Jadzinski Patryk, Pocock Helen, Lofthouse-Jones Chloe, King Phil, Taylor Sarah, England Ed, Cavalier Julian, Fogg Carole
University of Portsmouth; South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0002-6752-0807.
South Central Ambulance Service NHS Foundation Trust ORCID iD: https://orcid.org/0000-0001-7648-5313.
Br Paramed J. 2021 Dec 1;6(3):31-40. doi: 10.29045/14784726.2021.12.6.3.31.
Dementia is common in older adults assessed by ambulance services. However, inconsistent reporting via the patient record may result in this diagnosis being overlooked by healthcare staff further down the care pathway. This can have a deleterious effect on subsequent patient care, increasing morbidity and mortality. We sought to understand how and where ambulance staff would like to record this finding on the electronic patient record (ePR).
We designed and implemented a survey of ambulance staff in a single service to understand how they identify patients with dementia, how they record dementia on the ePR and how the ePR could be improved to better capture dementia. Scoping questions on frailty were included. The survey was tested using cognitive interviewing. Analysis was conducted using descriptive statistics for closed questions and thematic analysis for open questions as appropriate.
131 surveys were completed; 60% of participants were paramedics and 40% were other grades of front line staff. Participants reported consulting electronic/paper sources, and individuals such as carers involved in the patients' care, to establish whether dementia had been diagnosed. Frailty assessments were prompted by social context, reduced mobility, a fall or diagnosis of dementia. Staff reported documenting dementia in 20 different areas on the ePR and 46% of participants stated a preference for a designated area to record the information. However, 15% indicated it was not necessary to record dementia or that no ePR changes were required.
We have highlighted the variation in ambulance staff practice in recording of dementia. Alterations to the ePR are required to ensure that dementia is recorded consistently and is easily retrievable. Clearer guidance on when to assess frailty may also enhance information provision to care staff in other sectors, resulting in more appropriate clinical and social care.
在接受救护服务评估的老年人中，痴呆症很常见。然而，通过患者记录的报告不一致可能导致这一诊断在后续护理过程中被医护人员忽视。这可能会对患者的后续护理产生有害影响，增加发病率和死亡率。我们试图了解救护人员希望如何以及在何处将这一发现记录在电子病历（ePR）上。
我们设计并实施了一项针对单一救护服务机构救护人员的调查，以了解他们如何识别痴呆症患者，如何在ePR上记录痴呆症，以及如何改进ePR以更好地记录痴呆症。还纳入了关于虚弱的范围界定问题。该调查通过认知访谈进行了测试。对于封闭式问题，使用描述性统计进行分析；对于开放式问题，酌情使用主题分析进行分析。
共完成了131份调查问卷；60%的参与者是护理人员，40%是其他级别的一线工作人员。参与者报告称，他们会查阅电子/纸质资料以及参与患者护理的人员（如护理人员），以确定患者是否已被诊断为痴呆症。社会背景、行动能力下降、跌倒或痴呆症诊断会促使进行虚弱评估。工作人员报告在ePR的20个不同区域记录痴呆症，46%的参与者表示倾向于设立一个指定区域来记录信息。然而，15%的人表示没有必要记录痴呆症，或者认为无需对ePR进行更改。
我们强调了救护人员在记录痴呆症方面做法的差异。需要对ePR进行修改，以确保痴呆症得到一致记录且易于检索。关于何时评估虚弱的更明确指导也可能会加强向其他部门护理人员提供的信息，从而带来更合适的临床和社会护理。
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