Improving recording and reporting of dementia and frailty via electronic patient record by ambulance staff in a single service (IDEAS)

Background: 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).

Methods: 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 electronic patient record (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.

Results: 131 surveys were completed; 60% of participants were paramedics and 40% were other grades of frontline staff. Participants reported consulting electronic/paper sources, and individuals such as carers involved in the patient’s 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.

Conclusions: 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.