Screening tools 

Liver

AUDIT- Screen for alcohol misuse/dependence using AUDIT. Downloadable version for patient self assessment here.

Resources

Liver disease (Remedy BNSSG ICB) 

FRAMES – advice on giving brief alcohol intervention (CKS)

AUDIT – screening tool for alcohol misuse/ dependence (Patient.co.uk)

Drinkaware – link to advice and leaflets for patients and health professionals

MUST (Malnutrition Universal Screening Tool)

Malnutrition is a state in which a deficiency of nutrients such as energy, protein, and vitamins and minerals causes measurable adverse effects on body composition, function, or clinical outcome. It is both a cause and a consequence of ill health and can be caused by social factors.

When should you screen a person for malnutrition?

  • Screen a person for malnutrition or risk of malnutrition opportunistically in primary care
  • Screen a person for malnutrition or risk of malnutrition if there is clinical concern

The Malnutrition Universal Screening Tool (MUST) can be used by healthcare professionals to screen for malnutrition in adults in all care settings

An online ‘MUST’ calculator is available on the British Association for Parenteral and Enteral Nutrition (BAPEN) website (www.bapen.org.uk).

Consider signposting the person and/or carers to the BAPEN Malnutrition self-screening calculator if a person has unexplained weight loss or has a loss of appetite and/or is not eating well.

See the Malnutrition Pathway document Managing malnutrition according to risk category using ‘MUST’ which provides information on risk score categories and management plans.

Resources:

Adult malnutrition | Health topics A to Z | CKS | NICE  NICE Guidance

‘MUST’ Calculator | BAPEN MUST Calculator

Delirium

Confirm a diagnosis of delirium by carrying out a cognitive assessment based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the short Confusion Assessment Method (short-CAM), or the 4A’s test.

The CAM criteria for delirium:

  • Confusion that has developed suddenly and fluctuates, and
  • Inattention — ask if the person is easily distracted or has difficulty in focusing attention, and either
  • Disorganised thinking — ask if the person’s thinking is disorganised, incoherent, illogical, or unpredictable (for example they have an unclear flow of ideas, change subject unpredictably, or have rambling or irrelevant conversation), or
  • Altered level of consciousness — ask about changes in level of consciousness from alertness to: lethargy (drowsy, easily aroused); stupor (difficult to arouse); comatose (unable to be aroused); or hypervigilant (hyper-alert).

The DSM-5 criteria for delirium:

  • A. Disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
  • B. The disturbance develops over a short period of time (usually hours to a few days), represents an acute change from baseline attention and awareness, and tends to fluctuate in severity during a day.
  • C. An additional disturbance in cognition (such as memory deficit, disorientation, language, visuospatial ability, or perception).
  • D. The disturbances in Criteria A and C are not better explained by a pre-existing, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal such as coma.
  • E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication, or withdrawal (due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple aetiologies

The 4A’s test (4AT):

  • This is a short, four-item tool designed for use in clinical practice.
  • The four items are alertness, cognition (a short test of orientation), attention (recitation of the months in backwards order), and the presence of acute change or fluctuating course.

If there is doubt about the diagnosis seek advice from an elderly care psychiatrist or physician.

Resources:

Assessment | Diagnosis | Delirium | CKS | NICE NICE Guidance

Sensory

Audiology – Hearing services (Audiology)

www.squintclinic.com gives online guide for patients and parents of patients with strabismus

www.myeyedrops.info was developed by doctors at Gloucestershire Hospitals to help patient who struggle with eye drops

www.oculoplastics.info was developed by speciality director, Mr R Caesar about oculoplastic surgery

Diabetes eye screening programme- Gloucestershire diabetic eye screening programme

Gloucestershire ophthalmology- Ophthalmology

ENT (Ears, Nose & Throat) Service- Referrals & Services | G-care

Falls- Falls : Extranet – NHS Gloucestershire

Continence

Overactive Bladder (Remedy)

https://www.nice.org.uk/guidance/cg171    NICE – Urinary Incontinence in Women

https://www.nice.org.uk/guidance/cG49     NICE – Faecal Incontinence

https://www.nice.org.uk/guidance/cg97      NICE – Lower Urinary Tract Symptoms in Men

https://www.nice.org.uk/guidance/cg61      NICE – Irritable Bowel Syndrome in Adults

https://pathways.nice.org.uk/pathways/constipation  NICE – Constipation in Adults Pathway

Continence Care in Residential and Nursing Homes | British Geriatrics Society