Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 319

1 Early detection and prevention, where possible, of frailty and geriatric syndromes

2 Medication review and reconciliation at every opportunity

3 Ensuring that a full collateral history is taken at every available opportunity

4 Maximizing communication at times of transition of care

5 Involving patients in their care as much as possible

6 Working with management to try to improve organisational culture toward older people

7 Ensuring that basic compassionate care is carried out

8 Supporting effective multidisciplinary teams that share goals and information as much as possible

9 Inspiring interest in the care of older people amongst juniors and other colleagues

10 Being aware of cognitive biases in decision‐making and the use of strategies to overcome them

The same communication and clinical reasoning skills required for geriatric assessment are also required to detect and manage adverse events in older people once they have occurred during a hospital admission. Successful care of older people requires staff to make complex decisions about medical and non‐medical matters with the involvement of the whole multidisciplinary team and with the aim of meeting patients’ best interests. In the hospital, this applies to decisions regarding both the inpatient care that elderly patients receive and the complex planning that is often required to maximize their safety on discharge from the hospital. Several educational strategies have been suggested to improve clinical reasoning,²³ such as the introduction of training in formal critical thinking, teaching with the use of clinical examples of cognitive biases, encouraging consideration of diagnostic alternatives, developing mental rehearsal for practical skills using simulations, and using cognitive aids such as guidelines, algorithms, or handheld computer devices.

Medical and nursing curricula should teach the recognition of frail and complex patients so that interventions for frailty and to prevent the occurrence of the geriatric syndromes can be implemented early. Undergraduate medical education should be designed to allow future practitioners to understand the physiological differences associated with age, informing safe prescribing for older people. Increasing attention is being paid to teaching communication skills – these need to be designed with the specific ability required of all healthcare professionals to communicate effectively with older people, such as those with cognitive or sensory impairment.

Keeping patients safe, particularly those with complex and fluctuating conditions, also requires anticipation, awareness of hazards, preparedness, resilience, and flexibility: the qualities that those studying high‐reliability organizations have sought to capture and articulate. To try to instil these qualities into the next generation of clinicians, patient safety is being incorporated explicitly into both undergraduate and postgraduate training. To aid this endeavour, there has been some work to identify the desirable knowledge, skills, behaviours, and attitudes of a safe healthcare practitioner. In surgery and anaesthesia, much work has been done to identify and enhance non‐technical skills–including communication, stress management, teamwork, decision‐making, and leadership⁵⁸ – that promote patient safety. Similar skills are, of course, crucial across all specialities, particularly in the care of older people.