bluuebunny/crossref_metadata_2025 huggingface dataset:
67 Audit of discharge summaries on a geriatric ward against the Health Information and Quality Authority (HIQA) National Standard
Authors: Radhakrishna K , Ratna A , Geraghty T , Hughes G , O'Shea D , Connolly W
Published: September 2023

Background

Discharge summaries are integral for safe transition of patient care. Complete, precise and succinct documentation can ensure improved quality of care and patient safety.

Methods

Retrospective data were collected from e-discharge summaries that were generated over a 7-month period from June-Dec 2022. A total of 20 samples were selected at random and assessed against the HIQA National Standard. The samples were compared to the physical medical records to countercheck if relevant information were present or omitted. There was a total of 78 outcomes measured as per the national standard.

Results

There were 8 (40%) discharge summaries with the complete clinical courses, in that they contained the main complaint, relevant clinical findings, relevant investigations results and the complete treatment courses. There were 4 (20%) summaries that had omitted documentation of inpatient complications or adverse events and 8 (40%) summaries had omissions present on medication prescriptions. There were 5 (25%) summaries whereby the list of stopped medications and the reasons for stopping the respective medications were omitted. There were 5 (25%) summaries with incomplete documentation of future plans. Only 4 (20%) discharge summaries had all the relevant information present.

Conclusion

Efforts to implement E-prescribing and electronic health records should be prioritised. The Irish Medical Council plans to introduce Entrustable Professional Activities (EPA), which are essential tasks that a trainee can be trusted to perform without direct supervision, once sufficient competence has been demonstrated. An entire EPA unit is dedicated to competent patient handover and discharge. A Discharge Summary Flowchart which highlights the inclusion of all the essential components of a complete discharge summary was introduced as a guide for the team. Finally, there is an ongoing continuous audit by Senior House Officers and Interns to assess the quality of discharge summaries after the recommendations have been implemented.
76 Improving medicines management of inpatient Parkinson’s Disease patients by making pharmacy interventions
Authors: Knipe M , Conyard E , Donovan M
Published: September 2023

Background

Hospital admissions of Parkinson’s Disease (PD) patients can result in disruptions in medication regimens causing adverse effects for PD patients. Evidence shows that interventions can reduce medication-errors and administration of contraindicated medicines in PD patients.

Methods

Three interventions (priority medicines reconciliation, stock optimisation and staff education) were implemented over a one month period. A ‘baseline’ audit was completed prior to intervention implementation measuring patient demographics, delay in 1st dose post-admission, medication-errors, pharmacist medicines reviews and time until completion and patient outcomes. A post-intervention audit identical to the ‘baseline’ audit was completed.

Results

The ‘baseline’ audit (mean age 81 years, 24 patients, 1,611 doses) and the post-intervention audit (mean age 80, 30 patients, 1,840 doses) were compared and analysed. Medicines reconciliations increased from 79% to 97% (p = 0.042) and these were completed 38.7 hours (p < 0.001) sooner post-admission. A reduction in 1st dose delay was seen (13.5 vs 4.4 hours [p < 0.001]), along with reductions in delayed (5% to 1% (p = 0.037)) and missed doses (8% to 2% [p < 0.001]). Omitted pre-admission PD medications reduced from 16% to 2% (p = 0.011). Staff education contributed to recorded due times increasing from 44% to 97% (p < 0.001). Contraindicated medicines were administered at reduced rates in the post-intervention audit. The length of admission was shorter due to the combination of interventions (19 vs 15 days [p = 0.475]). These improvements resulted in a reduced prevalence of falls, delirium episodes and rigidity. Patients were more able to interact with allied health professionals in the post-intervention audit (46% vs 100%). Improvements in non-oral PD medicines prescribing occurred in ‘nil by mouth’ patients.

Conclusion

This study showed that the introduction of the pharmacist-led interventions, staff education, priority medicines reconciliation and stock optimisation, can improve PD inpatient outcomes, by reducing medication errors, decreasing the administration of contraindicated medicines and preventing delays in the administration of PD drugs.
77 Introducing a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and treatment escalation plan (TEP) guideline in an acute hospital.
Authors: Brolly A , Hanlon J
Published: September 2023

Background

In hospital cardiopulmonary resuscitation has a 13–20% survival rate to hospital discharge. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders reduce resuscitation activity in people who are unlikely to survive due to underlying co-morbidities. The project aimed to identify current DNACPR practice and cardiac arrest calls in an acute care hospital and to improve communicating and documentation of DNACPR decisions.

Methods

A baseline audit of 20 medical charts identified variable practice on documenting DNACPR, inappropriate cardiac arrest calls and poor communication between the multidisciplinary team and patients on DNACPR decisions. A sub-committee of Medical Clinical Governance developed a hospital wide Guideline and Proforma for DNACPR that included a treatment escalation plan (TEP). Using quality improvement methodology and plan-do-study-act cycles the DNACPR proforma and decision support framework was refined and tested. Implementation strategies included stakeholder engagement, education, re-formatting documentation and recruitment of ward champions over a six month period. Post implementation audit measured compliance with completing the proforma and resuscitation calls.

Results

Clinical audit in February 2023 of 33 patient medical records identified 100% (n = 33) of patients with a DNACPR decision had the correct form in use. 96% documented communication with patients. All proformas were signed by a senior decision maker, included a TEP and were filed correctly in the patients notes. There was a 25% reduction in cardiac arrest calls. Only 56% of proformas were signed by nursing staff.

Conclusion

Implementing a standardised DNACPR proforma was feasible and improved documentation, visibility and ease of locating DNACPR decisions. It promoted timely communication with patients and families setting realistic goals of care in the TEP. In turn there has been a reduction in cardiac arrest calls. Nurses role in the process remains sub-optimal and there is a need to understand the experience of patients and families.
86 Meitheal programme (MP) phase 2 supporting the needs of nursing home staff delivering palliative care (PC) to the older person
Authors: Richardson J , Diver E Sweeney , McTeggart M , McElhinney J
Published: September 2023

Background

There was a need identified within residential settings to build staff awareness of palliative care, to improve PC provision and to reduce inappropriate hospital transfers of residents. Acknowledging the absence of training undertaken in palliative care, the MP was designed to facilitate and support staff to integrate an early PC approach. This is undertaken by the Meitheal Clinical Nurse Specialist (CNSp) attending the residential setting, facilitating education and clinical support.

Methods

A structured programme was designed offering flexibility, in recognition of the many demands within a nursing home setting. The Meitheal CNSp facilitates multi-modal interactive education through workshops and support sessions, including live case scenario discussions of residents’ care. Informal clinical support facilitates further learning and integration of person-centred PC to enhance better quality of living. Resources to support and help sustain the programme learning are provided.

Results

Our current programme was adapted from the results of the Evaluation of the Meitheal Programme Phase 1. This highlighted five main themes: (i) Support, (ii) Teamwork, (iii) Communication, (iv) Knowledge and (v) Quality of life. Participants reported: (i) Strong need for support for all, including bereavement, (ii) Enhanced awareness of importance of teamwork and recognition of roles, (iii) Improved communication with residents and families and less fear of sensitive conversations, (iv) Increased confidence, knowledge and understanding of early palliative care and (v) Greater understanding of appropriate medications and earlier intervention for symptom management.

Conclusion

The Meitheal Programme is different to other PC programmes, as it provides ‘onsite’ education & ‘on the ground’ clinical support. The Meitheal CNSp is present within the nursing home, enhancing the application of theory to practice in real time with real case scenarios. It is evident that the Meitheal Programme has initiated significant improvements to date. However, there are many challenges to overcome as we continue Phase 2 Meitheal Programme delivery and rolling evaluation.
89 Mapping the development of education to implement National Clinical Guideline: appropriate prescribing of psychotropic medication for non-cognitive symptoms of dementia
Authors: Bracken-Scally M , Maloney P , Ward R , Farrell S , O'Dowd S
Published: September 2023

Background

National Clinical Guideline No. 21 (NCG No. 21; ‘Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia’) was published by the Department of Health in 2019. The National Dementia Office secured funding through the Health Service Executive National Service Plan to implement NCG No. 21.

Methods

The implementation programme for NCG No. 21 encompasses three work packages; communication and engagement, education and training, and evaluation. As part of work package two, a multi-component education package (encapsulating Facilitator education, an eLearning module and other resources) has been developed for relevant staff. This is currently being rolled out in a number of settings. An audit tool has been developed and adapted for use across settings. Process mapping of the development process of the education package was completed.

Results

It is hoped that the education package will further increase awareness of the guideline as well as embed the guideline across settings and improve the management of dementia. Audit tools and associated activities to assess compliance with the guideline will contribute to improved quality of care and will enable identification of areas for quality improvement initiatives. Process mapping outlines the various stakeholders and stages involved in the development process. Learning to date from the development of the education package, through process mapping, is presented, highlighting particular facilitators and challenges which were experienced.

Conclusion

Process mapping of the development of the education package to implement NCG No. 21 has provided valuable learning for continued roll-out, as well as for the development and roll-out of other education packages.
90 Combining scoping review and concept analysis methodologies to clarify the meaning of filial coercive control
Authors: Quinlan F , Donnelly S , O’Donnell D
Published: September 2023

Background

Increasingly the phenomena of non-intimate coercive control has been identified as a significant social problem experienced by older adults. This form of elder abuse occurs in relationships where there is an expectation of trust and shares many attributes with psychological elder abuse. Extensive research studies have examined how coercive control is enacted within intimate relationships. However, our understanding of how adult children employ strategies of coercive control in their relationships with their older parents is severely limited.

Methods

Scoping review and concept analysis methodologies were combined in a hybrid model to clarify and analyse the concept of filial coercive control. The framework proposed by the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR), guided the systematic literature review. Then, using the steps of Rodger’s (1989) evolutionary concept analysis, the antecedents, attributes, and consequences of filial coercive control were described in detail.

Results

This study has extended the theoretical framework of elder abuse by incorporating filial coercive control as a subtype of abuse experienced by older adults. The subject area is complex and heterogenous, encompassing literature generated in the disciplines of law, social science, psychology, and criminology among others. This research has enabled the construction of a theoretical conceptual boundary around the subject by identifying key concepts, theories, surrogate terms and sources of evidence of filial coercive control.

Conclusion

As an emergent topic area, the phenomena of coercive control has been subject to inconsistent terminology. The theoretical framework underpinning the literature has not always been explicitly stated leading to confusion about how the phenomena is constructed. Using scoping review and concept analysis methods, it was possible to gain a better understanding about the evolution of the concept of filial coercive control enabling us to propose a tentative operational definition.
94 Polypharmacy in older adults: the role of the advanced nurse practitioner
Authors: Alookaran S , O'Sullivan F
Published: September 2023

Background

Polypharmacy is the concurrent use of five or more medications and is more prevalent in the care of Older Persons. Polypharmacy is a global issue and is linked to poor health outcomes especially in Older Persons. It is estimated that 20% of people over 65 years of age in Ireland, are prescribed at least 10 drugs repeatedly and 5% are prescribed at least 15 drugs repeatedly. Prescribing and deprescribing medication is a complex process and it can be challenging for people who are over 65 years of age It is estimated that people taking more than 10 medicines are twice as likely to develop frailty; frail cohort were twice as likely to be prescribed a potentially inappropriate medication and three times likely to be admitted to hospital. Over 10% of emergency hospital admissions in this cohort were estimated to be related to adverse drug reactions. Appropriate deprescribing will improve patient outcomes and reduce healthcare costs.

Methods

The Registered Advanced Nurse Practitioner populated a database of all medications that were prescribed and deprescribed within the caseload over the two year period. STOPP/START tool was used for deprescribing.

Results

The study confirmed that Appropriate Prescribing is a person-centred intervention, which required up-to-date knowledge of the patient’s condition, review of medical notes and/or co-ordinating with Pharmacist and/or General Practitioner (GP) to obtain the full list of medication, shared decision-making, monitoring for adverse effects, monitoring laboratory values and routine follow up. Patient engagement and education was vital to achieve positive outcomes. Encouraging the use of unit dose packaging for this cohort was noted to be an effective method of medication adherence.

Conclusion

The study recommends regular medications reviews for patients on Polypharmacy. Future changes in the healthcare should include electronic prescribing, improved access to medical records for Primary and Secondary care to improve prescribing in Older Persons.
98 Bone health: managed correctly? A clinical audit
Authors: Rust G S
Published: September 2023

Background

Bone health is as important in the geriatric population as any other clinical system. The International Osteoporosis Foundation states that approximately 75 million people have osteoporosis across Europe, the United States and Asia. Osteoporosis and Fragility Fractures have become a common finding in presentations to general practices and emergency departments. Clinical guidelines exist with key elements to best identify, investigate, treat, and follow up these patients—but are guidelines being followed?

Methods

A clinical audit and service evaluation of patients attending a geriatric assessment and treatment clinic was compared to the new 2021 United Kingdom National Osteoporosis Guideline Group publication. The comparison between strong recommendations in these guidelines and clinical practice in patients with known osteoporosis and fragility fractures was undertaken using a self-designed matrix. 28 patient files were identified, and findings recorded.

Results

This study suggests that bone health in geriatric patients is undertreated. Only 25% of identified patients were investigated, treated, and prescribed bone health medication as per the 2021 United Kingdom National Osteoporosis Guideline Group publication. History taking regarding comorbidities, level of mobility and frailty scoring were judiciously completed across the 28-patient sample. Referrals to allied health practitioners was lacking though patient follow up was well documented.

Conclusion

The key is to identify poor bone health early, act swiftly with relevant investigations and commencing medications and preventing fragility fractures and hospital admissions. Future reviews of bone health management in the geriatric populations are still required to allow full understanding on the topic.
100 Prevalence of probable sarcopenia and associated factors in older adults undergoing Comprehensive Geriatric Assessment
Authors: Sayers K , King L , Ryan S , Harty E , Donnellan C
Published: September 2023

Background

Sarcopenia is a skeletal muscle disorder, underpinned by adverse muscle changes that accrue across the lifespan. It is associated with increased likelihood of falls, fractures, physical disability and mortality. Low muscle strength is a principal parameter of sarcopenia. Sarcopenia is probable when low muscle strength (grip strength) is detected. The aim of this study was to evaluate the prevalence of low grip strength in older adults referred for Comprehensive Geriatric Assessment (CGA). The relationship between grip strength and sarcopenia- related factors was evaluated.

Methods

A period prevalence study was undertaken between September 2022 and March 2023. All patients ≥65 years who underwent CGA by a Community Specialist Team were included. Grip strength was measured using the Southampton Protocol. Associated factors measured were age, gender, frailty (CFS: Clinical Frailty Scale score), risk of malnutrition (MST: Malnutrition Screening Tool), co-morbidity, cognitive change on Dementia Screening Interview (AD8), falls history and mobility impairment. Probable sarcopenia was based on EWGSOP2 definition. Descriptive statistics, odds ratio (OR) with 95% confidence intervals (CI) and cross tabulation using Persons Chi squared test were used to determine if there was correlation between probable sarcopenia and associated factors.

Results

In total, 173 people attended for CGA (69 male, 104 female), mean age was 80 years (SD =7) and the median CFS score was 5 (mildly frail). The percentage of people who had their grip measured was 84% (n = 145). The prevalence of probable sarcopenia was 52% (n = 75). A positive correlation was identified between probable sarcopenia and age (p = 0.039), Clinical Frailty Scale score (p = 0.025), mobility impairment (p = 0.033) and those reporting cognitive change (p = 0.008). A positive association was identified between those with probable sarcopenia and ≥ 6 co-morbidities (OR 2.13; 95%CI 1.1–4.2).

Conclusion

Probable sarcopenia is associated with frailty, multi-morbidity, impaired mobility and cognitive change. Grip strength can identify older people who require CGA and targeted multimodal intervention.
123 Setting up a new pathfinder service—peaks and pitfalls
Authors: O'Donoghue B , Griffin A , Meagher B , Burke D , Cox T , O'Shea T , Allen T
Published: September 2023

Background

Pathfinder is a team of advanced paramedics, physiotherapists and occupational therapists which responds to low-acuity 999 calls to provide alternative care pathways to hospital emergency departments. Pathfinder originated as a joint initiative between Beaumont Hospital and the National Ambulance Service (NAS). Since then, Pathfinder has been rolled out nationally with the aim of expanding the service further in the future. The geographical landscape and available acute and community services vary in each organisational context, requiring each new service to identify its needs individually. This research highlights the peaks and pitfalls of rolling out a nationwide initiative within a local context.

Methods

This new Pathfinder service implementation was structured using a Plan, Do, Study, Act Cycle. This included the development of structured organisational processes between the NAS and the hospital. The creation of terms of reference documents, relevant policies and a risk register to guide service implementation. The promotion and education of the service and appropriate referrals. The establishment of integration between the service and existing acute and community resources.

Results

A group of local stakeholders were identified and monthly operational meetings with an agreed terms of reference were set up. Relevant policies and risk registers were developed. Eleven information sessions were completed to increase awareness and to aid in discussions regarding the integration of services. Referral sources were identified, and education of the service took place through information leaflets, emails, presentations, communication and informal feedback to staff. Local referrals to Pathfinder service increased post local education by 83%. Ongoing challenges include the separate Information Technology systems and communication channels within acute and community settings.

Conclusion

Setting up national services within different organisational contexts requires further thought and consideration. Close working relationships and good communication with key stakeholders are essential in setting up services. Education and networking lead to increased awareness of the service and appropriate referrals.
138 Falls management simulation
Authors: Pierpoint R , McElwaine P , Mullen C , Varghese S , Smith A
Published: September 2023

Background

Simulation is a clinical education opportunity that creates an experience without having to go through a real event. Simulation facilitates a debriefing for the participants of the ‘event’. Simulations support healthcare professionals in developing knowledge and skills. Falls are common in hospital and are potentially serious events. Prompt patient post-fall assessment is important in identifying injuries, ensuring safe observations levels and taking action to prevent the next fall. Our aim was to improve post fall patient care through a Falls Management Simulation.

Methods

Falls management simulations, with a standardised patient event, took place on two Specialist Geriatric wards between February and April 2023 with 31 learners taking part consisting of CNM’s, staff nurses, healthcare assistants, and physiotherapists. Post simulation participants completed a Kirkpatrick’s level 1 and 2 evaluation.

Results

Kirkpatrick’s level 1 evaluation (feedback questionnaire) asks participants to rate eight general statements about the programme. The median outcome for each of these statements indicated participants found the simulation to be a positive learning experience. Kirkpatrick’s level 2 evaluation (self-assessment pre and post training) showed an improvement in knowledge post simulation. Participants were asked to evaluate their level of knowledge pre and post simulation from very high to very low. In the assessment of injuries post fall and, the care of the patient after an unwitnessed fall participants’ knowledge improved post simulation from a median of unsure (pre simulation) to very high (post simulation).

Conclusion

The feedback on the simulation reflected an increase in participant’s knowledge and confidence on the management of a patient post-fall. This education programme is in its early development. We aim to continually monitor and adapt the simulation to meet the learners’ needs, provide variation for repeat learners and ensure it is a positive educational experience for all.
142 Identifying common housing conditions affecting older people relevant to integrated Care for Older Persons in Ireland
Authors: Grey T , O'Donoghue J , Xidous D , Nicol S , Kennelly S , Coveney E , O’Neill D
Published: September 2023

Background

The health and well-being of older people is significantly affected by housing, representing an essential aspect of preventative healthcare in the community. Good quality housing is an important factor in a person’s ability to maintain mental and physical health, as well as sustain optimal quality of life. This is particularly true for older people who may spend more time at home than other demographic groups. This study explores the linkages between housing conditions and the health and wellbeing of older people with the aim to inform housing designers, providers, and policy makers about the key aspects of healthy homes and common housing hazards, affecting older people.

Methods

The qualitative research programme involved an in-depth stakeholder engagement strategy, with activities including focus groups, diaries, and interviews to place the perspectives of older people at the centre of the work. The research also included a series of case study visits to the homes of patients of an Integrated Care Programme for Older People, where the research team conducted a series of qualitative semi-structured interviews with the patient, as well as a technical and quantitative survey of the home.

Results

Key themes identified throughout the research programme include overarching themes such as healthy ageing and housing and ageing in place; themes related to the hospital and integrated care, and the local authority; housing conditions and hazards; and built environment issues across the key spatial scales.

Conclusion

There is a need for better, more accessible data on the housing issues, conditions, and hazards for older people throughout Ireland. Additionally, it is essential to consider the needs of patients with additional care requirements, such as those living with dementia, as the built environment greatly impacts them.
145 Audit of yearly prevalence of atrial fibrillation in ischemic stroke patients admitted to a level III acute Irish hospital
Authors: Sohail A A , Mergani M , Gaffney C , Varghese B , Ziya N
Published: September 2023

Background

Global AF burden in acute ischemic stroke patients is studied in some evidence at 30%, with similar results in Ireland. We therefore sought to perform an audit of prevalence of atrial fibrillation in acute ischemic stroke patients in a level III hospital in republic of Ireland, to study its comparability with available evidence nationally and internationally.

Methods

The study was retrospective observational audit study of all patients admitted with a diagnosis of acute ischemic stroke to the concerned hospital from January, 2022 to December, 2022. Patients were identified via their diagnosis recorded in HIPE coding and in-hospital stroke registry. All patients with the diagnosis of acute ischemic stroke were screened for presence of atrial fibrillation via 72 hours R-testing. Data was collected via charts review and R test result review, compiled via flow charts, graphs and excel sheets, and studied.

Results

156 patients were admitted to the hospital’s stroke service with ischemic stroke in the set time frame. 41% (N = 65) had Atrial Fibrillation (AF) which was deemed to be the cause of their stroke. 18% (N = 29) had newly diagnosed Atrial fibrillation. 23% (N = 36) had known AF. In those with known AF (N = 36), 13.8% (N = 5) were not on anticoagulation, 58.3% (N = 21) were on the adjusted dose, and 27.7% (N = 10) were not fully compliant. All new and existing AF patients not anticoagulated, were commenced on anticoagulation.

Conclusion

The audit shows that total atrial fibrillation burden and rate of pick-up of new atrial fibrillation in the acute ischemic stroke patients in the concerned hospital, were comparable to international evidence. Under dosage and poor compliance were major causes of anticoagulation failure in patients who were anticoagulated with known AF.
150 Strengthening community bonds to support older people: a dynamic partnership between ALONE and the GAA
Authors: Rooney P , Clarke R , Moloney S , Regan C , O'Reilly A
Published: September 2023

Background

The GAA and ALONE were both members of a multi-sectoral COVID-19 Community Response Team that worked to ensure all vulnerable members of communities affected by the pandemic were appropriately supported. Subsequently, ALONE and the GAA entered a formal partnership with the aim of improving understanding of older people’s needs, building local capacity to support older people, and raising awareness of ALONE services. As part of this collaboration, ALONE delivered a series of information and awareness events via the GAA Heathy Club initiative in nine locations across Ireland. The GAA also ran a pilot exercise programme in their Connacht GAA Centre of Excellence for older persons to improve their cardiovascular health and wellbeing.

Methods

Attendees at information and awareness sessions were asked to fill in a short survey about their satisfaction with the event, awareness of ALONE services, and whether the event had enhanced their intentions to support older people. Club coordinators were also invited to complete a short survey to provide feedback on organising the event and willingness to host similar events in the future.

Results

Overall, over 200 people attended the nine events, held in a mix of urban/rural locations: 81 attendees and six club coordinators responded to the survey. Feedback from attendees was very positive; all indicated they were more likely to support older people in their community while club coordinators indicated they were likely to host a similar event in the future. A small increase in referrals to ALONE services was observed after the event.

Conclusion

This project demonstrated there is substantial demand within local communities for support services for older adults, and a real willingness among communities to support this group. Services need to ensure they respond to this need but should also focus efforts on building capacity in local communities to support older people.
161 Mapping and analysing outpatient clinics for a quality improvement
Authors: Marion I , Power D
Published: September 2023

Background

Due to the increasing prevalence of chronic non-communicable illnesses for a growing, ageing population, the outpatient clinic has to be efficient to cope with the demand. It creates a logistical challenge on top of a complex operation.

Methods

Quality improvement project management was designed and executed in an outpatient Clinic in North Dublin with a capacity of 400–450 patients per month between October 2022–May 2022. Key concepts of operation management were utilised, including process mapping and run charts. Problem areas were identified using TIMWOODS (Transportation, Inventory, Motion, Waiting, Overproduction, Overprocessing and Defects) framework. A few main problems were addressed, including lost clinicians’ time to session start late and finish early, high variability of patient waiting time, and carrying out additional investigations that are not needed. Key stakeholders were identified and approached, including frontline staff, managers and patients. The QI team focused on one problem, specifically on the cohort of patients who missed the appointment or came to the appointment outside the allocated time using the DMAIC (Define, Measure, Analyse, Improve and Control) Six Sigma tool. An appointment reminder system was established, including a short messaging system and a quick phone call 24 hours before the clinic. A month of baseline data was collected, presented, followed by three months of intervention. A pre and post-descriptive analysis Fischer Exact test was applied.

Results

There was a significant improvement in patients attendance from 69% to 82% (p < 0.05).

Conclusion

A QI team identified a few problem areas utilising lean six sigma tools. A simple, cost-effective intervention of appointment reminder systems was carried out. Continuous, incremental quality improvement is an ongoing process to ensure sustainability. There is a need to engage with the main stakeholders, exploring their valuable opinion and increasing their engagement (Gemba walk).
173 The development and early experience of a multidisciplinary acute in-patient frailty team
Authors: Bambrick P , Doyle M , Prendergast A , Doherty-Walsh A , Byrne E , Simpson S , Murphy G
Published: September 2023

Background

Frail older adults represent a growing proportion of the acute in-patient population. A point-prevalence audit in our hospital revealed 40% of adult in-patients were frail (median age: 74). Following a patient-mapping exercise and review of service-user requirements, a consensus was reached among stakeholders that a multidisciplinary in-patient frailty team would be the most effective approach to supporting this group. The Rapid Assistance with Frailty Team (RAFT) work closely with Emergency Department (ED) and ward-based colleagues to optimise their care.

Methods

Newly admitted patients >75 years are screened daily for mild to moderate frailty (Rockwood Clinical Frailty Scale 5–6) and a Comprehensive Geriatric Assessment (CGA) is completed within 72 hours of admission. Hospital-associated complications e.g. deconditioning, delirium, weight loss, constipation, falls, cognitive and functional decline, are addressed through CGA-led recommendations. Physical and functional status are optimised through supplementary ward-based therapy and Geriatric Medicine support, with a view to facilitating earlier discharge.

Results

609 CGAs were completed over a one-year period. Patients were primarily identified through daily screening (77.51%). Other referral sources included the ED Therapy Team, Primary Teams, therapies and nurses. In 50% of patients reviewed, new onset of confusion, decline in memory, or delirium was noted, with only half of those having a prior history of cognitive impairment. 80% presented with a decline in general function and approximately 35% were admitted with a fall as their main presentation. Polypharmacy was identified in 80% of this patient population.

Conclusion

The initial steps in implementing an inpatient frailty service, i.e. developing a system of patient identification, documentation to support CGA, and an integrated approach to working in a busy clinical environment, have been achieved. The focus is now on prospective data collection, continuous monitoring of key performance indicators, and feedback from service-users and staff, to further streamline this approach.
174 A silver lining: the identification of silver trauma at triage for older persons (>65) presenting to the emergency department
Authors: Connolly K , Keogh S , Kelly L , O'Sullivan L , Geraghty C , Grufferty A , Bennett M
Published: September 2023

Background

Trauma in patients over 65 (silver trauma), can result in serious injury from lower impact mechanisms. The NOCA Major Trauma report highlights that 58% of major trauma is a result of a fall from 2 metres or less and mortality increases with age and comorbidities. Failure to identify, rapidly assess and treat older persons who have suffered silver trauma results in prolonged emergency department stays with an increase in morbidity and mortality. We therefore, performed a completed audit cycle to assess the identification of Silver Trauma in our emergency department.

Methods

A focus group involving key stakeholders was established, including Emergency Physicians, nurses and members of the Gerontological Emergency Department Intervention team. An audit assessed patients triaged as ‘major trauma’ from October to December 2022. We established silver trauma guidelines for triage. Teaching sessions on the recognition of silver trauma were provided, daily briefings were given, and information leaflets were placed in all triage areas. A triage discriminator of ‘Silver Trauma’ was introduced to prompt recognition and review by clinicians. A full audit cycle was completed.

Results

Our initial audit (October to December 2022) revealed 25 patients triaged as ‘Major Trauma’ who were aged over 65. After the completion of the initial audit and implementation of measures, 122 patients were triaged as ‘Silver Trauma’ between January 20th and March 31st. We identified that 59% (N = 72) were due to falls from 2 meters or less. Other mechanisms of injury included unwitnessed fall (21% N = 25), syncope (7% N = 8), fall from height (11% N = 13) and Major Trauma (3% N = 4). Seventy-one (58.19%) were admitted and 51 (41.80%) were discharged home.

Conclusion

This audit demonstrates that departmental education and implementation of a triage discriminator has significantly improved the recognition of silver trauma within the ED setting.
176 The AVERT DOSE international trial: an update on the Irish experience
Authors: McDonnell M W , Kelly N , O'Malley T , Coleman S , Kavanagh H , Prendergast C , Joksaite K , Lynch O , Donohue A , Cassidy T , Mackey C , Dolan E , Lucey F , Hennessy E , O’Connor M , Twomey D , Murphy S , Kelly P , Horgan F , Bernarhdt J
Published: September 2023

Background

Mobility training is a complex intervention and recovery post-stroke is multidimensional. AVERT DOSE aims to define optimal early intervention regimens for people with mild to moderate ischaemic stroke.

Methods

AVERT DOSE (ACTRN:12619000557134) is an international randomised trial that will recruit >2,500 patients. Randomisation is to two groups according to stroke severity. Patients are then randomised to one of four mobility training regimens in each strata and the intervention is delivered for up to 14-days. Primary Outcome: Identification of the intervention regimen that results in higher proportion of favourable outcome at 3-months post-stroke.

Results

In Ireland, 4 sites are actively recruiting (1,2,3 and 7), one completing training (4) and two finalising ethical approval and contracts (5,6). Eighteen patients have been recruited to date in Ireland, and over 400 internationally. Trial set-up has proven complex with processes and requirements differing significantly across Irish sites. Time to ethics approval has ranged from 10-months to over 3-years. The novel status of this trial as a non-drug/medical device trial, but rather rehabilitation trial, had led to discussion in relation to the need for a trial EU representative. Staff recruitment and retention challenges have proven to be a significant barrier to recruitment in recent months. The development of an Irish Avert Dose group to collaboratively address challenges and provide peer support has proven very successful in both supporting sites to reach recruitment stage and throughout the stages of screening, recruitment, intervention and blind assessment.

Conclusion

Undertaking rehabilitation research against the backdrop of a global pandemic and increasing staffing challenges requires a determined, problem-solving approach. Irish sites have embraced this opportunity to answer an important stroke research question. Health and social care professionals have displayed innovation and competence in steering clinical research and this should improve future rehabilitation trial readiness. Trial recruitment is expected to gain pace as more Irish and international sites are approved.
202 Development of a be-SPOKE ICPOP clinics in a rural catchment area
Authors: Neachtain M Ni , Okon M , Hanrahan C , Walsh L , Rogan M , Munnelly P , McClean F , Joy S , Geoghegan J , Canavan M , Costello M
Published: September 2023

Background

The hub and spoke model within the healthcare setting is designed around the principle of a main healthcare setting (hub) which offers a full complement of services and investigations and supporting secondary (spoke) clinics, which offer a narrower range of services but may be much more practical and preferable environment for assessment for older adults. This strategic model can meet patient needs fully, allow for appropriate concentration of resources and offers great potential for delivery of high quality patient care.

Methods

Our aim is to describe the development of several SPOKE clinic in a rural catchment area as part of the Integrated care for Older Persons (ICPOP) service.

Results

Our catchment covers a population of 38,000, many of whom are living rurally with few accessible public transport options to attend the nearest city for medical assessments. We identified key locations to develop a spoke clinics to deliver comprehensive geriatric assessments on those with new falls, frailty and decline in cognition. We gathered key stakeholders and identified clinical space, listed equipment and upgrades that would be required and process mapped the patient journey compared to attending a city based hub clinic. Our first spoke clinic began January 2023, with two further locations added in April 2023 with positive feedback from patients and caregivers to date. Practical aspects have been praised by patients including parking, distance to clinic room and accessible facilities.

Conclusion

This model is in its early phase but has been satisfactory to date. An additional benefit has been improved interaction with local services and primary care teams co-located at spoke clinic sites. This model would be suitable to implement in any community catchment area with a large urban and rural population mix.
204 A prospective study using the Irish Hip Fracture Database developed Frailty Index to predict delirium and prolonged length of stay
Authors: Fitzpatrick D , Bradley E , Lannon R , McCarroll K , Romero-Ortuno R
Published: September 2023

Background

Hip fracture in older adults is associated with life changing disability and mortality and those with frailty are at greatest risk. The National Office of Clinical Audit, in collaboration with the Irish Hip Fracture Database (IHFD) has developed a Frailty Index specific to this population. A retrospective review of Hospital Inpatient Enquiry (HIPE) and IHFD data demonstrated an association between frailty index and adverse outcomes. In this study, we evaluate the use of this tool prospectively to predict delirium and prolonged Length of Stay (LoS) in older hip fracture patients.

Methods

Data was collected prospectively on an acute inpatient orthopaedic ward from October 2022 to May 2023. We excluded patients aged <60 years and those with periprosthetic or atypical femoral fractures. The Frailty index (a 21-item scale based on comorbidities and premorbid functional status) was calculated and delirium identified by a 4AT score ≥ 4 or a documented clinical diagnosis. Logistic regression was used to evaluate the potential relationship between frailty index and outcomes of delirium and delirium prolonged LoS (≥30 days).

Results

There were 92 patients, of whom 68.5% were female with a mean age of 79.5 ± 9.1 years. Delirium developed in 29.3% of patients and 19.5% had a length of stay of ≥30 days. A 4AT score was calculated in 45.7% of patients. Patients with versus without delirium had a lower frailty index (0.13 vs 0.21). Frailty index was also associated with delirium (p = 0.04) and prolonged LoS (p = 0.04) independent of age and gender.

Conclusion

The IHFD Frailty Index is effective in predicting delirium and prolonged length of stay in older hip fracture patients. Using a frailty index may help identify frail patients who are at greater risk of adverse outcomes and may benefit from early targeted interventions and orthogeriatric review.
220 Kildare West Wicklow OPT: a pilot study to provide early supported discharge for older adults (>65) in Naas General Hospital
Authors: Dunne E , Fingleton C , Kenny B , Hayes S , Dempsey G
Published: September 2023

Background

In the absence of clinical governance from a Consultant Physician in Geriatric Medicine, KWWICPOP team developed an altered pathway in collaboration with Naas General Hospital (NGH). The Kildare West Wicklow Older Persons Team (KWWOPT) early supported discharge pilot commenced in October 2022. KWWOPT is an interdisciplinary team whose aims, in line with Slaintecare, are to: (1) Provide timely planned coordinated care via a therapy at home model, (2) Minimise acute hospital admissions, (3) Facilitate early supported discharge, (4) Augment the link between acute and community services and (5) Provide early supported discharge for older adults (>65 years) in NGH who would benefit from receiving multidisciplinary coordinated rehabilitation, (>2 disciplines currently employed on OPT) in the home.

Methods

Referrals are received from NGH. A keyworker is appointed and Comprehensive Geriatric Assessment is completed. The keyworker presents the results at MDT meeting and generate internal referrals to other team members. If referrals are required to other services not currently in post, referrals are generated to Primary Care Services. Clients may also be referred to external services. Each discipline carries out their own individual assessment and treatment and clients are discussed at MDTs at regular intervals to ensure care is coordinated. A discharge summary is prepared by each discipline involved in the clients care. The discharge summary is sent to the clients GP and local Primary Care Centre. All clients and their families are given a feedback form to complete at the end of their episode of care.

Results

Referrals in the first 5 months of this pilot: (1) 69% from inpatient wards (early supported discharge and reduced hospital bed days), (2) 25% from Naas General Hospital Frailty Intervention Team (Admission avoidance) and (3) 6% other sources.

Conclusion

The KWW OPT continues to grow and provide interdisciplinary integrated care as part of the National Care Programme for the Older Person.