10 ideas for audit in the geriatric medicine rotation with links for resources

10 ideas for audit in the geriatric medicine rotation with links to resources

Collected and written by: Mohamed Hassan 

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You have to check the up-to-date information about the topic also, review the local legal regulations 

Geriatric medicine is a speciality that focuses on the health and care of older people. It involves the prevention, diagnosis and management of age-related conditions, such as dementia, delirium, falls, frailty, incontinence and polypharmacy. Geriatric medicine also aims to improve the quality of life and functional status of older patients, by providing holistic and person-centred care that involves multidisciplinary teams and integrated services.

Audit is a quality improvement process that measures current practice against agreed standards and identifies areas for improvement. Audit is an essential part of clinical governance and professional development for doctors. Audit can also benefit patients by enhancing their safety, satisfaction and outcomes.

In this blog post, I will share 10 ideas for audit in the geriatric medicine rotation, along with some links for resources that can help you plan and conduct your audit project.

1. Audit the documentation of comprehensive geriatric assessment (CGA) in the case notes of older patients admitted to the geriatric wards. CGA is a multidimensional and interdisciplinary process that evaluates the medical, functional, cognitive, affective, social and environmental aspects of older patients. CGA can improve the diagnosis, management and prognosis of older patients, as well as reduce hospital length of stay, readmission rates and institutionalisation rates. A standardised form or template can help improve the documentation of CGA in the case notes. You can use the audit form developed by Dunn et al (1987)  or adapt it to suit your local setting and standards.

2. Audit the screening and management of delirium in older patients admitted to the hospital. Delirium is an acute confusional state that affects up to 20% of older hospitalised patients. Delirium is associated with increased morbidity, mortality, length of stay, institutionalisation and dementia. Delirium can be prevented or treated by identifying and addressing its underlying causes, such as infection, dehydration, medication changes or pain. You can use the 4AT tool  or the Confusion Assessment Method (CAM)  to screen for delirium in older patients. You can also use the NICE guideline  or the Scottish Intercollegiate Guidelines Network (SIGN) guideline  to audit the management of delirium in your hospital.

3. Audit the assessment and management of falls and fractures in older patients admitted to the hospital. Falls are common and serious events that affect up to 30% of older people living in the community and up to 50% of those living in care homes. Falls can result in injuries, such as fractures, head trauma or soft tissue damage, as well as psychological consequences, such as fear of falling, loss of confidence and reduced mobility. Falls can be prevented or reduced by identifying and modifying risk factors, such as medication review, vision correction, exercise prescription, home hazard assessment and multifactorial interventions. You can use the NICE guideline  or the SIGN guideline  to audit the assessment and management of falls and fractures in your hospital.

4. Audit the prescribing and deprescribing of medications in older patients admitted to the hospital. Polypharmacy is defined as the use of five or more medications by a patient. Polypharmacy is common and increasing among older people, especially those with multimorbidity. Polypharmacy can increase the risk of adverse drug reactions, drug interactions, medication errors, non-adherence and poor outcomes. Polypharmacy can be rational or appropriate if the benefits outweigh the risks or burdens of treatment. Polypharmacy can be irrational or inappropriate if the medications are unnecessary, ineffective, harmful or not aligned with patient preferences. Deprescribing is the process of reducing or stopping medications that are no longer needed or appropriate. Deprescribing can improve patient safety, quality of life and outcomes. You can use tools such as STOPP/START , Beers criteria , Medication Appropriateness Index (MAI)  or Patient's Attitudes Towards Deprescribing (PATD)  to audit the prescribing and deprescribing of medications in older patients.

5. Audit the screening and management of urinary incontinence in older patients admitted to

the hospital. Urinary incontinence is defined as any involuntary loss of urine that causes a

problem to the patient. Urinary incontinence affects up to 40% of older women and 20% of

older men living in the community. Urinary incontinence can impair physical, psychological

and social functioning, as well as increase the risk of falls, infections and pressure ulcers.

Urinary incontinence can be classified into four main types: stress, urge, overflow and

functional. Urinary incontinence can be treated by conservative, pharmacological or surgical

methods, depending on the type, severity and impact of the condition. You can use tools such

as the International Consultation on Incontinence Questionnaire (ICIQ) , the Bristol Female

Lower Urinary Tract Symptoms (BFLUTS) questionnaire , the International Prostate

Symptom Score (IPSS)  or the NICE guideline  to audit the screening and management of

urinary incontinence in older patients.

6. Audit the assessment and management of dementia in older patients admitted to the

hospital. Dementia is a syndrome of progressive cognitive decline that affects memory,

language, orientation, judgement and executive function. Dementia affects up to 10% of people

over 65 years and up to 30% of those over 85 years. Dementia can also affect mood, behaviour,

personality, activities of daily living and quality of life. Dementia can be caused by various

diseases, such as Alzheimer's disease, vascular dementia, Lewy body dementia or frontotemporal dementia. Dementia can be diagnosed by a comprehensive assessment that includes

history, examination, cognitive testing, blood tests and brain imaging. Dementia can be treated

by pharmacological and non-pharmacological interventions that aim to improve cognition,

function, behaviour and quality of life. You can use tools such as the Mini-Mental State

Examination (MMSE) , the Montreal Cognitive Assessment (MoCA) , the Addenbrooke's

Cognitive Examination (ACE-III)  or the NICE guideline  to audit the assessment and

management of dementia in older patients.

7. Audit the screening and management of malnutrition in older patients admitted to the

hospital. Malnutrition is defined as a state of nutrition in which a deficiency or excess of energy,

protein or other nutrients causes adverse effects on body composition, function or clinical

outcome. Malnutrition affects up to 10% of older people living in the community and up to 40%

of those admitted to the hospital. Malnutrition can increase the risk of infections, pressure ulcers,

frailty, falls, hospital length of stay, readmission rates and mortality. Malnutrition can be

screened by using tools such as the Malnutrition Universal Screening Tool (MUST) , the Mini

Nutritional Assessment (MNA)  or the Nutritional Risk Screening (NRS-2002) . Malnutrition

can be treated by providing adequate oral, enteral or parenteral nutrition, as well as addressing

the underlying causes and barriers to nutrition. You can use tools such as the NICE guideline ,

the British Association for Parenteral and Enteral Nutrition (BAPEN) guideline  or the European

Society for Clinical Nutrition and Metabolism (ESPEN) guideline  to audit the screening and

management of malnutrition in older patients.

8. Audit the assessment and management of frailty in older patients admitted to the hospital.

Frailty is a state of increased vulnerability to stressors due to reduced physiological reserves

across multiple organ systems. Frailty affects up to 10% of people over 65 years and up to 50%

of those over 85 years. Frailty is associated with increased risk of adverse outcomes, such as falls,

delirium, disability, hospitalisation, institutionalisation and mortality. Frailty can be assessed by using tools such as the Clinical Frailty Scale (CFS) , the Frailty Index (FI) , the Edmonton Frail Scale (EFS)  or the PRISMA-7 questionnaire . Frailty can be managed by providing comprehensive geriatric assessment, individualised care planning, multidisciplinary interventions and advance care planning. You can use tools such as the NICE guideline , the British Geriatrics Society (BGS) guideline  or the Canadian Frailty Network (CFN) guideline  to audit the assessment and management of frailty in older patients.

9. Audit the provision and quality of end-of-life care for older patients admitted to the hospital.

End-of-life care is defined as care that helps people with advanced, progressive or incurable illness to live as well as possible until they die. End-of-life care involves managing physical symptoms, such as pain, breathlessness or nausea; providing psychological, social and spiritual support; respecting patient preferences and values; involving family and carers; and planning ahead for future care needs. End-of-life care

Good luck