bluuebunny/crossref_metadata_2025 huggingface dataset:
326 Pre-morbid sleep disturbance and its association with stroke severity: results from the international INTERSTROKE study
Authors: Carthy C Mc , Yusuf S , Judge C , Ferguson J , O’Donnell M
Published: September 2023

Background

We have previously shown that disturbances in sleep to be associated with acute stroke, but their association with stroke severity is less certain. In the INTERSTROKE study, we evaluated the association of pre-morbid sleep disturbance with stroke severity and functional outcome in acute stroke patients.

Methods

INTERSTROKE was an international case–control study of first acute stroke. This analysis comprised cases who completed a standardised questionnaire concerning nine symptoms of sleep disturbance (sleep onset latency, duration and quality, nocturnal awakening, napping, snoring, snorting and breathing cessation) in the prior month (n = 2,361). Two indices were derived representing sleep disturbance (range 0–9) and Obstructive Sleep Apnoea (OSA; range 0–3) symptoms. The modified-Rankin score (m-RS) was used to measure stroke severity at initial assessment and functional outcome at 1-month follow-up. Severe stroke was defined as an m-RS of >3, and functional deterioration was defined as an increase in m-RS at 1-month. Logistic regression was used to estimate the magnitude of association between symptoms and stroke severity.

Results

The mean age of participants was 62.9 years, with 42% female, 80% diagnosed with ischaemic stroke and 17% reporting >5 sleep symptoms. On multivariable analysis, there was a graded association between increasing number of sleep disturbance symptoms and initially severe stroke (2–3: Odds Ratio [OR]:1.44; 95% CI [Confidence Interval]:1.07–1.94, 4–5: OR:1.66; CI:1.23–2.25, >5: OR:2.58; CI:1.83–3.66). Having >5 sleep disturbance symptoms was associated with a significant increased odds of functional deterioration at 1-month (OR:1.54; CI:1.01–2.34). A higher OSA score (2–3 vs 0–1) was also associated with a significant increased odds of initially severe stroke (OR:1.48; CI:1.20–1.83) but not functional deterioration at 1-month (OR:1.19; CI:0.93–1.52).

Conclusion

Symptoms of sleep disturbance were common and associated with an increased odds of severe stroke and functional deterioration at 1-month. Interventions to modify sleep disturbance may help prevent disabling stroke/improve functional outcome after stroke, and should be the subject of future research.
329 The impact of a novel tele-education programme on phases score and palliative care symptom severity markers in nursing home residents
Authors: Dowling M , Molloy U , Murphy C , McLean S , Ryan D
Published: September 2023

Background

Education delivery to nursing homes may improve the palliative care residents receive, improving symptom burden and potentially avoiding unnecessary hospital admissions. Phases Score is an internationally utilised palliative care outcome-based tool to describe a patient’s condition. Patients are categorised as stable, unstable, deteriorating, or dying; the patient can move from one Phase to another based on response to their treatment plan. The aim of this study was to explore the impact of a novel teleconference-facilitated education programme (Project ECHO) by monitoring the change in residents’ Phases scores and other palliative care markers in participating and non-participating nursing homes.

Methods

A ten-session education programme was delivered to 20 nursing homes in Dublin. Palliative care severity markers (Phases Score, pain, etc.) were collected from residents that had been referred to community palliative care. Data collection took place for six months prior to and six months after the education programme in nursing homes that participated (cases). For further analysis, data was also collected in non-participating nursing homes (controls).

Results

Data was collected on 94 palliative care episodes for 34 patients from participating nursing homes. After the ECHO education programme there was a trend towards a higher proportion of residents in the ‘Stable Phase’ (1/18 (6%) pre-ECHO vs 18/76 (24%) post-ECHO, p = 0.09). There was also a trend towards a lower proportion of residents in the ‘Unstable Phase’ (4/18 (22%) pre-ECHO vs 7/76 (9%) post-ECHO, p = 0.12). Post-ECHO, there was a significant reduction in the proportion of residents reporting pain (12/18 (67%) vs 30/76 (39%), p = 0.03). A 1:1 age-matched case–control analysis with non-participating nursing homes did not show the benefits seen in the ‘Pre/Post-ECHO’ analysis of cases.

Conclusion

This study attempted to validate an educational approach using a ubiquitously utilised palliative care tool and may indicate a trend towards improved symptom control associated with the education programme.
3 Defining loneliness for older adults: a multi-study synthesis
Authors: Power J M
Published: September 2023

Background

Loneliness is an unpleasant experience linked to multiple adverse health outcomes, but we lack effective interventions to reduce or prevent it. Most interventions are based on a social psychological definition of loneliness (“a perceived discrepancy between actual and desired social relationships, but such interventions are typically unsuccessful. A recent umbrella review of loneliness interventions suggests that they should target specific population subgroups to be effective. This means that we may need more specific definitions of loneliness. In this presentation, I will integrate data from across studies to present an integrated definition of loneliness for older adults.

Methods

Across two qualitative grounded theory studies, we interviewed two samples of adults aged 60 and over: one living rurally and identifying as socially isolated; the other spousal dementia caregivers whose spouse recently moved to long term care. Data from these studies were integrated and framed in the context of a theoretical synthesis of loneliness we published and recently updated.

Results

Loneliness was defined in multiple ways, arising from boredom or inactivity, vulnerability, passivity, giving way to predictable behavioural patterns such as distracting tasks, and affective responses such as self-pity. We integrated this with our theoretical synthesis, which frames loneliness as arising from factors on proximate levels (loss of intimate partners, parental relationships, life transitions), as well as more distal influences such as the social network, and culture).

Conclusion

We argue for cohort-specific definitions of loneliness since these are likeliest to lead to effective interventions. We offer some possible definitions and aspects of loneliness to focus upon in interventions for older adults.
11 Audit of the effectiveness of the MBI as a functional outcome measure & the correlation between admission scores and discharge destination
Authors: Kennedy S , Somers J
Published: September 2023

Background

Current health and social care policies are changing. The importance of rehabilitation has been highlighted, therefore gathering evidence and having measurable outcomes are essential. Stroke is currently the largest cause of community disability in Ireland. The current widespread lack of community services is having a significant impact on people living with stroke in the community. Therefore emphasis has been put on quality of rehabilitation and treatment to reduce the disability post stroke and promote independence of stroke survivors. As Occupational Therapists we focus on outcome measures to evaluate real changes that occur for clients. Outcome measures provide evidence of effectiveness of treatment and whether an intervention impactful.

Methods

MBI was completed pre and post intervention with a total score identified. All clients in the stroke rehabilitation unit between June—August 2021 were included. SHAH’s prediction table was used to forecast discharge destination based on MBI scores.

Results

MBI performance scores increased from 41–63/100 with an average increase of 22%, ranging up to 49%. 56% were predicted as ‘unlikely to return home’ compared to 38%. 25% were predicated to need community services compared to 50%. 13% were predicted to move from dependency to assisted independence compared to 6%. 6% were predicted to be discharged independent compared to 0%.

Conclusion

The outcome demonstrated the effectiveness of the MBI as an outcome measure. The improvement of scores clearly show how OT intervention can maximise independence and decrease dependency. No significant correlation was identified between BMI and SHAH’s predicted outcomes. Further research into this area is warranted with a larger population size. Measuring post stroke functional outcomes, quality of rehab and dependency level of stroke survivors returning to the community is essential. The burden of disease is estimated to double worldwide by 2030 therefore restoration to living from an acute/rehabilitation setting is essential.
20 Clinical competencies of the clinical nurse specialist in Care of the Older Person in a geriatric assessment unit
Authors: Artiles C E , Toner C , Álvarez L P , Thomas S
Published: September 2023

Background

Access to geriatric assessment, coordination between healthcare providers and integration of care across the health system are critical to meet the care needs of older adults living in the community with complex care needs. Clinical Nurse Specialists (CNS) with knowledge and clinical skills in gerontological nursing are key for the provision of care in this cohort. Our aim was to conduct an audit of CNS activity in the Geriatric Assessment Unit (GAU) in relation to specialist nursing clinical competencies.

Methods

We conducted a retrospective audit of CNS activity during the first quarter of 2023 with a focus on the CNS clinical core competencies as defined in the Framework for the Establishment of Clinical Nurse\Midwife Specialist Posts in two GAU in Louth.

Results

In total, n = 301 patients attended the two GAU in the first quarter of 2023, 58% female, with mean age 79.90 (95% CI 79.18–80.62), n = 78 of whom were new to the service. Within an interdisciplinary approach, a Comprehensive Geriatric Assessment (CGA) is conducted by the CNS, which includes obtention of a detailed medical history, nutritional assessment, falls risk, skin integrity, frailty and dependency level, assessment of continence, cognitive screening and swallow screening. These assessments led to n = 273 referrals to community-based services, including Public Health Nurse (n = 51), Occupational Therapist (n = 38) and Memory Rehab (n = 18). Mean waiting time to attend the clinic for the first time was 104.13 days (95% CI 89.79–118.47).

Conclusion

The CNS in Care of the Older Person conducts a CGA, identifies unmet care needs and plans, coordinates and initiates person-centred care for older adults living in the community with complex care needs. CNS input is key to achieve adequate management of complex care needs while avoiding negative outcomes and promoting quality of life.
24 Benefit of therapeutic oral trials in dysphagia rehabilitation
Authors: Loughnane H , Seoighe C D , Sheridan M
Published: September 2023

Background

Therapeutic oral trials (also known as ‘swallow trials’) are one therapeutic approach offered by Speech and Language Therapists (SLTs) as part of dysphagia rehabilitation. It involves offering prescribed amounts of a specified consistency of food and/or fluids to patients whom it is felt would not safely take full portions of oral intake due to risk of aspiration. These patients typically receive the majority of their nutrition and hydration artificially with the purpose of therapeutic oral trials being comfort, enjoyment and an opportunity to swallow in a functional manner (incorporating principles of neuroplasticity such as specificity, intensity and grading).

Methods

Three patients >60 years age from a variety of patient cohorts (stroke, cardiothoracic surgery, critical care) presented with moderate–severe dysphagia (confirmed on instrumental assessment). All received full nutrition and hydration via nasogastric tube. All received baseline clinical bedside assessment and Fibreoptic Endoscopic Evaluation of Swallowing (FEES). Based on the results of same, programme of dysphagia rehabilitation exercises were provided. All patients also received daily swallow rehab consisting of therapeutic oral trials (ice chips, fluids, diet) along with traditional exercises. Repeat FEES was completed after three weeks to assess progress and guide recommendations for oral intake and rehab.

Results

After three weeks, all patients showed two point improvements on dysphagia outcome severity scale. After six weeks, all patients were on full oral intake, no longer receiving artificial nutrition. Anecdotally, all patients reported that therapeutic oral trials provided significant enjoyment and added to quality of life. SLTs subjectively noted improved engagement and improved oral hygiene versus swallow rehab alone.

Conclusion

The concept of therapeutic oral trials builds on principles of neuroplasticity and are a useful adjunct in the dysphagia rehab toolbox of the SLT. They can have clinical benefit and support traditional rehabilitation. Importantly, patients report significant enjoyment and improved swallow-related quality of life when receiving them.
30 An Irish multi-hospital longitudinal study of discharged patients with a diagnosis of dementia
Authors: Kilgannon A M
Published: September 2023

Background

Approximately 64,000 people in Ireland are living with dementia. The care of people living with dementia poses increasing challenges in acute inpatient settings, yet a lack of data exists in Ireland and Europe on the distribution and prevalence of dementia across acute hospitals. To date studies indicate a dementia prevalence in adult inpatient admissions of 29% in 6 Cork hospitals and 42.4% in a single London teaching hospital.

Methods

Retrospective longitudinal analysis of discharge data extracted from NQAIS Clinical from January 2018 to December 2022.

Results

According to data retrieved from NQAIS Clinical for those over 65 years, only 1% of patients discharged from ten acute hospitals had a dementia diagnosis in 2018. This figure remained relatively unchanged between 2018 and 2022. A decrease of 0.04% was noted during the COVID-19 pandemic in Ireland from March 2019 to early 2021. Data recorded for patients under 65 years indicates a gradual upward trend from 2018 to 2022.

Conclusion

Ireland has no systematic approach to the collection and analysis of dementia data. This data only includes diagnosed dementia cases, entirely relying on hospital record documentation. These results reinforce the lack of accurate dementia diagnosis recording and coding within the acute setting and highlights the need for improvement of dementia services given the rising number of dementia diagnoses.
34 Dysphagia at the front door: profiling dysphagia in a frail population presenting to the emergency department
Authors: Leonard A
Published: September 2023

Background

The prevalence of both frailty and dysphagia advances with age. Worsening dysphagia increases the degree of frailty and reduces quality of life. The aim of this study was to describe the characteristics and mortality risk of a population of patients identified for Speech and language therapy (SLT) review in a Frailty at the Front Door (FFD) team.

Methods

A FFD team performs comprehensive geriatric assessment (CGA) for older frail patients presenting to the emergency department. To assist service planning, all patients were screened for the possible presence of dysphagia using the 4QT and those with a response to 1 or more screening questions underwent SLT review. Data were collected from consecutive SLT patient records and a hospital based patient database of CGAs over a 3-month period. Age, gender, 4AT, MST malnutrition risk screen, clinical frailty score (CFS), nursing home (NH) residence, dysphagia outcome severity scale, need for acute hospital admission and mortality rate at 1000 days was collected. Data were entered onto Excel and analysed using descriptive statistics.

Results

69 swallow assessments were carried out. The mean age was 83 (+/−9) years. 71% (n = 49) were female. The 4AT was ≥4 in 36% (n = 25). 42% (n = 29) were at risk of malnutrition. The CFS was ≥6 in 62% (n = 43). 23% (n = 16) resided in a nursing home, 72% (n = 50) had dysphagia, 92% (n = 63) required hospital admission and 36% (n = 25) were experiencing their ‘last 1,000 days’ at follow-up.

Conclusion

Older patients presenting to the ED with a coexisting dysphagia are at high risk of malnutrition and delirium, moderately frail, present with moderate dysphagia, and are more likely to require acute hospital admission. This cohort need early screening, identification, assessment and intervention, in order to reduce dysphagia related risks and improve patient outcomes, particularly given the high proportion that are in their last 1,000 days.
38 Operational teams leads-stuck in the middle?
Authors: Shé É Ní , Hartnett P J , Burke P , O'Shea M , O’Donnell D
Published: September 2023

Background

Middle managers have a crucial role in implementing integrated care service models, but very little research has been undertaken on their experiences. A key element of the National Clinical Programme for Older People’s support for the implementation of the National Older Person’s Service Model is the establishment of Community Specialist Teams for Older People (CST-OP). These interdisciplinary teams are critical to supporting older people with complex care needs necessitating integrated care. Operational Team Leads (OTLs) are responsible for coordinating the interdisciplinary team effort to meet that aim. This research is focused on capturing OTLs experiences as they commence their roles in supporting inter-professional collaboration to achieve integrated care.

Methods

We employed a qualitative case study design. The unit of analysis was the process of OTLs establishing their roles over two-time points. A total of 18 OTLs participated in interviews (n = 11), and focus groups (n = 7) documentary summaries were reviewed.

Results

OTLs are creating networks to share knowledge to advance their work Key factors impacting some OTLs included a lack of induction and preparation for the role. They noted a need for national centralised resources and guidance, national standards development, education and networking and feedback loops. Locally there are some tensions in role clarity and clear reporting lines. Work is required to position the CSTs within community governance structures. Developing a team’s vision, mission and goals, building trust and ensuring psychological safety are necessary. Resources on how to undertake change were stressed. Recognition by OTLs of managing expectations of their role as they focus on shifting from acute to the community with some recruitment challenges, need for a shared ICT system, and enabling collaborative team spaces.

Conclusion

The role of managers within integrated care systems is evolving. There is an evidence gap in understanding the operations of implementing integrated care for older people. This research responds to these gaps and will be shared across the CSTs network.
50 Employing Shared Decision Making (SDM) to reduce NSAID-related harm and hospitalisations, in at-risk patients in primary care
Authors: Kinahan C
Published: September 2023

Background

10% of hospital admissions in Ireland are Adverse Drg Reaction (ADR) related, and 71% of these are potentially avoidable. NSAID-related ADRs have been implicated in up to 30% of all ADR-related admissions. Addressing NSAID related STOPP criteria may prevent hospital admissions with bleeding, Cerebrovascular (CV) events and renal impairment. If stopping NSAID is not possible, dose reductions or drug switches can minimise the risk of harm. Preferred NSAIDs are naproxen (lower CV risk) or ibuprofen <1,200 mg/day (lower CV and gastrointestinal bleed risk).

Methods

Patients aged ≥65 years with valid prescriptions for NSAIDs were identified via software search using the M01 ATC classification system code. Each patients file was reviewed for NSAID related STOPP criteria. Specific software searches using additional ATC classification system codes were undertaken to identify those at high risk of harm e.g. NSAID with anticoagulant. Patients were engaged in Shared Decision Making (SDM) with the practice pharmacist and prescription changes were agreed and enacted by the GP.

Results

63 patients>65 yrs had a valid prescription for an NSAID. 42 had ≥1 NSAID related STOPP criteria. 35 were deemed appropriate for intervention. 7 were prescribed a preferred NSAID and had mild hypertension only. 23 were deemed at high risk of harm. Software searches identified the same 23 high risk patients. 35 patients were engaged in SDM. 100% of these agreed to a change to their prescription. 51% stopped their NSAID whilst 40% changed or dose reduced their NSAID and 9% agreed to addition of gastroprotection. This achieved an overall 60% STOPP resolution rate. A higher average 91% resolution rate was achieved in the higher-risk patients.

Conclusion

SDM achieves higher STOPP resolution rates in patients at higher risk of harm who are identifiable though specific GP practice software searches. These software searches can be employed annually to effectively and efficiently prioritise patients for SDM interventions.
52 ‘I remember when. . .’—environmental, event-based and personally relevant objects that support reminiscence in virtual reality and other digital settings
Authors: Collins R , Tsabary C , Hopper L
Published: September 2023

Background

Limited but growing evidence is emerging to support technology-supported reminiscence. Although some studies involved older adults, few included people with dementia. Little guidance is available for facilitators regarding the themes and objects that best support reminiscence in a digital environment or those that are best used with a cognitively impaired population. This study aimed to address this research gap.

Methods

Thirty-seven older adults, with and without cognitive impairment, collaborated with our research team across two rounds of participatory workshops; held in each of two locations (urban and rural town). The first involved capturing and probing memories from young childhood to present day. Workshop discussion and outputs were thematically analysed, themes with higher levels of engagement were identified and content analysis of each theme identified associated objects. These results were reviewed in the second workshop and recommendations were made as to how they could best be used in digital environments.

Results

Engaged and positive reminiscence experiences were supported by: Environmental Objects—prompting memories closely linked with specific settings (e.g. school, childhood home, playing on the street, old shops); Event Objects—triggering memories relating to specific occasions of types of events (e.g. holidays, dances, sports, hobbies); and Meaningful Objects—items with personal relevance for individuals (e.g. first bike, record player, telegram). Object-rich digital environments were deemed to best support VR reminiscence, rather than single item interactions which can be effective for in-person sessions.

Conclusion

Objects recommended for use in digital VR reminiscence support the limited findings that are available from previous research. Fewer cross cultural differences were noted, and we recommend that this research is extended to learn more about reminiscence prompts in more ethnically diverse groups. Nevertheless, a catalogue of objects, environments and meaningful events are now available to support clinical and technical developers of digital reminiscence.
65 A review of the Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)
Authors: Kruis A , McNamara R
Published: September 2023

Background

The conventional paradigm of emergency care may not address the multifaceted care needs of older patients, who present to the emergency department with multiple comorbidities, geriatric syndromes, and health determinants, complicating diagnosis and therapy. OPRAH was introduced in 2019 to meet the needs of our changing population. The unit was initially developed out of existing resources within the ED but more recently expanded with the addition of a Geriatric ANP, additional ED GEM (Geriatric Emergency Medicine) consultants, an occupational therapist and a physiotherapist to the team.

Methods

The electronic records of all patients seen by the OPRAH team were reviewed to determine the impact of the service. The data collected included the patient’s age and outcome of the patient (admission vs discharge).

Results

From 1st of January to 30th of April 2023, 1,118 patients were assessed. Three hundred and forty patients were admitted to a hospital (30.41%). Of those, 264 patients were admitted to X (23.61%), 64 to Y (5.72%), 10 to Z (0.89%) and two patients in A (0.17%). The remaining patients were either discharged back home or referred to convalescence in a nursing home. The mean age was 82, ranging from 35 to 103.

Conclusion

The expansion of OPRAH in the ED has improved access for all patients living with frailty to short-stay ED-led care. The implementation of integrated care had led to patient-centred care with the timely discharge of suitable patients to either their own homes with support structures in place or onward referral to more appropriate settings (e.g. a nursing home or step-down facility with MDT) when admission to an acute hospital was not required.
74 Making mobility falls prevention and management everyone’s business
Authors: Brolly A , Buckley M
Published: September 2023

Background

Falls in hospital are detrimental to patient safety and the highest reported patient safety incident. The falls committee undertook a review. It identified a need for improved processes around the identification of falls risk. There was a need for a succinct multi-disciplinary approach to falls prevention following the identification of falls risk. Staying mobile and having clear visible mobility goals while in hospital was targeted as a strategy. This was appropriate as reduced mobility is a modifiable risk factor for in-patient falls.

Methods

PDSA quality improvement methodology was used. A mobility and falls policy was developed. The policy provides a framework of three algorithms for falls risk identification, prevention and management. Additionally, referrals to health and social care professionals were streamlined to reduce time from risk assessment to referral. Falls prevention information leaflets were developed to help make patients partners in the process. Whiteboards were used behind patients beds with magnets to clearly show falls risk. Mobility status and goals were written on the whiteboard. This ensured a succinct joint approach to patient mobility. Education and staff engagement enabled implementation. Excellence was awarded with a certificate for display on the wards quality boards. Clinical audit was used to measure results.

Results

Review of audit data between October 2022 and January 2023 recognised improved processes in the identification and management of falls. Outcome measurement showed up to 100% increase in communication between healthcare professionals in relation to patient mobility status and goals.

Conclusion

In conclusion, we learnt that identifying and communicating falls risk was not enough. A clear succinct multi-disciplinary plan of action was required. Patients must be partners in that plan.
75 The COVID-19 pandemic and social frailty: an evaluation of Occupational Therapy practice in a day hospital
Authors: Webster C , Brennan B , O'Donoghue N , Manning Z
Published: September 2023

Background

Restrictions imposed to limit transmission of COVID-19 and to protect vulnerable persons led to loss of roles and routines, social isolation, sedentary lifestyles, increased anxiety, depression, and increased frailty among older people. In Occupational Therapy (OT) literature, ‘occupational deprivation’ describes this state of enforced disengagement in meaningful occupations which negatively impacts wellbeing. Clients attending a Day Hospital for Comprehensive Geriatric Assessment (CGA) reported residual elements of occupational deprivation and negative effects of COVID-19 restrictions with associated social frailty. OT practice was evaluated to determine the extent of services offered to remediate or improve social frailty and overall wellbeing.

Methods

During CGA, OTs assess clients’ occupational performance including cognition, mood, mobility, social environment and engagement in meaningful occupations. Routine (quantitative) data collected to evaluate the service was inputted and analysed using Microsoft Excel. OTs logged numbers of clients referred to services to remediate social frailty including day centres, social prescribing and an OT-led anxiety management group in the Day Hospital. Six months of data in 2023 was analysed.

Results

288 clients received CGA by OT. The average age was 83. 33% were referred to Memory Technology Resource Rooms. 6% were referred to Day Centres or Active Retirement. 7% were referred to OT anxiety management group in the Day Hospital. 3% were referred to ALONE befriending. As part of routine OT practice, almost all clients were advised to continue with or to re-engage with previously enjoyed (meaningful) occupations such as attending mass, playing bridge, and visiting friends.

Conclusion

Occupational deprivation experienced by older adults during the COVID-19 pandemic contributes to increased social frailty. Older adults attending a Day Hospital received routine OT intervention focusing on enhancing their wellbeing and reversing social frailty associated with the COVID-19 restrictions. Assessment and management of social frailty is vital to understand the effects of the pandemic on older people and provide appropriate services.
80 ‘Before you go’: ensuring thickener is prescribed on discharge
Authors: Ward C , Cheannabhain A Ni
Published: September 2023

Background

Dysphagia prevalence in the acute setting is 30%. Managing dysphagia can reduce mortality, length of stay and increase overall quality of life. Use of thickener for patients with dysphagia should be the last alternative. However, in the acute setting due the patient’s respiratory or cognitive status, thickener use is required to manage the risk of aspiration and ensure patients improve clinically. The goal is for discharge prescriptions to contain all the necessary information for patients. The aim of this audit is to investigate the rate of prescription of thickener on patient’s discharge.

Methods

Two retrospective chart audits of discharge prescriptions were completed (December 2022 and May 2023); pre and post implementation of a new communication strategy for thickener being prescribed. All patients discharged from hospital on thickened fluids were included as identified via Speech and Language Therapy database. The audit investigated the rate of thickener on discharge prescription and documentation in the Kardex.

Results

Initial audit was completed in December 2022. 20 patients were included. 0% of patients had thickener prescribed on discharge with no (0%) documentation in the Kardex. Re-audit was completed in May 2023, following the implementation of a new communication strategy involving SLTs place a sticker on the Kardex, included 13 patients 77% (10 patients) had thickener prescribed on discharge with the same number (77%; 10 patients) having documentation in the Kardex.

Conclusion

Improved communication between healthcare professionals results in better patient outcomes and reduces the risk of re-admission. The use of instrumental assessment has enabled SLTs to truly identify those who require thickener, particularly during an acute admission. The SLT department is striving to reduce the use of thickener for patients, however, in those who do require this management option, it is imperative that it is included on their discharge prescription.
81 Does premorbid frailty status affect rehabilitation outcome?
Authors: Salawu A , Fan C W , Glynn M
Published: September 2023

Background

Frailty is associated with poorer rehabilitation outcome in functional gains, Length of Stay (LoS) and discharge destination. The aim of the study is to determine if pre-morbid frailty status affect functional gains, LoS, and discharge destination of patients undergoing rehabilitation.

Methods

188 men and 241 women were (age 81+/− 10 years) admitted for rehabilitation with median LoS of 36 days. All data were collected as part of routine physiotherapy. Age, Clinical Frailty Score (CFS), functional gains [change in Berg Balance Score (BBS) and de Morton Mobility Index (DEMMI)], LoS and discharge destination (home or non-home) were recorded. 392 (91%) had CFS, 331 (77%) BBS, DEMMI 325 (75%) recorded. Patient with CFS category 1–4 were defined as Non-frail, Category 5–7 as Frail. Results are presented as mean (SD). Statistical tests included unpaired t-test, paired t-test and chi-square test. Significance is set at p < 0.05.

Results

Of the patients, 76% were living with frailty and were older (83.6 [7.9] years vs 78.4 [8.1] years) than the non-frail group (p < 0.0001), had longer LoS (49.1 [34.2] days vs 41.0 [31.8] days, p = 0.044) but just as likely to return home (71% vs 78%, p = 0.14). Patients living with frailty had lower pre and post-BBS and DEMMI score, both groups had significant functional gains (p < 0.0001). Pre and post-BBS in Frail group and Non- frail groups were (19 [13] vs 26 [15]) and (30[15] vs 42[13]) respectively. DEMMI in Frail and Non-frail group pre vs post were 32(15) vs 45(16) and 43(17) vs 60(18) respectively. While there was no difference in functional gains in BBS between groups (p = 0.17), the difference in DEMMI score were lower in frail group (p = 0.018).

Conclusion

Our study showed that both frail and Non-frail patients made functional gains with rehabilitation and patients living with frailty are just as likely to return home.
85 I DO, I CARE: implementing delirium screening for older people to improve care, awareness and recognition in the emergency department
Authors: Mupada B , Mocke C , Pillay I , Costello J , Scanlon S , Naughton C
Published: September 2023

Background

Delirium is prevalent (7%–20%) in older patients in emergency departments (ED). The diagnosis is often missed (57%–83%). This Quality Improvement (QI) project aimed to improve delirium screening by 30% in the ED, in keeping with the HSE’s ‘Early Identification and Management of Delirium in ED (2021) and to identify barriers to sustain screening.

Methods

The Institute for Health Improvement Quality Improvement essentials toolkit was used. Patients ≥75 years with Manchester triage category of 2–5 were included. Plan Do Study Act cycles included auditing 110 patient charts in a weekly rapid cycle audit was performed. Actions included 1) formation of an organisational oversight group 2) triage nurses and healthcare assistants placed ‘Screen me with 4AT’ stickers on charts 3) ED Doctors screened with 4-AT 4) 4AT tool was incorporated into all adult proforma 5) 5 face to face information sessions with ED nurses 6) 8 individualised information sessions with ED nurses 7) EM registrar education of junior doctors 8) 4-AT lanyard reminder card 9) twice-weekly WhatsApp group sharing of results 10) Informal feedback invited from doctors who did not complete the 4AT. Data was entered onto Excel and analysis done using descriptive statistics.

Results

The mean (SD) age was 84 (5.6) years, the mean (SD) Manchester triage was 2.6 (0.6) and 56% were female. At baseline 1/20 (5%) charts contained a completed 4-AT. On average the 4-AT completion improved to 38% (42/110) (range 10% to 60%). Delirium was diagnosed in 38% (16/42). Barriers identified pre and post implementation included knowledge deficits, no out-of-hours referral pathway, low priority above competing demands, and fluctuations in ED staffing.

Conclusion

The QIP achieved the target but sustainability due to doctor’s rotations is questionable. Senior clinical leadership and role modelling, nursing team buy-in, education, and referral pathways are required to build on current progress.
93 Reduce falls rates in care homes by replacing falls risk screening with a Multifactorial Falls Risk Assessment Tool
Authors: Wellwood A , Brophy N , Huele N , Mohandass H , Joseph B , Johny S , Thomas T , Williams N
Published: September 2023

Background

Following a review (Nov 2022) of 203 residents across four locations, it was noted that falls risk screening tools were used to identify falls risk status. This resulted in a proportion of residents identified as low (5%) and medium risk (28%). New falls prevention guidelines incorporating care homes, recommend against falls risk screening (Montero-Odassa et al, 2022). The guidelines recommend that all residents in care homes should be considered at high risk of falls and use of a Multifactorial Falls Risk Assessment Tool (MFRAT) is preferable in falls prevention. Our aim is a reduction in falls rate by discontinuing the use of falls risk screening tools and implementing a MFRAT. Embed this change within a new standardised falls policy and deliver staff education sessions to support this change.

Methods

Stakeholder engagement and development of a falls committee with seven representatives across each location including nursing, management, quality and patient safety advisor and falls coordinator was undertaken. Communication strategy of weekly online meetings developed a standardised falls policy, tailored MFRAT and audit tool to monitor compliance. Reported falls were cross referenced with our national incident management system. Falls rate calculation across each location was used to measure the impact of change.

Results

Results demonstrated a 29% reduction in falls rate for the first quarter of 2023, compared to 2022. 100% compliance with policy implementation across all locations, with 68% of staff trained through education sessions face to face and online.

Conclusion

Implementing a MFRAT, aligned with new world guidelines, supported by staff education, and associated falls prevention interventions provides a reduction in fall rates in care home residents. The process of falls rate calculation across locations provides ease of evaluation.
96 Implementing Multifactorial Falls Risk Assessments in the community for older adults at high risk of falls
Authors: Wellwood A , Duffin G , Cusack S , Browne V , Devitt A , Doherty A , Byrne R , Wade R , Burke K , Kelly N , Power S , Stephenson G , Keeley C , Forde B , Harty C
Published: September 2023

Background

Falls prevention improves health outcomes and reduces healthcare costs. New world guidelines for falls prevention and management in older adults exist. Older adults identified at high risk of falls should receive a Multifactorial Falls Risk Assessment (MFRA). A review of the use of MFRA across community healthcare divisions was undertaken in November 2022. It was noted that many variations of falls risk stratification existed, and implementation of a MFRA was not routine. This study aimed to implement a MFRA on all identified at high risk of falls.

Methods

Stakeholder engagement and project team (n = 14) development of physiotherapy, occupational therapy, podiatry, dietetics, and nursing was undertaken. A falls pathway was developed, outcome measures agreed, and a service user education booklet designed. Inclusion criteria incorporated older adults over 65 referred due to a fall, fall-related injury or through opportunistic case finding. A survey and focus group were undertaken. Qualitative and quantitative data was collated.

Results

186 participants were risk stratified resulting in high (56%), moderate (29%), low (24%) risk. A MFRA was completed on all identified as high-risk. Their profile encompassed, 57% aged 80 and above; 35% opportunistic screening; 70% fell at home; 14% sustained a fracture; 64% presented as frail. Service user engagement themes; importance of good information ‘booklet very helpful’; under-reporting of falls ‘I feel embarrassed’.

Conclusion

Results highlighted 56% of older adults identified as high risk crossed all divisions of our healthcare system, indicating falls risk stratification and implementation of MFRA is every healthcare professional’s responsibility. Opportunistic case finding is necessary as older adults (35%) may not present following a fall. Good sources of information are needed to engage in falls prevention behaviours.
104 Oxygen prescription on a specialist geriatric Ward
Authors: Murphy B , Mulroy M
Published: September 2023

Background

Oxygen delivery is an extremely useful tool in treating hypoxaemia. While it has beneficial effects when administered at correct doses it can also lead to serious adverse outcomes when not delivered correctly. Given this, oxygen should be treated as any other drug we use in practice and prescribed accordingly. Studies done around the world show very poor rates of appropriate oxygen prescription. This is particularly important on a ward which specialises in care for the older adult, where neurocognitive disorders, delirium and multi-morbidity is common.

Methods

An audit was carried out on all patients admitted to the specialist geriatric ward over a two week period, documenting whether the patient was receiving oxygen therapy and if so whether it was charted appropriately. Following this education was provided to staff on the ward and posters were hung at the oxygen ports as a reminder to ensure oxygen was prescribed in the Kardex. A re-audit was then carried out, measuring any change in practice.

Results

Following the initial audit, 120 new patients were admitted to the ward, 25 of which were receiving oxygen therapy (21%). Of the 25, only 7 had oxygen prescribed (28%). Following staff education and the introduction of reminder posters at the oxygen ports a reaudit was carried out. 103 new patients were admitted to the ward, 18 of which were receiving oxygen therapy (17%). Of the 18, 17 had oxygen prescribed appropriately (94%).

Conclusion

Simple reminders can influence behaviour greatly. Appropriate oxygen prescription improved three-fold with an inexpensive, simple intervention.
107 Communication deficits at transitions of care
Authors: Walsh A , Costello R , Larkin J , O’Connor M
Published: September 2023

Background

Successful rehab relies on accurate and timely communication between the referring and receiving hospital. As it currently stands patients’ case notes are not permitted to accompany patients on transfer to our off- site rehabilitation centre. Transfer documentation is depended upon to provide accurate medical information. Delays in obtaining this documentation and omitted information and or information deficits exposes patients to considerable clinical risk. This audit examined the adequacy and accuracy of documentation provided at transition of care.

Methods

The discharge documents of patients transferred from an acute hospital to an off-site rehabilitation unit over 3 months were analysed. Demographic information, presenting complaint, history of presenting complaint, past medical history, course of hospital stay and follow up plans were recorded.

Results

Transfer documentation of 27 consecutive patients were analysed; median age 78 years (range 71–95 years);52% female. One of the 27 letters contained all relevant medical information. Demographic data was correct in 26/27 the remainder had no patient identifier recorded. Presenting complaint was recorded in all letters but the history of same was included in just 44%. 48% of letters had incomplete medical history. Conditions omitted which may require adaptation to rehab programme included joint replacements (n = 4), dementia (n = 3), visual impairment (n = 3) and respiratory conditions (n = 3). 67% of patients underwent acute orthopaedic trauma surgery, 50% had no surgery date recorded and 83% had no weight bearing status recorded. A follow up plan was documented in 18% of patients.

Conclusion

Transitions of care pose significant risk to safe continuity of patient care. Our study shows transfer documentation was substandard and deficient in medical information that is necessary to formulate a safe and appropriate rehabilitation plan. Furthermore it exposes the patient to unnecessary duplication of diagnostics. Contemporaneous access to patients case files during their rehab admission would reduce exposure to potential harm and expedite formulation of realistic shared goal setting in the rehab setting.
108 Accuracy of medication prescriptions at transitions of care: an avoidable patient risk
Authors: Walsh A , Costello R , McKeag A , O'Connor M
Published: September 2023

Background

Transitions of care are well recognised as exposing patients to potential risk and harm. Patients in our rehabilitation centre transfer from a nearby acute hospital. Case-notes are not permitted to accompany patients off-site. The aim of this study was to record and quantify medication errors and omissions occurring at care transitions.

Methods

The transfer documents and prescription of consecutive admissions over a three month period were analysed. Allergy status, accuracy of medication lists including drug omissions, duplication, dosing errors; and inappropriate prescribing were recorded. Medication reconciliation by our clinical pharmacist took place within 24–72 hours of patients transfer to our rehabilitation unit.

Results

27 patients were included, median age 78 years (range 71–95 years). 52% female. 59% of transfer medications lists were inaccurate. No allergy status was recorded in 22% of cases. Discrepancies between letters, prescription and Kardex occurred in 55% of patients. A total of 38 prescribing errors were noted in 16 patients with 10 patients having ≥1 error, 3 patients with ≥3 errors and 3 with ≥5 errors. The most common errors related to: analgesia (n = 8), bone protection and vitamins (n = 6), antiplatelet and anticoagulants (n = 5), anti-hypertensives (n = 4), sedatives (n = 3). 2 patients transferred to rehab with prosthetic joint infection had their antimicrobials omitted from transfer documentation.

Conclusion

Medication errors, omissions and inappropriate prescribing are common on discharge from acute care. in some cases patients had been on incorrect doses of medications for the duration of their acute stay. This reiterates the importance of clinical pharmacy as an integral part of comprehensive geriatric assessment and where it is absent the risk of avoidable patient harm is considerable. It took considerable time and effort from medical and pharmacy staff on the rehabilitation unit to reconcile patients medications in a timely manner to reduce serious harm.