elderly patients: a stepped wedge trial, Implementation Science 2012, 7:13
There is no specified text here
Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Scientific staff / researchers
Administrative support (secretary, clerk, receptionist etc.)
Quality manager
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
There is no specified text here
Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
Yes
List of sources where public information is accessible
Brochures on website of Dutch national patient safety program (vmszorg.nl)
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
Yes
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
Lack of incentive
Lack of knowledge on implementation strategies
No data feed back to involved staff
No management support
No motivation among staff
Not sufficient financial resources available
Staff or management did not recognise the need for change
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
There is no specified text here
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Not known
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Cordula Wagner
Country: NETHERLANDS
Organisation: NIVEL
E-mail: c.wagner@nivel.nl
Phone: 0031302729700
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