bluuebunny/crossref_metadata_2025_split huggingface dataset:
251 Communicating End of Life Care Decisions in an Acute Hospital
Authors: Morrison Laura , Clarke Rebecca , McAteer Claire , Dolan Eamon , O'Connor Marie 
Published: September 2019

Abstract

Background
Research by the Irish Hospice Foundation reports 43% of Irish deaths occur in hospital. The aim of this study was to review in-hospital deaths in a university teaching hospital to examine whether escalation of care and resuscitation instructions were documented clearly where death was a likely outcome during hospitalisation.

Methods
Medical records from 50 deaths in 2018 were reviewed. A proforma was designed to record detail on: demographics, if death was expected, and if resuscitation status, ceiling of care and discussion of these with the patient or family were clearly documented.

Results
50 patients were included, median age 83.5 years. In 84%, end of life was anticipated by the medical team. 74% of patients were seen by palliative care. The most common cause of death was pneumonia/respiratory sepsis (46%) and median length of stay was 13 days. 3 patients (6%) had cardiac arrest calls.
A clear ceiling of care was recorded in 46% of cases. Goals of care were documented as discussed with the patient in 2% of cases and family in 78%. Resuscitation status was recorded as discussed with family in 62% and the patient in 4%.
Resuscitation status was documented in 96% of cases; 60% by the primary team, 36% by on-call staff. In only 54% of cases the name, position and Medical Council number of the person recording resuscitation status were all clearly written. Resuscitation status was correctly documented on the Early Warning Score chart in 32% of cases.

Conclusion
Clear documentation around treatment escalation plans is needed in patients admitted to an acute hospital. Resuscitation status and ceiling of care, if appropriate, should be decided and documented by the primary team where possible and discussed with the patient/family. This study showed a need to improve documentation and discussion with patients and families approaching end of life.
254 An Audit of the Frequency of Early Swallow Screens Performed in Patients Diagnosed with a Stroke
Authors: Kelly Lisa , Murtagh Niamh , Leonard Rachel , O'Malley Tom 
Published: September 2019

Abstract

Background
The National Stroke Audit 2015 showed that Ireland had made great advances in stroke care but one notable area of deficiency was in access to early swallow screening (within 4 hours). An early swallow screen is recommended by the Royal College of Physicians Stroke Guidelines (2016) to minimise the risk of aspiration pneumonia. The National Guideline for Swallow Screening in Stroke was released in May 2017 and outlines the need to have staff who are trained in swallow screening available 24/7. This audit aimed to evaluate the percentage of stroke patients in our hospital who received a documented swallow screen within 4 hours of admission.

Methods
Data relating to swallow screens/assessments and the time in which they were performed was extracted from our hospital’s HIPE database. The sample size included all confirmed strokes seen by the stroke service in our hospital in the first 6 months of 2018 (1/1/2018- 30/06/2018 inclusive). This amounted to 78 patients.

Results
In our hospital >90% of patients diagnosed with stroke get admitted to our stroke unit. Of the 78 patients, 38 (48.1%) had a documented swallow screen/assessment during admission, 27 did not have a documented swallow screen/assessment (34.2%) and for 14 patients (17.7%) it was unclear whether they had one during admission. Of the 38 patients who had documented swallow screens/assessments during admission 5 (13.2%) of these occurred within 4 hours of admission.

Conclusion
In summary while our hospital is succeeding in getting the vast majority of diagnosed strokes into our stroke unit we are not currently meeting the UK target for early swallow screening. We aim to roll out an education and training programme targeting nurses and doctors in our stroke unit regarding early swallow screening and re-audit this in 6-12 month’s time.
257 Participants’ Experience of a Novel Group Exercise Program: Results from the DEFRAIL (Diet and Exercise for Frailty) Study Pilot
Authors: Bambrick Pádraig , Phelan Niamh , Byrne Thomas , McMahon Clare , Pope George , Harrison Michael , Mulcahy Ríona , Cooke John 
Published: September 2019

Abstract

Background
DEFRAIL (Diet and Exercise for Frailty) is a translational study examining the effect of an eight-week multicomponent group exercise program and protein supplementation on frailty in older adults. As part of the development of this novel intervention, a four-week pilot was carried out to assess participants’ experience of the program, with a view to optimising the final format.

Methods
Inclusion in the DEFRAIL study requires a candidate to be deemed frail as per the Fried criteria. During the initial stages of recruitment for DEFRAIL, any individual who was identified as pre-frail was offered the opportunity to participate in the pilot trial (11 x 1-hour group sessions at a local sporting facility). Following its conclusion, a telephone interview using a standardised questionnaire was conducted on all participants to assess various aspects of their experience.

Results
Of 9 participants recruited for the pilot, 7 completed the four-week program (One participant failed to attend any sessions due to difficulties with transport and one participant withdrew after the first week, reporting excessive fatigue as the main issue). Amongst these 7 individuals, attendance was 90.9%. The only other adverse events recorded were delayed-onset muscle soreness (DOMS) in 4 out of 7 and aggravation of a pre-existing joint injury in one individual (neither of which prevented participation in subsequent classes). All attendees reporting enjoying the program with additional feedback obtained via the questionnaire regarding the timing, duration, frequency and intensity of classes, in addition to identifying potential barriers or enablers to participation.

Conclusion
This pilot of a novel exercise program for older adults was enjoyed and well-tolerated by pre-frail older adults. Participant feedback, both during the pilot and through a standardised questionnaire following completion, has had a meaningful impact on the final version of the exercise program that will be used for frail older adults in the DEFRAIL intervention.
263 An Audit of Patient Medication Lists in the Outpatient Setting
Authors: McAteer Claire , D'Alton Maeve , Farrell Sarah , Dunne Elaine , Soh Josephine , O'Connor Marie , Dolan Eamon , Kennelly Siobhán , Donohoe Orla , McGann Ciara , Colthorpe Anna 
Published: September 2019

Abstract

Background
Medication Reconciliation involves creating the most accurate list of medications that a patient is taking, with the patient/family member/caregiver being the first point of information. The main aim of this audit was to ascertain what proportion of patients attending outpatient appointments, brought an up-to-date list of their medications.

Methods
The audit was conducted using two anonymous, unlinked questionnaires, one completed by patients/caregivers, another completed by Doctors/Candidate Advanced Nurse Practitioners (cANP). Data was collected between 6/11/18 – 9/11/18 and incorporated Memory Clinics, General Geriatric Clinics and Hypertension/Stroke Clinics. 54 patient questionnaires and 53 Doctor/cANP questionnaires were completed.

Results
67% of patients reported having an up-to-date list of medications. 62% of doctors/cANP felt the patient had an up-to-date list. The majority of patients were aged 71-80, on 5-10 medications and felt that their GP had the most up-to-date list of their medications. Only 17% of patients reported that they themselves had the most up-to-date list of their medications. Where patients did not have an up-to-date list, Doctors/cANPs compiled a list by phoning the Pharmacy in 50% of cases and referring to previous clinic letters in 30% of cases. 34% of patients had medications changed at their clinic visit.

Conclusion
This audit shows that roughly one third of patients do not bring up-to-date lists of medications to their outpatient appointments and only a small proportion of patients feel that they themselves have the most up-to-date list of their own medications. Suggested areas for improvement include patient education campaigns, reminder letters/text messages to patients prior to their clinic appointments and the introduction of a Clinical Pharmacist to the outpatient setting.
270 Tackling Chronic Disease Burden and Building Resilience in Frail Community Populations in an Integrated Model- the ExWell Project
Authors: Byrne Emmett , McDermott Laurie , McCaffrey Noel , Kennelly Sean 
Published: September 2019

Abstract

Background
ExWell is a research validated, large scale, community-based chronic illness rehabilitation service. It is a collaborative project between local acute hospital, community organisation, local authority, and exercise medicine specialists. The mission of ExWell is to transform the lives of people with chronic illness through Physical-activity based rehabilitation. Participants are medically prescribed to the ExWell program by hospital physicians or their GP.

Methods
Referred participants have a two-day induction which includes strength and fitness testing that are covered by key metrics - hip/waist ratio, BMI, grip strength (upper body strength), sit to stand time for 10 repetitions (lower body strength), 6 minute time trial and posterior chain flexibility. These metrics are retested in 3 and 6 month intervals to assess progress. Participants are instructed on exercise technique and class fundamentals. These comprise of 4 stations (1) strength/resistance training; (2) Aerobic conditioning; (3) Balance/core strengthening; and (4) Dynamic movement. The regular full class comprises of 10min warmup, 40minute exercise and 10min cooldown.

Results
Since its inception in May 2018, ExWell based in the local leisure centre has grown exponentially with classes having tripled to 6 pw, with a further 3 classes pw starting in May 2019. Over 600 referrals have been received in the first year, 85% of these were from hospital services. Approximately 400/600 of referred participants were inducted into classes. Reasons for non-induction include diminished motivation, transport, work commitments. The average attendance each week is approximately 150 visits with an age range 27-92 years. (Average 68.3 years with 63.5% over the age of 65 and 10.7% over the age of 80).

Conclusion
ExWell demonstrates a scalable integrated partnership model for delivering sustainable exercise based programs to target chronic illness and frailty in community populations. Next steps include consolidating the ExWell program here and in two partner sites, with subsequent expansion to other areas.
274 From Clinical Care Programme to Frailty Pathway; a Multidisciplinary, Interagency Journey
Authors: Casey Amanda , Wei Fan Chie , Duggan Joseph 
Published: September 2019

Abstract

Background
The National Clinical Programme for Older Persons was introduced in the Model 4 Adult teaching hospital in 2012 with the development of a Specialist Geriatric Ward, supported by an existing Day Hospital and access to post acute rehabilitation in the local model 3 hospital. The continuing growth of the population over 70 years in the catchment area and the increasing awareness of the complex needs of this group of patients required a new way of thinking and working.

Methods
Using Lean methodology the group restructured the focus of the care pathway for older persons using evidence based practice and data collection. Workstreams have been identified and iterative project charters established to guide and empower staff to design and evaluate the supports they provide. Key internal and external stakeholders were identified and invited to participate in the ongoing steering group and the voice of the customer was used to underpin targeted improvements.

Results
The hospital now has a structured framework for the delivery and evaluation of care provided to older persons attending our services. Overall governance is provided by a Frailty Steering Group with strong clinical leadership and is informed by agreed quality indicators and realtime data. Despite increases in numbers requiring admission, length of stay has decreased, readmission rates have remained stable and a greater proportion of our patients are accessing both offsite rehabilitation and home supports on discharge.

Conclusion
This is an ongoing project with medium and long term goals identified across all workstreams. The evidence and data gathered will inform service planning and resource allocation. A number of collaborative research proposals are now being considered from across acute hospital and Community Healthcare Organisation.
283 Does a Pen and Paper Assessment of Executive Skills Correlate with Functional Decline Identified Through Specialised Occupational Therapy Assessment?
Authors: Tobin Fiona , McGuinn Caitriona , Pearson Corinne , Dooky Joshi , McHale Cathy , Coughlan Tara , O'Neill Desmond , Ryan Daniel , Collins Ronan , Kennelly Sean 
Published: September 2019

Abstract

Background
Executive skills refer to a set of cognitive skills that allow individuals to engage in goal directed behavior. They encompass planning, initiation, inhibition, monitoring and flexibility in approach to tasks, and are necessary for functional competence. Executive skills are vulnerable to disruption with damage to the brain, as occurs with dementia.

Methods
Participants were recruited from a tertiary memory assessment and support Service. The Assessment of Motor & Process Skills (AMPS), a standardised observational assessment of occupational performance (1Fischer, 2003) was administered by trained Occupational Therapists. In addition, the EXIT-25, a pen & paper based assessment of executive skills (2Royall et al, 1992) was administered. Process scores from the AMPS, and overall score from the EXIT 25 were utilised for correlation analysis.

Results
22 participants, 12 male and 10 females, age range 60-91 (mean 75.5 years), was analysed using Spearman’s Rho correlation (-.2). Results did not identify a strong correlation

Conclusion
Dementia is commonly regarded as a disorder of memory. However, diagnosis is dependent on functional decline related to cognitive decline. The AMPS provides a formal assessment of functional skills, in terms of motor & process skills with cut off scores regarding safe independent living. The results of this study indicate that the AMPS is not associated with executive scores on formal cognitive assessments, highlighting the value of an extensive multi-component MDT approach (also incorporating history taking, imaging, bio marker testing etc.) in assessing and diagnosing a dementia.
284 Improving Adherence to Irish Hip Fracture Database Standards 1 and 2
Authors: Hearne Siofra , Smyth Hannah , Monahan Pheadra , McGowan Hugh , Timmins Shirley , Hillary Paddy , Mahapatra Anant , Walsh Alan , Conlon Ciaran , Dunnill Eithne , Campbell Eleanor , Carolann Danielle , Ahern Tomas , O'Brien Helen 
Published: September 2019

Abstract

Background
The Irish Hip Fracture Database (IHFD) National Report 2017 demonstrated poor performance across all six IHFD standards in our hospital. For the purpose of this study we focused on standards 1 and 2. IHFD standard 1: All patients with hip fracture should be admitted to an acute orthopaedic ward within 4 hours of ED presentation/ brought directly to theatre from ED within 4 hours, and IHFD standard 2: All patients with hip fracture who are medically fit should have surgery within 48 hours of admission and during normal working hours.

Methods
We examined IHFD standards 1 and 2 from August 2017-January 2018 and August 2018-January 2019 after the appointment of an orthogeriatrician and use of the first Hip Fracture Pathway in August 2018. We also analysed data collected from February-April 2019 after amendment of the hip fracture pathway for patients presenting to the ED.

Results
IHFD Standard 1: From August to January 2017, 2.5% of patients were admitted to an orthopaedic ward within 4 hours versus 18.1% in 2018. IHFD Standard 2: in 2017, 64.8% underwent surgery within 48 hours during working hours, versus 65.3% in 2018. From February to April 2019, 32.1% of patients were admitted to an orthopaedic ward within 4 hours (IFHD 1) and 56.6% of patients underwent surgery within 48 hours and during working hours (IFHD 2).

Conclusion
Close collaboration between Emergency Medicine, Orthopaedic Surgery, Radiology, Nursing colleagues, Allied Health Professionals and Orthogeriatrics and amendment of the Hip Fracture Pathway have led to improvements in Standards 1 and 2. The addition of an orthogeriatric service in the hospital has resulted in an improvement in adherence to all IFHD standards. However, there are ongoing challenges to achieving Standard 2 including limited theatre access and increasing numbers of older patients on novel oral anticoagulants.
28 Steps Towards a more “Dementia Friendly” Medicine for the OLDER PERSON Acute Admission Ward
Authors: Lavery Paula , Smith Finola , Peel Michelle 
Published: September 2019

Abstract

Background
A “Dementia Friendly” ward is an environment that has been designed and adapted to take into account the care needs and environmental requirements of dementia patients (Dementia Action Alliance, 2013). Hospitals should be dementia friendly from admission to discharge (National Dementia Strategy 2014).
Occupational Therapists (OT) have unique skills in assessing the environment and understand the influence these have on a person’s engagement in valued occupations.
A one-day patient census on a Medicine for the Older Person Acute admission ward indicated that 60% of patients had an acute delirium. Fifty percent of patients had a documented diagnosis of dementia or mild cognitive impairment. In light of this, the OT team completed an audit to assess how “Dementia Friendly” the ward is.

Methods
The “Is your ward Dementia Friendly” Enhanced Healing Environment Assessment Tool, developed by the Kings Fund (2014) was utilised for the audit. The assessment tool contains seven sections which include “Orientation, Meaningful Interaction and Safe Mobility”. Following the audit, results were calculated in percentile format and long/short term goals for improvement were developed incorporating dementia friendly design principles.

Results
Meaningful Interaction: 35% Well-being: 37% Eating & Drnking: 37% Mobility: 34% Continence and Personal Hygiene: 40% Orientation: 44% Calm, Safety & Security: 53% The overall, average ward score achieved was 40% “Dementia Friendly” environment.

Conclusion
Following audit, the OT provided feedback to the ward manager and a ward committee was established with a wide variety of stakeholders, including, catering, nursing, allied health, and dementia services director. This committee meets on a regular basis with a joint vision to enhance the “dementia friendly” ward environment. Currently, actions are underway to target improvements in orientation and way-finding and social interaction. A re-audit will be completed in May 2019.
32 Exploring the Efficacy of a Discharge to Assess Model using a Combined Approach Involving FITT, OPAT and CIT
Authors: Lawlor Louise , O'Reilly Ciara , Platts Anne , Myler Lorraine 
Published: September 2019

Abstract

Background
Following hospital admission, older patients are at an increased risk of death and admission to nursing home care (Bachmann et al, 2010). Functional deterioration in older patients occurring prior to hospital admission is as a result of acute illness however deterioration following admission can be as a result of polypharmacy, excessive bedrest, sleep deprivation, institutionalisation and inadequate nutrition and may be amenable to changes in the processes of hospital care (Coleman et al, 2012) In terms of reducing costs in an ever-increasing older population, maintaining people in their own homes is more cost effective than high numbers going to residential care.

Methods
Therapists in the hospital identified appropriate patients and referred to FITT therapist’s (0.5 Occupational Therapist and Physiotherapist) and CIT nurses for review. Within 24 hours of discharge, patients were followed up by a home visit by FITT. The therapy team communicated the needs of the patient and the CIT nursing team would complete a visit. Once patient’s immediate needs were met and situation stabilised at home, onward referrals to both community and hospital services were co-ordinated as required.

Results
Sixteen patients over a four-week period were included. The main reason for referrals included: functional review in home environment, pain and medication management, patient and carer support.100% of patients were reviewed at home within 24 hours of discharge and required on average of 5 visits at home which equated to 119 bed days at home. This cross organisational project identified that rapid discharges can be facilitated which reduced length of stay and increased patient and family’s satisfaction with the discharge process.

Conclusion
This alternative model to the traditional hospital-based rehabilitation model needs to be considered in future service planning.
313 Caring for Older Persons with Dementia in an Acute Medical Care Setting: An Exploration of Nurses’ Experiences and Perceptions
Authors: Fitzmaurice Kay , Flynn Angela 
Published: September 2019

Abstract

Background
Presently in Ireland there are 55,000 people with dementia, with figures projected to rise to 130,000 by 2041. In acute hospitals, ensuring the provision of high standard, person-centred care for people with dementia is an essential part of policy and practice development. While nurses are key in implementing safe, effective and evidenced based care it is unclear at this moment what their experiences are, when caring for patients with dementia. It is twelve years since the last study was conducted in Ireland in a purpose-built unit for older patients so will not be reflective of an acute care setting. Therefore, it is timely to gather a current description of nurses’ experiences and perceptions in caring for patients with dementia in an acute care setting.

Methods
A purposeful sample of nine nurses working in an acute medical ward caring for patients with dementia participated in the study. Data was collected using semi-structured interviews, transcribed verbatim and analysed using content analysis.

Results
The findings are current and highlight that nurse’s display immense respect and empathy to patients with dementia and see beyond the dementia to the individuality of the person. This demonstrates positive attitudes towards these patients, despite organisational and environmental constraints. The findings further identify that staffing levels are inadequate and that nurses require specific education on dementia. Furthermore, the organisational culture and environmental design are not conducive for patients with dementia and changes need implementing in line with the Irish National Dementia Strategy and the Dementia Friendly Hospital Design Guideline.

Conclusion
These findings have provided a current view of nurses’ experiences and perceptions of caring for patients with dementia in an acute medical ward and support previous study findings. Strategies are now required to address these issues, with a focus on the six priority action areas from The Irish National Dementia Strategy.