Frailsafe collaborative

This is the Frailsafe members' area where you will be able to discuss research and statistics from the programme. If you believe you should have access but don't, please get in touch via the contact page.

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The Safety Tool

Frailsafe was first conceived in an Institute for Healthcare Improvement (IHI) 90 day Research and Development cycle in 2010. On 10 March 2010 Tom Downes and Kevin Stewart constructed the first version (Fig 1) having sought the expert opinion of a range of geriatric and patient safety experts. Patient involvement has been a strong foundation; in the initial development, in the USA, input came from the

The checklist is designed to be a ‘check and challenge’ list triggering an interaction between the senior doctor and another member of staff (eg nurse or junior doctor) on acute medical assessment units (AMUs).

In 2012 the British Geriatrics Society formed the Frailsafe network – a small group of geriatricians aiming to design and improve the older patient safety checklist into a usable and effective tool. Through a series of iterative cycles of testing the checklist gradually improved to the current version 6 (Fig 2) which was based around the structure of the AMBERcarebundle with three stages; Recognition, Initial Check and Monitor.

An earlier version (v6) of the checklist can be found below (we are now testing version 8) :-

Pilot data from the cycles of testing were used to achieve the following improvements:

  • The addition of a frailty identification trigger. Phase 1 of Frailsafe is used to identify the target population of patients. Frailty-rating scales alone are of limited use in risk stratifying older people being discharged from acute medical units.[1] Consideration was given to the challenge of identifying frailty – although there are effective tools for quantifying frailty, there is scant evidence of an effective tool for identification. Through iterative design the group determined that the three questions of Phase 1 have a sensitivity of over 90% for identifying appropriate patients and a high specificity when combined with pragmatic common sense.
  • The language and structure of Phase 2 underwent major changes to improve usability. The checklist now takes less than one minute to perform – additional time is required when the checklist identifies elements of care that need to be addressed.
  • Addition of Phase 3 to ensure key interventions are sustained over the first 5 days of acute care.