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Updated: Jun 22, 2025

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Implementing a Frailty-Specific Postoperative Order Set to Improve Postoperative Outcomes in Frail Adults After
Amani Allen1, Mary Ann Francisco, Jessica Jatis
1Author Affiliations: The University of Chicago Pritzker School of Medicine (Dr Allen), Department of Public Health Sciences (Dr Nordgren), Department of Anesthesia and Critical Care (Dr Rubin), Section of Geriatrics and Palliative Medicine, Department of Medicine (Drs Huisingh-Scheetz and Gleason), Section of Thoracic Surgery, Department of Surgery (Drs Bryan, Donington, Ferguson, and Madariaga), University of Chicago, Chicago, Illinois; and Department of Nursing Research and Evidence Based Practice (Mss Francisco, Jatis, and Turner), University of Chicago Medical Center, Chicago, Illinois.
Background:
Frailty is independently associated with adverse patient outcomes after surgery. The current standards of postoperative care rarely consider frailty status.
Local Problem:
There was no standardized protocol to optimize specialized postoperative care for frail patients at an academic medical center.
Methods:
A quasi-experimental pre-/postimplementation study design, using the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework, was utilized.
Interventions:
A frailty-specific postoperative order set (FPOS) was developed, including tailored nursing care, activity levels, and nutritional goals.
Results:
There were significant improvements in nurse's self-reported familiarity with frailty ( P = .003) and FPOS awareness ( P < .001). The number of orders for delirium prevention, elimination, nutrition, sleep promotion, and sensory support increased ( P < .001).
Conclusions:
Implementing an FPOS showed improvements in nurse frailty knowledge, awareness, and order set utilization.
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