bluuebunny/crossref_metadata_2025_split huggingface dataset:
304 ED-FASU: A Novel ‘Front Door’ Multidisciplinary Service Assessing Patients with Falls and Syncope in the Emergency Department
Authors: Bourke Robbie , Rice Ciara , McMahon Geraldine , Cunningham Conal , Anne Kenny Rose , Briggs Robert 
Published: September 2019

Abstract

Background
Patients with falls/syncope/presyncope frequently present to the emergency department (ED) and many that could be managed safely in an ambulatory care setting are admitted for extensive diagnostic work-up.
A pilot intervention commenced in March 2019, with direct access to specialist assessment in the ED for patients presenting with falls/syncope/presyncope, aiming to provide appropriate testing and early diagnosis to reduce unnecessary hospitalizations.
This pilot study assessed the feasibility of embedding this service within the ED, as well as the effectiveness of the intervention in terms of admission avoidance.

Methods
The study was conducted between 25th March and 19th April 2019 in a large urban teaching hospital with a dedicated Falls & Syncope Unit and compared to similar data from March/April 2018.
The core ED-FASU team comprised a consultant geriatrician, specialist registrar in geriatric medicine and clinical nurse specialist.
Inclusion criteria were those of all ages, presenting with falls/syncope/presyncope/dizziness between 0800-1800 Monday-Friday. Patients were reviewed directly from triage or after referral from the ED team.

Results
In total, 203 patients were assessed during the pilot, an average of 10 assessments per day. The median age of those seen was 63 (58.0-67.0) years. Almost one third (57/203) were aged ≥75 years.
After excluding those who were already admitted to the acute hospital and awaiting a bed when seen in the ED (n=29), 24% (41/174) of those seen were admitted to hospital. This compares to an admission rate of 33% (73/223) for the 2018 comparison group (p = 0.045).

Conclusion
This pilot study shows that it is feasible to embed specialist assessment for falls/syncope/presyncope in the ED.
Initial pilot data suggests a significant reduction in admission rates for those seen by this service but needs to be confirmed over a more prolonged assessment period and alongside data on readmission and length of stay.
312 Implementation of a Formalised Weekend Hospital Handover Process
Authors: Chapman Lucy , Hannigan Oisin , Courtney Grainne , Cunningham Conal , Byrne Declan 
Published: September 2019

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.