title: Use of standard risk screening and assessment forms to prevent harm to older people in Australian hospitals: a mixed methods study.
abstract: BACKGROUND
  Standard risk screening and assessment forms are frequently used in strategies to prevent harm to older people in hospitals. Little is known about good practices for their use.
  
  
  OBJECTIVE
  Scope the preventable harms addressed by standard forms used to screen and assess older people and how standard forms are operationalised in hospitals across Victoria, Australia.
  
  
  METHODS
  Mixed methods study: (1) cross-sectional audit of the standard risk screening and assessment forms used to assess older people at 11 health services in 2015; (2) nine focus groups with a purposive sample of 69 participants at 9 health services. Descriptive analysis examined the number of items on forms, preventable harms assessed and sources of duplication. Qualitative thematic analysis of focus group data identified themes explaining issues commonly affecting how health services used the forms.
  
  
  RESULTS
  152 standard assessment forms from 11 Victorian health services included over 3700 items with 17% duplicated across multiple forms. Assessments of skin integrity and mobility loss (including falls) were consistently included in forms; however, nutrition, cognitive state, pain and medication risks were inconsistent; and continence, venous thromboembolism risk and hospital acquired infection from invasive devices were infrequent. Qualitative analyses revealed five themes explaining issues associated with current use of assessment forms: (1) comprehensive assessment of preventable harms; (2) burden on staff and the older person, (3) interprofessional collaboration, (4) flexibility to individualise care and (5) information management. Examples of good practice were identified.
  
  
  CONCLUSIONS
  Current use of standard risk screening and assessment forms is associated with a high burden and gaps in assessment of several common preventable harms that can increase risk to older people in hospital. Improvement should focus on streamlining forms, increased guidance on interventions to prevent harm and facilitating front-line staff to manage complex decisions.
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.|Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health, Clayton, Victoria, Australia.
authors.forename: Bernice
authors.identifier: http://orcid.org/0000-0002-2376-3989
authors.initials: B
authors.lastname: Redley
authors.affiliation: School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Raggatt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003071:Cognition; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D008403:Mass Screening / Q000458:organization & administration*; D051346:Mobility Limitation; D009752:Nutritional Status; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*; D018570:Risk Assessment; D012867:Skin / Q000503:physiopathology; D011795:Surveys and Questionnaires / Q000592:standards*; D014739:Victoria
keywords: Health services research; Healthcare quality improvement; Patient safety; Risk management