Let's be honest: when it comes to assessment and management tools in health and aged care, the list is literally endless. Not to mention, everyone has their own 'pet' assessment tools they like to use for various situations. But when it comes down to it, most health and aged care workers want access to assessment tools that are simple, reliable, valid, and actually give you some answers so you can make an action plan for the person's best care outcomes. (Because what's the use of all these fancy assessments if it doesn't give you any plans or direction, right?).
So here are five tools that (if you're not already) using, you should be...and why:
If you haven't heard of the RUDAS it stands for the Rowland Universal Dementia Assessment Scale. The RUDAS is a simple six-domain cognitive test that gives a result comparable to the Mini-Mental Score Examination (MMSE). "Why is it better?" I hear you ask? Well for starters, you don't face the problem of those frequent flyers who have somehow managed to memorise 'apple; table; penny', whilst simultaneously being unable to recall their middle name. Secondly, the RUDAS is still valid for persons from non-English speaking backgrounds and lower language, literacy and numeracy (LLN) levels - unlike the MMSE.
RUDAS also tests a wider variety of cognitive domains, including my personal favourite - judgement. Because what's the use of being able to subtract 7 five times if you can't work out how to get across the street in one piece? I rest my case.
Being the person-centred care experts that we all are, we know that one size does not fit all when it comes to falls prevention. Enter the Falls Risk Assessment Tool (FRAT).
The FRAT is a handy guide to assess how likely a person is to have a fall. And for those of us who can't cope with the grey area of 'medium risk', FRAT cuts out the middle man and simply gives you a result of the person being 'At Risk' or 'Not At Risk'. As a handy bonus it even identifies what the person's main problem areas are - things like toileting, mobility, poly pharmacy (yes, who knew that too many drugs could cause us to fall over?! Ummmmm...).
Thank you FRAT, very helpful.
Hand in hand with the FRAT goes the FRAMP - the Falls Risk Assessment Management Plan - not unlike Tweedle-Dee and Tweedle-Dum. (Especially as you really don't need a whole lot of brain power for either of these tools, which is why I like them).
The great thing about the FRAMP is that you can quickly skip the sections that don't apply, and focus on the strategies that do. For example, if the FRAT identified the person has a falls risk associated with mobility and poly pharmacy, then you only need to fill out those relevant sections (yes, less paperwork...hallelujah!).
The other great thing is that at the end of the FRAMP you are left with a ready-made list of easy strategies that staff can put into place immediately to start reducing the person's risk of a fall-related injury. Seriously practical. Seriously simple. Seriously.
Now prepare for my hobby horse everyone. Delirium. For those of my vintage this is not a reference to the LadyHawke hit of 2008. Rather I refer to one of the most under-recognised medical emergencies of the current age - delirium.
If you haven't heard, delirium is defined as an acute onset confusion or disturbance in mental state, often resulting in disorganised thinking and behaviour, altered sleep/wake cycles, and/or difficulty sustaining attention. Delirium, different from dementia, has its origin in organic or medical causes.
The problem is, a lot of people who have delirium often get lumped in under the umbrella of dementia. This is unhelpful, since the cause of delirium could be as simple as dehydration, or constipation, and may be easily treated in many cases. But the problem is...how can you tell the difference?
Here's where the Confusion Assessment Method (CAM) shines. My friend CAM is here to help us work out 'who's who in the zoo' when it comes to differentiating between delirium and dementia, and what to do when you come to the end result. And it's just a few simple questions to get there. Easy.
5. Your own clinical observations
Yes people, your own eyes and brains are ok to use as well. Back yourself! Trust your clinical observations and clinical reasoning.
Remember, formal assessment tools are just that - tools. No formal assessment tool is the be-all to end-all when it comes to helping a person. They are guides to point us in the right direction, to confirm our observations and help form our reasoning and action plans.
So hone your observations of the person, not only your general obs from rounds, but also how the person goes about their daily tasks, their speech, their gait patterns, their social situation. It all counts to form a full and comprehensive picture for the way forward.
So do yourself a favour today, and put these tools are your disposal. Everyday practice will be a lot easier, and you will find yourself armed with heaps of practical information and strategies for formulating a quality care plan for those in your care. And you'll save time too...winning!