Avoid Risk, Avoid Damage

Preventive measures make the most effective way of avoiding risks in human and economic terms. A variety of indicators have been developed to support nursing, helping to identify the risks at an early stage and target medical resources properly.

Among the risk assessment tools used most commonly in Finland are the Braden Scale assessing pressure ulcer risk, Nutritional Risk Screening 2002 (NRS 2002) predicting the risk of malnutrition, and the Falls Risk Assessment Tool (FRAT) predicting the risk of falls. However, the practical implementation of these risk assessment tools (i.e. paper forms, mental scores calculation, table interpretation and the challenge of documentation) as well as the busyness of nursing often cripples their use.

When Risks Are Realised, Treatment Costs a Lot

Risk assessment by nurses should be systematic and continuous in both hospital wards and home care. Recurring risk assessment takes its time, but considerably less in terms of cost than having the risk realise.

• Annually, the cost of pressure ulcers in Finland is more than 400 million euros, or about 2–3% of Finnish healthcare expenditures. About 95% of these pressure ulcers would be avoidable with preventive measures. [1.]
• Malnutrition lengthens a hospital stay period by 3–6 days, up to tripling the cost of treatment [2].
• In 2000, the cost of acute outpatient and inpatient treatment of falling injuries sustained by people over the age of 64 in Finland was about 39 million euros. The expenses are expected to rise up to 72 million euros by 2030. [3.]

Moving to Digital

Completing risk analyses and forms along with documenting risk scores ought to be brought into this decade. The practical implementation of risk assessment tools should support nursing and not burden it. Paper forms are a burden to work.

In the autumn of 2018, Seinäjoki Central Hospital began utilising the Medanets app in risk assessment. The mobile solution steps through the assessment criteria of the selected risk indicator (e.g. Braden, NRS 2002 or FRAT) and automatically calculates the total score. In addition to this, it shows the nurse the instructions for action corresponding to the score. The risk score itself is documented via the mobile solution directly into the Electronic Health Record. When work that was previously done manually is automated, the nurse can focus on patient care.

Mobile Forms Lower the Threshold

As the patient risk status can be assessed quickly and easily, it is also assessed more frequently. A smart phone goes along with the nurse not only in terms of work flow, but also in terms of other duties. Thus, the threshold for completing a mobile form is not big.

Regular risk assessment helps to prevent harm to the patient.

In addition to Seinäjoki Central Hospital, the solution is being used at Satakunta Central Hospital, Kainuu Central Hospital, and Raahe Hospital. Kanta-Häme Central Hospital and Päijät-Häme Central Hospital will be introducing the risk assessment mobile feature in the early part of 2019.

Moreover, Päijät-Häme Central Hospital is introducing not only the Braden, the NRS 2002, and the FRAT mobile feature, but the following other risk assessment features as well: Geriatric Depression Scale 30 (GDS30), Alcohol Use Disorders Identification Test  for the over 65s (AUDIT65), Alcohol Use Disorders Identification Test—Consumption (AUDIT C), Pain Assessment in Advanced Dementia (PAINAD), Beck Depression Inventory 21 (BDI-21), Mini Nutritional Assessment (MNA), and Complementary and Alternative Medicine (CAM).

References:

[1] Harjumaa, M. 2013. Painehaavat käyvät kalliiksi. Sairaanhoitaja 13, 10.

[2] Karuvuori, A. 2013. Ruoka on nostettu pöydälle. Sairaanhoitaja 12, 16–25.

[3] Piirtola, M, et al. 2002. Iäkkäiden kaatumisvammojen akuuttihoidon kustannukset. Suomen Lääkärilehti 57, 4,841–4,848.

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