Implementation of a Frailty Care Bundle to reduce hospital associated decline

Project Outline

Aim

To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline.

Methods

We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards. A clinical facilitator worked with ward teams to modify ward routines: setting patient mobility goals, recording highest level of mobility, nurse assisted mobilisation, supervision and assisted mealtimes, enhanced snack rounds and team communication.

Results

We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was an 11% (average) increase  in patient mobility (step count) post intervention. This was associated with a  non-significant trend for higher modified Barthel Index (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36),

Conclusion

It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Future research will aim to optimise implementation of the FCB as evidence based practice, combining clinical facilitation for direct care staff with front-line manager implementation leadership and organisational alignment to improve implementation climate.