bluuebunny/crossref_metadata_2025 huggingface dataset:
312 Implementation of a Formalised Weekend Hospital Handover Process
Authors: Chapman Lucy , Hannigan Oisin , Courtney Grainne , Cunningham Conal , Byrne Declan
Published: September 2019

Background

Patient handover has been described as “one of the most perilous procedures in medicine” (British Medical Association, 2004). The Irish Medical Council underlines the importance of high-quality, relevant clinical information communication at shift changes.

Methods

On Friday January 26th 2018, the weekend handover practice for medical inpatients requiring medical registrar review was formalised in a large Dublin teaching hospital. Firstly, pertinent clinical information and the purpose of review were captured in an electronic order placed on the electronic patient record (EPR). A verbal handover meeting each Friday supported further discussion and patient handover. Data from the 26th of January to the 7th of July 2018 was analysed from the EPR. The purpose of weekend review was grouped under four categories - full clinical review, laboratory results review, review to facilitate discharge and patients who did not demand formal review but were handed over for information only.

Results

Over the 23 week period, 652 electronic orders for weekend review were placed on medical inpatients. This equated to an average of 27 reviews per weekend. The average age of patients reviewed was 63 years (SD 18.8 years). Median length of stay (LOS) was 4 days with a higher median LOS (6.7 days) observed for those aged 65 years and over. Over half (54%) of all weekend reviews required full clinical review whilst 27% of reviews were for laboratory results follow up only. Comparison between medical inpatients aged less than 65 and greater than 65 years noted little differences between the two cohorts in terms of the purpose of weekend review. Daily review was required for 73% of patents handed over to the medical registrar.

Conclusion

Weekend review of medical inpatients by medical registrars constitutes a significant workload. A formalised weekend handover practice complimented by an electronic process facilitates safer patient handover by improving the quality, transparency and accessibility of clinical information.
320 Assessment of Medication Prescribing using Test your Care Metrics
Authors: Leahy Aoife , Hynes Jason , McCarthy Christine E , Roy Amrita , Mohd Asri Nur Atikah , Saif Kiran , Murphy Elizabeth , Sebaoui Salim , Matti Basil , Gabr Ahmed , Zulkifli Muhamad Daniel , Crotty James , Quinn Colin , Peters Catherine , Lyons Declan , O'Connor Margaret
Published: September 2019

Background

Medication records are essential components of patient care and a source of medical error. The HSE Code of Practice for Healthcare Records Management has highlighted criteria which must be complied with in these records. In the HSE Clinical Strategy and Programmes Division, “Test your care” is used to promote a code of practice and a set of metrics which need to be adhered to.

Methods

We reviewed all drug kardexes in 14 wards both medical and surgical in a 48 hour period. We assessed the drug kardexes based on 9 different metrics. (Generic names used, capital letters used, start date recorded, legible dosing, route and frequency of medication documented, minimum dosing documented, legible prescriptions and discontinued drugs crossed off)

Results

285 drug kardexes were reviewed. No drug kardex was fully compliant with the 9 standards. The main deficits were in relation to use of brand names, no documentation of frequency and omission of IMC numbers. The average number of metrics met was lower on surgical wards than medical wards - 3.6 vs 4.7 respectively, and this difference was statistically significant (p< .00001; 2 sample t test).

Conclusion

The universal poor compliance with these standards highlights both the poor design of the current drug kardex and poor awareness with prescribers of these standards. In the current drug kardex, there is no dedicated space for frequency or IMC number and therefore these are often forgotten. The use of brand names consistently highlights poor prescribing practice and more education is required to improve this. We plan to improve current prescribing education sessions for all doctors to highlight the current deficiencies and to increase compliance with standards.
34 A Review of the Implementation of a Stroke Education Programme in a Dublin Teaching Hospital in 2018
Authors: Donaghy Lisa , Dolan Eamon , O'Connor Marie
Published: September 2019

Background

Aim: To commence Stroke education in a specific Dublin Hospital to improve the assessment of management of Stroke patients.

Methods

Seven 1 day study days were organised in 2018. These study days were multidisciplinary team (MDT) led with theory in the morning session delivered by the Stroke Clinical Nurse Specialist (CNS) followed by MDT led workshops in the afternoon.

Stroke education was delivered to Emergency Department (ED) doctors on each rotation. Whiteboard education sessions were carried out for nurses on Medicine for the Elderly Ward/Stroke Unit.

Results

A total of 103 health professionals were trained over the 7 study days. Stroke Study Day attendances consisted of 69 RGN/CNMs 26 student nurses (21 intern nurses who are now staff nurses working in the hospital), 2 Allied Health Professionals, 1 CNS and 5 from Practice development. 32 ED doctors were trained over 3 separate induction days. Weekly scenario based sessions with nurses on the Stroke Ward.

Conclusion

Staff applying the learned knowledge and competencies to Stroke patients has significantly improved following the commencement of the education.

100% of staff who attended the Stroke study day stated that the training improved their knowledge and skills. 100% of staff would recommend the Stroke Study Day to other colleagues.

We aim to continue the study days and whiteboard sessions with health professionals in all wards in 2019.
330 Insights into Dementia- An Integrated Care Approach to Family Support
Authors: McHale Cathy , McGovern Martina , Dewergifosse Josephine , Domsa Maria , McMahon Anna , Timmons Fergus , Greene Julei , Tobin Fiona , Bennett Aine , Donnelly Myra , Coughlan Tara , O'Neill Desmond , Dookhy Joshi , Hyland Caroline , Scanlan Jean , Ryan Daniel , McElwaine Paul , Kennelly Seán
Published: September 2019

Background

The increase in the number of people with dementia in the coming years will be significant and could be as high as 132,000 people by 2041. There is a growing need for enhanced post diagnostic supports for patients living with dementia and their families. We identified the need for a localised educational resource for families and supportive others attending our specialist memory service

Methods

Staff from the Integrated Care Team, Specialist Memory Service and Primary Care were trained by the Alzheimer’s Society of Ireland to deliver a 6 week ‘Insights Into Dementia’ carers course. Tutors and dementia advisors from the Alzheimer’s Society of Ireland provided in-depth training prior to course delivery and feedback to the facilitators on a weekly basis. The course included advice and education on Dementia; Changing Relationships, Communication; Responding to changes in behaviour; Nutrition; Engaging in activities; Assisting with personal care and Safety in the home. Families gained advice regarding their self-care needs and learned how to access information and support.  All services involved worked together to identify, refer and support families with dementia in the local area. The group took place in an accessible location at a time which accommodated families to attend. Each course attendee completed a questionnaire prior to and after commencing the group.

Results

The group has delivered education and support to 48 families to date. Feedback from participants was very positive with self-reported increase in confidence, knowledge and awareness about dementia. Waiting time to access support has significantly decreased. Every course has led to a support group who meet up on a regular basis in their community.

Conclusion

This novel collaboration has become a key part of the integrated care pathway we have developed to support people living with dementia and their supportive others in our catchment area. The Integrated Care approach has served to enrich the programme and allow for timely signposting to localised supports.
332 GEMS: Geriatric Emergency Service - Outputs and Outcomes from the Acute Floor Team
Authors: Cornally Lorna , Hayes Brennan Megan , Reddy Danielle , Gallagher Grainne , O'Callaghan Maureen , Mulholland Ann , Gibbons Ruth , Nolan Jane , Normoyle Cathriona , Ahern Emer
Published: September 2019

Background

Frailty is now a key concept in healthcare planning and delivery and is driving vertical and horizontal integration. The positive narrative of Frailty is further emphasised by the growing scientific evidence in the prevention, reversal and modification of Frailty. Early identification of Frailty and early intervention with Comprehensive Geriatric Assessment (CGA) is fundamental. Older people with Frailty admitted to hospital who receive a CGA early are more likely to return home. Benefits are seen early and are sustained (Ellis et al 2011).

Methods

The aim of GEMS is to improve care, outcomes and the patient experience for older people living with Frailty. All people aged 75 years and older who attend as an emergency are screened on triage using the Variable Indicative of Placement Tool (VIP). Screening is automatic and mandatory. The GEMS Acute Floor Team respond early to those who screen positive by starting a CGA. The GEMS Home Team case manage those who are admitted.

Results

Over 2 years 10,037 patients were triaged. The median time from arrival to VIP was 15 minutes. 43% screened positive for Frailty. 66% received a CGA. The median time from VIP to CGA was 1.7 hours. 84% identified at risk of polypharmacy, 27% at risk of malnutrition, 29% with delirium. 74% were admitted from home. 78% returned to pre-admission residence. 4% new admissions to NH care. Median length of stay was 7 days. The readmission rate within 30 days was 16%. 7% in hospital mortality.

Conclusion

The GEMS Team have developed and delivered a pioneering integrated care approach to the management of older person at high risk of adverse outcomes attending the acute floor.
342 The Association Between Benzodiazepine Use and Falls, and the Impact of Sleep Quality on this Association: Data from TILDA
Authors: Marron Louise , Segurado Ricardo , Claffey Paul , Kenny Rose Anne , McNicholas Triona
Published: September 2019

Background

Benzodiazepines (BZD) are associated with adverse effects, particularly in older adults. Previous research has shown an association between BZDs and falls and BZDs have been shown to impact sleep quality. The aim of this study is to assess the association between BZD use and falls, and the impact of sleep quality on this association, in community dwelling adults aged over 50.

Methods

Data from the first wave of The Irish Longitudinal Study on Ageing were used. Participants were classed as BZD users or non-users and asked if they had fallen in the last year, and whether any of these falls were unexplained. Sleep quality was assessed via self-reported trouble falling asleep, daytime somnolence, and early-rising. Logistic regression assessed for an association between BZD use and falls, and the impact of sleep quality on this association was assessed by categorising based on BZD use and each sleep quality variable.

Results

Of 8,175 individuals, 302 (3.69%) reported taking BZDs. BZD use was associated with falls, controlling for con-founders (OR 1.40; 1.08, 1.82; p-value 0.012). There was no significant association between BZDs and unexplained falls, controlling for con-founders (OR 1.41; 95% CI 0.95, 2.10; p-value 0.09), however a similar effect size to all falls was evident. Participants who take BZDs and report daytime somnolence (OR 1.93; 95% CI 1.12, 3.31; p-value 0.017), early-rising (OR 1.93; 95% CI 1.20, 3.11; p-value 0.007) or trouble falling asleep (OR 1.83; 95% CI 1.12, 2.97; p-value 0.015), have an increased odds of unexplained falls.

Conclusion

BZD use is associated with falls, with larger effect size in BZD users reporting poor sleep quality in community dwelling older adults. Appropriate prescription of and regular review of medications such as BZDs is an important public health issue.
51 Evaluation of a Clinical Pharmacy Service on an Inpatient Ward in an Acute Hospital
Authors: McGann Ciara , Love Bernie , Carr James , O'Connor Marie , Dolan Eamon
Published: September 2019

Background

Intensive clinical pharmacy input from admission to discharge has been shown to improve patient outcomes. The clinical pharmacy service in our institution has historically been under-resourced. The aim of this study is to develop a ward-based clinical pharmacy service and to evaluate its impact using a number of clinical, safety and financial metrics.

Methods

A clinical pharmacist was assigned to provide pharmaceutical care to patients on a Medicine for the Older Person ward. Over an eight week period, the pharmacist prospectively recorded her interventions/activities. To assess impact on patient care, interventions were graded according to the Eadon criteria. The potential cost avoidance associated with interventions was estimated. Medication incident reporting was analysed to assess the impact on patient safety.

Results

87% of patients had at least one pharmacist intervention, across a spectrum of activities including medication reconciliation and clinical review. 90% of interventions requiring follow-up with the medical team were accepted and resulted in a change to patient’s care. Eadon grading of interventions deemed 99% to be significant, with 81% improving the standard of patient care. Two different methods were used to estimate potential cost avoidance: one estimated annual savings of €154,103 - €344,926; the other estimated these at €174,373. Given current pharmacist salary costs, this equates to a cost-benefit ratio of 2.8:1 to 6.3:1. (This does not include the 27% reduction in drug spend observed during the study period. However, more longitudinal data are required to confirm and characterise this phenomenon.) A five-fold increase in medication incident reporting from the ward was observed, suggestive of an enhanced culture of patient safety.

Conclusion

This study assessed and quantified a wide spectrum of pharmacist contributions to medication management and safety. Costing of these contributions estimates the cost-benefit ratio of the clinical pharmacy service, providing compelling support for the extension of this service throughout the hospital.
54 Acute Blood Pressure Lowering in Spontaneous Acute Intra-cerebral Haemorrhage: A Re-audit in a Tertiary Referral Stroke Centre
Authors: Walsh Erica , McCabe John , Murphy Sean , Kelly Dearbhla , Nicholson Emer , Killeen Emily
Published: September 2019

Background

Acute blood pressure (BP) lowering to a target of <150mmHg systolic improves outcomes in patients with acute spontaneous intra-cerebral haemorrhage (sICH). It is thought that the beneficial effect of BP-lowering in sICH is time-sensitive and mediated through the prevention of haematoma expansion. The American Heart Association guidelines state that BP lowering to <150 mmHg or lower is safe and can improve functional outcome. Our aim was to re-evaluate the performance of clinicians in meeting target SBP levels of <150mmHg in patients with acute sICH within 1 hour of presentation, following the introduction of a BP-lowering protocol in our centre.

Methods

We undertook a retrospective chart review of consecutive patients with an acute sICH admitted to our centre between September 2017 and May 2018. Any patient who did not receive active medical management from the outset of presentation due to immediate initiation of palliative measures were excluded. The time from presentation to target BP and BP measured at 1 hour were recorded. Any protocol violations were also documented

Results

11 patients were included (mean age 77.5years, 55% female). The mean BP at presentation and 1 hour was 186/93mmHg and 161/93mmHg respectively. The median and mean times from presentation to first achieved target BP was 129 and 120minutes respectively. At least 1 protocol violation occurred in 66.6% of cases. The most common protocol violation was the failure to escalate to an intravenous infusion of a BP-lowering agent in a timely manner when bolus therapy had failed.

Conclusion

An introduction of a BP protocol for patients with an acute sICH did not improve performance on achieving rapid SBP-lowering to target levels of <150mmHg. Strategies to improve awareness of this protocol are required to improve adherence and its successful implementation.
59 Male Family Carers’ Perceptions of Formal Support Services, a Meta-ethnography
Authors: Finn Caroline , Boland Pauline
Published: September 2019

Background

Family carers provide thousands of hours of unpaid work every year, a third of whom are men, however this group are generally under-represented in research. Comparative studies have shown that male carers experience their caring role differently to female counterparts. Social concepts related to masculinity can help to explain help-seeking behaviours of male carers, as well as their attitudes to accessing outside support. Compared to women carers, men have lower rates of uptake of formal support services. This aim of this review, therefore, was to examine accounts of male carers’ experiences and perceptions of receiving formal support.

Methods

The study followed a meta-ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the included studies was evaluated using the McMaster checklist. Using NVivo 12 software, primary qualitative data was analysed and key themes were identified. Results were synthesised using Noblit and Hare’s (1988) process of meta-ethnography, retaining direct quotes from the studies.

Results

Eighteen studies were included in the final paper. Three main themes were identified: 1) asserting control over the caring role 2) desire to excel in caring role and 3) coping without formal support.

Conclusion

For the most part, male carers expressed a desire to be competent in their caring role. Perceived loss of control within the caring relationship was a key factor when men had low trust and dissatisfaction with services. Support services that were collaborative, education-based and gender-sensitive were favoured by the men. To engage more male carers, service providers should acknowledge men’s experience and capabilities as well as their wish to stay involved in decision-making around care for their family member. For men over the age of 85 male family carers outnumber females in Ireland (CSO 2016). It is important to understand male carers’ experience to develop more inclusive supports and consequently increase service uptake.
67 How Well is Osteoporosis Checked for and Treated in Those Admitted with Fragility Fractures on General Medical Call?
Authors: Salehmohamed Muhammad Ridhwaan , O'Riordan Sarah , Doyle Rachael , O'Dwyer Clodagh
Published: September 2019

Background

Patients suffering a fragility fracture should be assessed and considered for treatment for osteoporosis according to current guidelines. This retrospective audit set out to assess if diagnosis and treatment of osteoporosis occurred appropriately in those admitted to a Model 2 Hospital with non-hip fractures on general medical call under all specialities.

Methods

All patients, admitted with fragility fractures, between January and June 2018, were included. Hip fracture patients treated through a separate ortho-geriatric rehab pathway were excluded. Data including source of admission, length of stay, type of fracture, investigations, treatments initiated or planned, were identified from patient’s records and collated using excel statistical analysis.

Results

From a total of 64 fracture admissions, 38 cases were non-Hip fractures. 34% (n=13) male, average age was 84 and 40% (n=15) patient had a history of previous fracture. Once admitted 68.4% (n=26), 60.5% (n=23) and 50.0% (n=19) had Vitamin D level, Bone profile and Serum Protein Electrophoresis checked respectively. Three patients passed away. 37% (n=13/35) of patients had a DXA scan performed either during or after their admission, all of whom were diagnostic for osteoporosis. 50% (n=19/38) were on Vitamin D at time of admission while 77% (n=27/35) were discharged on Vitamin D supplementation. 8% (n=3/38) were on osteoporosis treatment at time of admission while 31% (n=11/35) were discharged on, or had a plan in place for, osteoporosis treatment.

Conclusion

Investigation for and management of osteoporosis in patients admitted with fragility fractures are not being adhered to as per recommended guidelines. A new pathway under the supervision of a newly appointed c/RANP is being developed, in line with osteoporosis guidelines as a result, with a view to re audit and better follow-up of these patients.
68 Autonomic Impairment and its Manifestations in Patients with Delirium
Authors: Shanahan Elaine , Ryan Sheila , Costelloe Aine , Sheehy Tina , Peters Catherine , Lyons Declan , O'Connor Margaret
Published: September 2019

Background

Delirium is common among unwell older adults. Despite this the pathophysiology remains poorly understood. We hypothesised that autonomic dysfunction may be associated with the development of delirium.

Methods

35 participants completed a case-control study. Delirium was assessed using DSM-IV and DRS-R98. Autonomic function was assessed with Head-Up Tilt testing (HUT), baroreflex sensitivity (BRS) testing using Baroreflex Effectiveness Index (BEI), 24-hour blood pressure variability (BPV), nocturnal blood pressure dipping status and 24-hour heart rate variability (HRV). A subgroup analysis of those without pre-existing cognitive impairment (CI) was completed.

Results

During tilting the delirium group (DG) had a median decrease of 1mmHg (IQR 38.5) in systolic blood pressure (SBP) compared to a median decrease of 17.5mmHg (IQR 20.75) in the control group (CG) (p=0.04). Increased delirium severity correlated with a reduction in the decrease in SBP (rs= -0.42, p=0.03).

In those without CI, BRS testing during HUT showed that increases in blood pressure were not followed by an appropriate reduction in heart rate with a mean BEI of 36.87% (SD 22.26) in the DG and 56.03% (SD 23.04) in the CG (p=0.05).

Nocturnal dipping differed during subgroup analysis. 58.3% (7) of DG were reverse dippers, 33.3% (4) were non-dippers and 8.3% (1) had a normal dipping pattern. In CG 57.1% (4) were non-dippers, 14.3% (1) had a normal dipping pattern and 28.6% (2) were extreme dippers (p=0.01).

BPV was measured by average real variability (ARV). In those without CI mean ARV was 13.81 (SD 5.98) in the CG and 9.69 (SD 2.75) in the DG (p=0.05).

No difference was detected in HRV.

Conclusion

We identified differences in autonomic function between the DG and CG. This is the first study to look at several components of autonomic function in delirium and thus can provide insights into physiological abnormalities present during, or contributing to delirium.
76 An Incorrectly Set Watch may Suggest Cognitive Impairment in the Older Patient
Authors: Feyzrakhmanova Martina , Killian Owen , Fennelly Evelyn , Toland Samuel , Power Dermot
Published: September 2019

Background

Disorientation to time can be used as a guide to determining the presence and severity of dementia. The inability to maintain one’s wrist watch at the correct time is assessed as a possible marker of dementia.

Methods

Inpatients in a post-acute care unit with a mean age of 76.2 (±12.4 years) were assessed with regard to the time on their wristwatch. The time was recorded as correct or incorrect with a permitted discrepancy of 15 minutes. A current Mini-Mental State Examination (MMSE) score was obtained and patients were divided into two groups: MMSE above/equal to or below 24, with the latter defined as an abnormal result.

Results

The most striking finding of this study was that any patient with an incorrectly set watch had an abnormal MMSE. The majority of patients with an abnormal MMSE had their watch set correctly (n=17, 38%), while only 10 (22%) were found to have an incorrectly set watch. All patients with a normal MMSE had their watch set correctly, n=18 (40%). Acknowledging the fact that conclusions of statistical methods used on a small sample size should be interpreted with caution, we report that the two-tailed Z score for 2 population proportions was 2.9277 (p=0.00338), significant at p<0.05.

Conclusion

This study presents evidence to suggest a relationship between the correctness of the older patient’s watch and their cognitive status. Assessment of time on the patient’s watch could be considered as an instantaneous, approximate “test” for dementia in clinical practice. This test would have a sensitivity of 37% and specificity of 100%.
78 Comparing the Management of Frailty between a Rapid Access Frailty Team and General Medical Teams at a Level Three Hospital
Authors: Tulsi Deeptish , Pillay Lushen , Ogunjembola Ibrahim , Farelly Alice , McGlynn Joanna , Doherty John , Donnelly Teresa
Published: September 2019

Background

Frailty represents a particularly high risk group of geriatric patients whom require specialized care. Dedicated multidisciplinary frailty teams led by Geriatricians have been shown to provide better outcomes. The aim of this study was to compare the inpatient interventions and length of stay (LOS) between patients under the care of a dedicated Rapid Access Frailty Team (RAFT) versus general medical teams.

Methods

Data was collected on a total of 163 patients who were screened as frail positive using a screening tool, over a period of 10 months in 2018. Basic Statistical Analysis was used to analyse data.

Results

Of the 163 patients, 113 were managed by the RAFT and 50 by a medical team. 61.9% were assessed as frail immediately in the Emergency Department, while the remainder where referred to the RAFT from other medical teams.

The main reasons for referral were: cognitive impairment (51.3%), poor mobility and safety awareness (70.8%), polypharmacy (82.3%), poor functioning in ADLs (76.1%) and medical reasons (77.9%). Interventions made by the frailty team included: medication rationalization (82.3%), MDT assessment (91.2%) and discharge planning (87%). 49.5% of patients seen by the RAFT had a MOCA score < 22.

Of patients managed by the RAFT 100% received Physiotherapy and 96.5% were seen by Occupational Therapy, while in the medical group this was 50% and 42% respectively. The mean length of stay was 9 days in the RAFT group, and 12.4 days in general medical group.

Conclusion

Patients managed by the RAFT had an average LOS of 3.4 fewer days. We hypothesize that this is linked to earlier identification by the RAFT, earlier referral and more intensive intervention by allied health services, and specialized Geriatric Medical input. We aim to increase the availability of our frailty service within our hospital to optimize the management of our frail patients.
87 Evolution of Atrial Fibrillation
Authors: Meagher Marykate , Noone Imelda , Davey Naomi , Cassidy Tim
Published: September 2019

Background

Atrial Fibrillation (AF) is a common cardiac arrhythmia and a well-established risk factor for stroke with its prevalence increasing with age. AF related strokes are associated with increased mortality and morbidity however the risk of stroke is reduced by almost 70% by oral anticoagulation (OAC).

Methods

Analysis of data using SPSS allowed us to identify all acute stroke patients admitted in 2018 with AF. We compared data on patients who were admitted with known AF and those who were newly identified with AF and looked at their outcomes.

Results

373 stroke patients admitted,of which 108(29%) patients had AF, mean age 79. 68(63%) had known AF and 40(37%) had a new diagnosis of AF. 52(76.5%) of the known AF were on an OAC (11 on warfarin) and 40(78%) on a Non- Vitamin K antagonist oral anticoagulant (NOAC).

16 patients (23.5%) with known AF were not anticoagulated on admission. (Reasons for no OAC-3 had a history of previous intracerebral haemorrhage (ICH). 2 a history of bleeding and 1 a history excess alcohol). 10 patients were on antiplatelet therapy and were subsequently anticoagulated on discharge.

33(48.5%) of the known AF were discharged home versus 15(37.5%) in the new AF cohort and while mortality was higher in the known AF, there were more patients in the new AF cohort 14(35%) that required long term care compared with 3(4%) in the known AF cohort which not only indicates the severity of their stroke but also suggests that if AF had been detected and treated sooner their outcome may have been very different.

Conclusion

There has been a significant increase in primary prevention practices for AF and this is reflected in the number of stroke patients presenting with known AF on a NOAC, however more needs to be done as there are still patients who have AF that are not being anticoagulated in the community.
88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit
Authors: McDaid Edel , Ross Elaine , Cogan Lisa
Published: September 2019

Background

Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2).

The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination.

Methods

A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel.

Results

Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores.

Conclusion

All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.
90 Demographics and Characteristics of Patients with Recurrent Falls Attending Tertiary Hospital Outpatients Department
Authors: Marion Mohd Ikhwan , Beatty Paula , Zainal Tariq , Riordan Marie-Anne , Daly Toddy , Kyne Lorraine , Duggan Joseph
Published: September 2019

Background

Falls are a common cause of morbidity and mortality in older adults, with most being caused by identifiable risk factors. This study aimed to assess demographics and clinical characteristics of patients who had recurrent falls attending the medicine for the older person (MFTOP) outpatient department at a tertiary centre.

Methods

Retrospective analysis of patients seen at MFTOP OPD between January 2018 and December 2018. Data were obtained from clinical notes. Age, gender, blood pressure, cognitive tests, blood tests, diagnoses and medications that could contribute to falls were recorded.

Results

100 patients were reviewed. 60% were female (60). Mean and median ages were 83. Causes of falls included; gait/balance disorders or weakness 36.0%, environment-related/'accident' 19.0%, alcohol 5.0%, dizziness/vertigo 5.0%, visual disorder 4.0%, confusion 4.0%, others 3.0%, drop attack 1.0%, unknown 5.0%. 18.4% (18/98) had orthostatic hypotension (OH), of which 44.4% (8/18) had low standing systolic BP <120 P=0.0205 compared to the non-OH group. Median HbA1c was 39 (30 - 83) for 80 patients 95% CI 39.5-43.4. 11.9% (11/92) had low serum sodium (<135) (95% CI 137.7-139.3). 29.0% (29/100) had impaired cognition of which 13.4% (4/29) were at risk of vitamin D deficiency P=0.5767. Other medical conditions potentially contributing to falls included; arthritis 16.0%, Parkinson’s disease 7% and incontinence 3.0%. Medications that can contribute to falls included; antihypertensive agents 67 (66.3%), tricyclic antidepressants 19 (18.8%), antianxiety agents 15 (14.9%), opiates 12 (11.9%), hypnotics/ tranquilizers 27(26.7%) and diuretics 28 (27.7%).

Conclusion

There is a high prevalence of co-morbidities and polypharmacy in patients with recurrent falls. Identifying modifiable causes may reduce the risk of falls in the future. Tighter glycaemic control was observed and relaxed glucose control in high-risk older adults are recommended.
91 A Descriptive Analysis of Causative Drgs/Drg Classes of Incident Adverse Drg Reactions in Acutely Hospitalized Older-Adults: SENATOR (Phase I)
Authors: Jennings Emma , Lavan Amanda , Dahly Darren , Eustace Joseph , Flanagan Evelyn , Gallagher Paul , Cullinane Shane , Petrovic Mirko , Perehudoff Katrina , Gudmondsson Adalsteinn , Samuelsson Ólafur , Sverrisdóttir Ástrós , Cherubin Antonio , Dimitri Frederica , Rimland Joe , Cruz-Jentoft Alfonso , Vélez-Díaz-Pallarés Manuel , Lozano Montoya Isabel , L Soiza Roy , Subbarayan Selvarani , O’Mahony Denis
Published: September 2019

Background

Adverse drug reactions (ADRs) are common and have serious repercussions for older-adults. This descriptive-analysis elucidates clinical presentations, severity and responsible drugs of incident ADRs in the SENATOR (Software ENgine for the Assessment & optimization of drug and non-drug Therapy in Older peRsons) phase I feasibility study.

Methods

SENATOR-phase-I was a European multicentre-prospective-observational study. Participants were ≥ 65 years, experiencing acute-hospitalisation and on pharmacological treatment for ≥ 3 conditions.

Adverse events (AEs) were identified by trigger list at recruitment, day-14/discharge and classified as ADRs when association with an administered drug was adjudicated as being probable/certain, according to the World Health Organization Uppsala Monitoring Centre ADR causality criteria.

Results

Of 644 participants recruited, 382 (59.1%) experienced 732 AEs, 363 AEs (49.6%) being incident. 139 participants (21.6%) experienced 177 (48.8%) ADRs. Full drug details were recorded in 156 patients (88%). Cardiovascular-system drugs accounted for one-third of ADRs (55, 35.3%).

Five drug classes caused three-quarters of ADRs (135, 76.3%); diuretics 28.2% (furosemide 24.4%), opioid analgesics 16.7%, anti-bacterials for systemic use 14.1%, anti-thrombotic agents 10.3%, and drugs used in diabetes 7%.

68 patients (10.6%) experienced 81 (45.8%) clinically significant moderate-severe ADRs. Significant serum electrolyte disturbance (32, 18.1%), acute kidney injury [AKI] (22, 12.4%), unspecified adverse event (UAE; 21, 11.9%), dyspepsia/nausea/vomiting (20, 11.3%), new-onset major constipation (19, 10.7%) were the most common presentations of ADRs, accounting for 114, (64.4%) of all ADRs. In moderate-severe ADRs; AKI (12, 14.8%), acute bleeding (11, 13.6%), new-onset major constipation (11, 13.6%), UAE (11, 13.6%), significant serum electrolyte disturbance (10, 12.4%) were the most common presentations.

Conclusion

This analysis highlights that;

1-in-5 older adults will experience an incident ADR during acute hospitalisation.

1-in-10 patients experience moderate-severe incident ADRs.

3-of-4 ADRs were caused by 5 drug classes (diuretics, opioids, anti-bacterials, anti-thrombotics and anti-diabetic agents).

This study allows for identification of potentially high risk medications which could be targeted for future ADR prevention.
93 A Multidisciplinary Approach to Restrictive Interventions in Residential Care
Authors: Conway Laura
Published: September 2019

Background

A residential service in Dublin is home to 100 older persons with wide-ranging, complex care requirements. Traditionally restrictive interventions (RI) for residents in the setting were the decision of the Nursing/Medical team. Evidence based best practice stipulates that RI must be supported by a systematic and collaborative assessment between the resident, their family/representative and members of the multi-disciplinary team (MDT). Thus, the MDT identified a need for a change in practice in respect of RI and to facilitate formal MDT discussions regarding the assessment, introduction and review of RI for individual residents.

Methods

A Restrictive Interventions Working Group (RIWG) was set up to facilitate an overall change in practice in respect of RI. The working group developed pathways for planned/emergency RI with particular focus on the development of a Planned RI form to guide MDT discussion. The pathways were implemented across the service. The RIWG drafted a new RI Policy to reflect the changes in practice, followed by education sessions facilitated by Occupational Therapy and Practice Support. Feedback was sought after each education session.

Results

The project was launched on August 1st 2018.

Sixteen Planned RI Forms were presented to MDT from August 2018 to February 2019. Seven of those restrictions were discontinued following MDT discussion.

43% reduction in mechanical RI and a 54% reduction in PRN psychotropic prescription between August and December 2018.

Staff reported the education sessions as being `very informative', `relevant to the setting', `allowed us to think about the key issues we face in our day to day work' and `improved my understanding of RI and the best practice approach'.

Conclusion

An MDT forum for discussing RI provides improved governance over the introduction, review and discontinuation of RI. Further education in respect of RI, management of responsive behaviours and staff competency assessment will further improve practice, with the goal of achieving a RI free home.
99 Safer Mobility: Practice vs Preach
Authors: Carey Sive , Salawu Adefunke , Glynn Marian
Published: September 2019

Background

Activity levels in older people undergoing inpatient rehabilitation are low. Intervention by the rehabilitation team amounts to 2% of a patient’s day. Interdisciplinary working helps to ensure that therapy continues beyond the physiotherapy gym. However, safe handling is required.

Aims

Examine the awareness of ward staff of the mobility status of their patients. Investigate if staff on a general geriatric rehabilitation ward are compliant with physiotherapy mobility recommendations.

Methods

Data collection took place on a general geriatric rehabilitation ward from February to March 2019.

Staff Awareness was assessed by individually asking ward staff (Nurses and Health Care Assistants) to identify the mobility status of their patients. Their responses were recorded and compared with the physiotherapy mobility recommendations as per the MDT (multi-disciplinary) communication whiteboard.

The mobility status of each patient was observed by means of random visual audits. Observations were recorded and subsequently compared to the physiotherapy mobility recommendations as above for compliance.

Results

For the staff awareness audit, 95 responses were obtained from 10 different staff members. 50.5% of responses (n=48) correctly identified patients’ mobility status. 49.5% (n=47) incorrectly identified patients’ mobility status.

From 10 visual audits, a total of 196 patient observations were recorded. In 37.2% (n=73) of observations, patients were not mobilising as per physiotherapy recommendations. 39.3% (n=77) of observations were as recommended. In 23.5% (n=46) of observations, patients were not mobilised at all.

Conclusion

There was limited awareness among ward staff of the mobility status of their patients. Over 1/3 of patients were not mobilised as per physiotherapy recommendations. These findings can compromise both patient and staff safety. The visual audit also highlighted low physical activity levels in some patients.

Implications for clinical practice include the need for education on safer mobility and the promotion of patient physical activity at ward level. Physiotherapy led educational and practical handling sessions for ward staff have proven to be beneficial in this regard.
108 A Prospective Audit and Review of Proton Pump Inhibitors (PPIs) in Older Adults in a Reablement Unit
Authors: Byrne Amy , Hizza Hila Ludin Nor , Byrne Sharon , Purcell Róisín
Published: September 2019

Background

The audit and review was carried out in a 24-bed reablement unit designed to improve independence and mobility in those ≥65 years. PPIs have been identified as a significant source of drug expenditure and evidence has shown that they are often prescribed inappropriately. PPIs are effective for conditions including dyspepsia and gastro-oesophageal reflux disease (GORD) but can also be associated with adverse effects and contribute to polypharmacy. The aim of the audit was to:

Determine the number of patients admitted on PPIs. Determine the appropriateness of PPI prescriptions. Review any inappropriate prescriptions.

Methods

Prospective data collection was carried out for all newly admitted older adults over a 9 week period using a pre-approved data collection tool. Information was collected on PPI prescription details, indications and risk factors. PPI appropriateness regarding indications and dosage was reviewed by the pharmacist using guidelines1 and clinical experience. The pharmacist’s recommendation was then reviewed by the medical team and changes to prescription made where deemed appropriate.

Results

n=40 patients assessed. n=24 (60%) prescribed a PPI. n=19 (79.2%) deemed inappropriate by the pharmacist. Interventions made for n=13 (68.4%) of PPIs deemed inappropriate: n=8 (42.1%) were dose reduced. n=5 (26.3%) were discontinued. n=6 (31.6%) deemed unsuitable for review: n=1 deemed high risk for a gastrointestinal bleed. n=3 with GORD symptoms despite PPI use. n=1 for GP follow-up. n=1 previous unsuccessful dose reduction.

Conclusion

Most patients on a PPI did not have a clear indication. The majority of inappropriate PPIs were deemed suitable for review and were subsequently dose reduced or discontinued. Some patients were unsuitable for PPI review due to multiple risk factors or ongoing symptoms of reflux. The continued need for PPIs should be assessed regularly and a risk-benefit analysis should be carried out.
113 Pharmacist Interventions at Discharge and the Quality of Older Patients' Care: A Systematic Review
Authors: Kalim Reham , McMahon Niamh , Ryder Sheila
Published: September 2019

Background

Discharge and transfer between healthcare facilities put older adults at risk of medication-related problems and early readmission. This review examined the evidence for pharmacist interventions at discharge and patients’ care quality.

Methods

Eight databases were searched systematically from inception to date, using the appropriate search strategy for each. A search for grey literature was conducted on eight further websites. No filters (e.g. language/dates) were applied.

Only prospective randomized/quasi-randomized controlled studies involving patients > 65 years of both genders, discharged alive from hospital, were included. The criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions formed the basis of the assessment, conducted using RevMan 5.3.

Results

9738 articles were obtained: 8120 unique articles after duplicate removal. Following screening, 12 studies were identified for inclusion. Interventions comprised follow up, medication review and patient counselling at discharge. Of these, 10 were delivered by pharmacists alone, while the remainder were delivered by pharmacists within a multidisciplinary team. Outcome measures included readmission rates, length of stay, medication adherence and care quality.

Nine studies showed significant improvements over standard care, e.g. a decrease in hospital admissions (0.68 OR, p=0.002), improved compliance (P<0.001) and a 47% reduction in emergency department visits (95% CI, 0.37-0.75).

However, three studies did not report positive results: Two reported non-significant improvement but the third reported poorer readmission rates. Risk of bias was low but the high baseline standard of care reduced the scope for improvement in two of these studies.

Conclusion

The review summarizes pharmacist interventions’ efficacy and their effect on care quality indicators where possible. The majority of interventions at discharge significantly enhanced patients’ care quality.

The findings should prove valuable to decision-makers when planning or improving discharge and post-discharge services.
117 AusTOMs An Outcome Measure to Determine the Impact of Environmental Adaptations on Functional Performance
Authors: Cannon Elaine , Delaney Siobhan
Published: September 2019

Background

Occupational Therapists routinely perform pre-discharge home assessment visits. The import of a supportive home environment to successful ageing has been established in the literature (Tanner, Tilse & Desleigh de Jonge, 2008), with housing adaptations and aids recognised as a method of promoting independence within the home (Stark et al, 2009).

In this hospital, home assessment visits review functional mobility, functional transfers and assess for environmental barriers within the home. The purpose of this study was to detect any change in functional performance following a pre-discharge home assessment visit and implementation of OT recommended aids/railings or both. The AusTOMs (Australian Therapy Outcome Measures) for Occupational Therapy scale was used as the outcome measurement tool.

Methods

The study was applied to a cohort of 20 consenting inpatients over 65 years of age. Convenience sampling was used for the purposes of the study. Inclusion criteria comprised of patients that attended a minimum of one pre-discharge OT home assessment visit. It was conducted over a ten week period in 2018.

The study was conducted by two occupational therapists (OTs) on the general rehabilitation team.

The scale was applied to review the following functional transfers within the home environment on initial home assessment visit and following the implementation of OT recommended aids/railings. 1. Access2. Stairs3. Bed4. Toilet5. Bath/Shower6. Seating

Results

The group Average AusTOMs Resultant score at initial home assessment was 3.05. The group average score following implementation of recommendations was 4.08. This indicates a change in performance from a Moderate Limitation experience to a Mild Limitation experience. This is reflected in Paired T test results. The two-tailed P value is less than 0.0001.

Conclusion

The AusTOMs Activity Limitation/Transfer scale indicated there is a positive correlation with the provision of OT recommended aids and equipment at improving functional transfer performance within the home context.