bluuebunny/crossref_metadata_2025_split huggingface dataset:
14 Identifying and Addressing Challenges Experienced by Nurses when Caring for Persons with Dementia Experiencing Responsive Behaviours in Acute Hospitals
Authors: Dookhy Joshi , Daly Louise 
Published: September 2019

Abstract

Background
Due to the increasing number of persons with dementia being hospitalised (Timmons et al., 2015), nurses working in acute hospitals need to be competent in caring for this patient population. Amongst other dementia-care specific competencies, nurses require competence in caring for those with dementia who experience responsive behaviours, a common phenomenon in acute hospitals. The aims of this study were to explore challenges encountered by nurses in caring for persons with dementia experiencing responsive behaviours in an acute hospital and to explore strategies used by nurses to address the encountered challenges.

Methods
A qualitative descriptive study, involving semi-structured interviews with nine nurses was conducted. Ethical approval was received from the School of Nursing & Midwifery Research Ethics Committee in the participating University. Data was collected in 2018 and was analysed using a thematic analysis approach.

Results
An analysis identified three challenging components for nurses, namely: emotional, environmental and organisational challenges.
These challenges in turn contributed to barriers to the provision of nursing care and management of responsive behaviours in the setting. To address these challenges, nurses implemented therapeutic interventions, for example reminiscence, and engaged with other healthcare professionals and caregivers.

Conclusion
This study explored how various emotional, environmental and organisational challenges are experienced and addressed by nurses when managing responsive behaviours in the acute hospital. The increasing number of persons with dementia attending acute hospitals necessitates an urgency for service development to enhance the specific dementia-care competency levels of nurses. Changes at an organisational level, to support competency development in dementia-care in acute hospitals, must also be adopted.
18 A Review of Interventions to Improve Medication Adherence in Patients with Parkinson’s Disease
Authors: McMahon Niamh , Kelly Neasa , Henman Martin 
Published: September 2019

Abstract

Background
In Parkinson’s Disease (PD) medication adherence has been neglected. Despite evidence of successful interventions in other chronic diseases, there is currently no review of medication adherence enhancing interventions in PD populations. This review sought to identify and evaluate interventions to improve medication adherence in patients with PD.

Methods
Six online databases (PubMed, EMBASE, Medline, PsycINFO, CinahlCOMPLETE, AMED) were searched. Key concepts “Medication adherence” and “Parkinson’s disease” were used. Reference lists of retrieved studies were hand searched. Studies were assessed for inclusion against pre-specified eligibility criteria. Data extraction was carried out using a standardised data extraction table. Critical appraisal was undertaken using the JADAD score, CASP Randomised Controlled Trial (RCT) checklist, “Quality Assessment tool for before-after studies with no control group” and the TREND statement checklist.

Results
The search resulted in 612 records of which five met inclusion criteria (3 RCT, 2 before-after studies). A total of 496 PD patients were included. Interventional strategies investigated were educational intervention, adherence therapy, effect of a Parkinson’s Tracker App (PTA) and intervention by a pharmacist. Five (100%) of the studies included in this review reported a statistically significant improvement in medication adherence post-intervention and some improvements in symptoms.

Conclusion
This is the first review of medication adherence in the PD population. Several different interventions proved effective in enhancing medication adherence, but the studies were small, short term and the risk of bias ranged from moderate to high. Consequently, the results may not be generalisable to other PD populations.
182 Feasibility and Usability of a New National Transfer Document for Older Persons: A Pilot Study
Authors: Coffey Alice , O'Reilly Pauline , Meskell Pauline , Tuohy Dympna , O'Brien Brid , Murphy Jill , Doody Owen , Graham Margaret , Fahy Anne , Barry Louise , O'Keeffe Jonathan , Kiely Michelle , O'Doherty Jane 
Published: September 2019

Abstract

Background
There is an increasing number of older persons experiencing transfer episodes between residential and acute care facilities (Griffiths et al. 2014). Current transfer documentation is diverse; often only containing basic information and very little person centred patient information. The objective of this HSE National Clinical Programme for Older People funded study was to develop a national person centred transfer tool, for use during patient transfer between residential and acute services. Following an extensive literature review, focus group interviews with stakeholders and input from an expert panel, a pilot transfer document was developed. This paper reports on the pilot study of this document.

Methods
Researchers, in consultation with the expert panel, developed questionnaires. Questionnaires were quantitative, with three open-ended questions. Of the 28 residential settings and 3 acute settings that were contacted, 26 residential and 3 acute settings (93%) participated in the study. The pre-pilot questionnaire asked staff in residential settings their perceptions on current transfer documentation (n=875). The post-pilot questionnaire asked staff in residential and acute care settings their thoughts on the new transfer document which was used for the pilot (n=1085).

Results
Findings suggest that staff agree that the new transfer tool is person centred, contains relevant patient information and could help communication between healthcare professionals in these settings. Findings also indicate that the length of time to complete the document is of concern, particularly in an emergency and there were suggestions from staff in residential care services that some sections could be prepopulated.

Conclusion
In order to have a transfer document that is efficient, and person centred, there is a need for it to be available electronically and easy for staff to fully complete particularly in an emergency transfer.
186 Tailoring Change Management - Learning from “Readiness-to-Change” and Learning Needs Analyses, Focused on Dementia Palliative Care, in Three Long-term Care Settings
Authors: Timmons Suzanne , Cornally Nicola , Hartigan Irene , Lehane Elaine , Buckley Catherine , O’Loughlin Christina , Finn Colette , Lynch Marie , Coffey Alice 
Published: September 2019

Abstract

Background
Over one third of people with dementia in Ireland reside in Long Term Care (LTC) settings. Dementia palliative care is complex; healthcare staff in LTC settings have requested specific guidance to support practice. This participatory action research project will introduce national evidence-based guidance documents relating to pain, hydration/nutrition, and medication management, into three LTC settings in Munster, using a tailored Work-based Learning approach, informed by a baseline multi-modal situational analysis.

Methods
Site and staff data were collected using a site profile tool; staff demographic and learning needs surveys; and the ‘VOCALISE’ readiness-to-change survey, in the three sites.

Results
Within the sites, 42-88% of residents had probable/definite dementia. Multidisciplinary input varied considerably between sites. In total, 69 staff (predominantly nurses and healthcare attendants) completed learning needs surveys. Many reported prior dementia education (range 53-76% across sites). This was twice as often on hydration/nutrition and medication topics than pain. Reflecting this, staff in all sites identified knowledge deficits, but particularly in pain identification, assessment and management. Other learning needs included supporting and communicating with families; resident care planning and advance care planning; and resident ‘comfort’.
Of 58 staff with completed VOCALISE data, 33% were rated as ‘ready to change’, 14% ‘not’, and the remainder ambivalent. Interestingly, staff had high confidence in the ability of change to happen, but low motivation scores; and overall ambivalence towards their own power to make change happen. Some barriers were site-specific, but overall, staffing levels, managing risk during change and perceived reluctance in others were common barriers to change, as was the possibility that patient wishes hadn’t informed the change process.

Conclusion
Our baseline data highlights that education and change implementation needs to be tailored to the recipient site, recognising site-specific barriers to change. We will now use this data in our Work-based Learning intervention.
213 A New Way of Memory Care in an Integrated Care HUB
Authors: Murphy Catherine , Cooke John , Mulchay Riona , Pope George , Bolger Maggie , Roche Suzanne , O'Gorman Millie , Brennan Jacinta , Phelan Niamh , Grant Emma , Doyle Marie 
Published: September 2019

Abstract

Background
The Occupational Therapy (OT) service in the integrated care HUB team was established in January 2018. Prior to this, there was an established memory clinic, however with inconsistent access to OT. The streamlining and structuring of memory clinics further highlighted the need for post-diagnostic support for example individual sessions focusing on memory education and practical strategies to enable independence in daily activities. The integration of OT enabled person-centred strategies to be provided to individuals experiencing memory loss.

Methods
A retrospective analysis was completed comparing the number of OT memory patient contacts between January to June 2018 and November 2018 to April 2019 also reflecting the memory care pathway developed during this period. OT assessed all new patients experiencing memory difficulties that impacted on functional activities to initiate referral process. In April 2018, the Memory Technology Resource Room (MTRR) opened and the OT HUB using to facilitate patient contacts. The design/implementation of cognitive rehabilitation groups in May 2018 added another step to pathway. Dementia cafés were established in public cafés in the city and county area, sponsored by local care provider, also supported by HUB team. Feedback was gathered from surveys given to individuals, carers and HUB team in the Café and MTRR.

Results
From January to June 2018 there were 50 memory streamed patient contacts completed by the OT. From November 2018 to April 2019, 206 patient contacts were completed. These include both individual and group cognition focused sessions. Positive qualitative feedback was retrieved from attendees to MTRR and Café all indicating at least one positive outcome from post-diagnostic supports and services.

Conclusion
A multi-domain cognitive OT service when initiated by an integrated care HUB proves to be an effective and acceptable memory care pathway. The development of this holistic pathway enabled the person to be seen in the right place, at the right stage of their journey with memory difficulties.
23 The Implementation of a Hospital “Buddy Walking Programme” to Improve Access to Mobility for Acute Hospital in-Patients
Authors: Lombard Eileen , Higgins Anna , Timmons Suzanne , McCullagh Ruth 
Published: September 2019

Abstract

Background
An acute hospital admission often means that patient’s mobility can decline if not maintained and encouraged throughout their inpatient stay. The “Buddy Walking Programme” is a joint initiative between the physiotherapy department, nursing department and hospital volunteers. The aim of this research was to implement a hospital “Buddy Walking Programme” within a teaching hospital in Cork to allow the provision of accompanied walking sessions by members of the hospital’s volunteer team.

Methods
Ward based physiotherapy staff and nursing staff identify suitable patients and add their bed number and mobility status to a list each morning. Patients are identified who are independently mobile or can safely mobilise with the supervision of one person, with or without a mobility aid and who are cognitively capable of simple commands.
Physiotherapists and nursing staff are made aware of the programme at induction. Volunteers partake in an educational session and manual handling training prior to offering supervised walking sessions.

Results
A standard operating procedure has been developed for the “Buddy Walking Programme”. Training has been rolled out hospital wide amongst nursing staff, physiotherapy staff and hospital volunteers.

Conclusion
This programme will help encourage a culture of physical activity within the hospital in-patient setting and improve mobility levels. Further research is warranted to explore the beliefs and perceptions of hospital staff and volunteers regarding the initiative and to examine barriers and facilitators to the programme.
226 Staff Knowledge of Orthostatic Hypotension
Authors: O'Brien Michelle , Britton Jennifer , Clarke Miriam , Collins Orla 
Published: September 2019

Abstract

Background
The prevalence of orthostatic hypotension increases with age(1). The aim of this audit was to assess healthcare provider’s knowledge of identifying and measuring orthostatic hypotension (OH) in the acute setting. Early identification and management of OH is an important step to prevent adverse outcomes and improve patient’s overall functional performance.

Methods
Fifty-one questionnaires were distributed to a random selection of non-consultant doctors and nurses in our hospital. The questionnaires included questions regarding basic knowledge of OH and its measurement. Questions were based on international guidelines on the appropriate measurement and assessment of OH(1). An education session was then offered to junior doctors and nurses, and subsequently carried out by a senior nurse. Staff were educated on OH and how to correctly assess it. Doctors and nurses were subsequently reassessed using the same questionnaire.

Results
Initial results showed that many of the respondents were interns (37%) and nurses (35%). 94% of respondents had never received formal training in the evaluation of OH. 51% knew that a patient should lie supine for 5 minutes prior to initial BP assessment. 61% knew to take the BP at 1-minute post standing, and 45% knew that the BP should again be taken at 3 minutes. 71% knew to take the pulse alongside the BP checks. The education sessions and repeat audit are ongoing.

Conclusion
Many of the hospital staff who assess for OH have not received specific training on how to evaluate and diagnose OH. It is our aim to educate front line staff as to the importance of looking for OH and how to diagnose it.
228 Potentially Inappropriate Prescribing in Community Nursing Units: Prevalence and Potential for Optimisation
Authors: Collins Neil , Gallagher Paul 
Published: September 2019

Abstract

Background
It is well researched that individuals in long-term care (LTC) are prescribed a greater number of medications, the leading risk factor for inappropriate prescribing, and are thus at greater risk of adverse drug reactions as a result. Many tools with explicit criteria are described in the literature for assessing potentially inappropriate prescribing (PIP) in the general geriatric population, but few have been developed to examine prescribing in LTC.

Methods
This was a point prevalence observational study of patients aged >65 years residing in three HSE-run LTC facilities in Cork. Demographic characteristics, medical diagnoses and medication regimes at time of admission (TOA) to LTC, and time of data collection were recorded and reviewed using STOPPFrail and NORGEP-NH criteria.

Results
98 patients met the inclusion criteria, with 66% being female. The median age was 83 years (IQR 77-88 years), and median length of stay was 31 months (IQR 14-53 months). The median number of medications per person on admission was 8 (IQR 6-11), which increased to 9 (IQR 7-11) at time of review (TOR)(p<0.001). PIP was found in 70 (84.3%) patients at TOA, and 79(80.6%) at TOR using STOPPFrail, and was recorded as 81 (97.6%) at TOA, and 95(96.9%) at TOR using NORGEP-NH. Among the STOPPFrail criteria most commonly implicated were continuous use of nutritional supplements and high dose PPI therapy. With NORGEP, the most commonly implicated were use of antidepressants and antihypertensives. There was an increase in number of patients prescribed benzodiazepines, z-drugs, anti-depressants and anti-psychotics from TOA to TOR, while statins were prescribed less often at TOR (p<0.001).

Conclusion
Potentially inappropriate prescribing is highly prevalent in older residents of community hospitals using validated prescribing indicators. Criteria such as those used in this study could be used to highlight potentially inappropriate or futile medications in older, vulnerable patients. Regular medication review is recommended to facilitate deprescribing of such medications.
243 An Audit of Documentation of Resuscitation Status in a Teaching Hospital
Authors: McDonough Anna , O'Hanlon Shane 
Published: September 2019

Abstract

Background
The documentation of discussions about resuscitation status with patients and their relatives is an important part of medical care, but can be a time-consuming process. These discussions may be difficult, particularly for patients who have cognitive impairment or are acutely unwell. The National Consent Policy1 recommends that resuscitation decisions should be made with patients themselves, or with family members if the patient cannot participate. It also recommends decisions are made by the most senior decision maker with responsibility for the patient’s care and discussions should be carefully documented.

Methods
The charts of all 106 inpatients in our hospital were audited on a single day. Documentation of resuscitation status in the medical and nursing notes was reviewed.

Results
The average age of inpatients was 79.8 years. 25.5% of patients had a DNACPR order. Of these, 92% had their DNACPR status documented in the nursing notes. 100% had a DNACPR form in their medical notes but none were fully completed. 48% had not had the decision endorsed by the consultant in charge of the patient’s care. 74% had not been discussed with the patient or had not had a reason documented as to why the decision had not been discussed. 41% did not have any discussion documented in the medical notes.

Conclusion
The DNACPR form in use includes the details recommended by national guidelines but these forms are not being completed in their entirety. Discussions with patients themselves are possibly inappropriate at the time resuscitation status is being considered, but documentation of the reasons for this is still important. This, in particular is an area which needs to be highlighted to medical staff in our hospital. Results of this audit will be incorporated into an education session, with a view to changing practice.
247 Antipsychotic Medication in the Management of Non-cognitive Symptoms of Dementia: An Updated Evidence Review
Authors: Fox Siobhán , Murphy Ashling , Jennings Aisling , Murphy Kieran , Timmons Suzanne 
Published: September 2019

Abstract

Background
Antipsychotic medications are commonly used in the management of non-cognitive symptoms of dementia (also termed behavioural and psychological symptoms of dementia), such as agitation, calling out, hoarding, or aggression. This is despite increased recognition of adverse effects, including mortality, from these medications for people with dementia. The current aim was to review the most recent evidence for the efficacy and safety of antipsychotic medications in the management of non-cognitive symptoms in dementia.

Methods
Relevant studies published in English from March 2015 through to March 2018 were identified by searches of 5 databases: Medline, EBSCO, PsycINFO, Cochrane DARE, and Cochrane CENTRAL. Systematic reviews, meta-analyses, and controlled trials evaluating the safety of antipsychotic medication, or comparing the effectiveness of antipsychotic medication with placebo, another antipsychotic medication, or non-pharmacological intervention, were included. Independent article review and data extraction was performed by two reviewers. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools.

Results
Thirteen studies were included. Benefits and harms vary among antipsychotic medications for people with dementia, however overall efficacy of antipsychotics remains modest at best. A significant number of side effects are associated with antipsychotics, not least cerebrovascular events, sedation, gait disturbances, falls, fractures, urinary tract infections, cognitive worsening, and mortality. Atypical antipsychotics have a more favourable safety profile in some respects. People with certain dementias, notably Lewy Body Dementia, may experience more severe side-effects.

Conclusion
The evidence reinforces caution when prescribing antipsychotic medications for people with dementia; these medications should only be considered when symptoms are severe or non-pharmacological interventions have failed. Clinicians should closely monitor people with dementia who are prescribed an antipsychotic for side effects, limiting use of these medications to short-term treatment if possible. The forthcoming national clinical guideline for appropriate prescribing of psychotropic medications for non-cognitive symptoms will support clinical decision-making in this regard.
259 The Electronic Patient Record as an Enabler for Hospital Wide Delirium and Dementia Screening -Lessons Learned from a Clinical Implementation
Authors: Chapman Lucy , Corbett Mel , Courtney Grainne , Lawlor Brian 
Published: September 2019

Abstract

Background
The validated 4 As Test (4AT) cognitive screening tool was incorporated into the electronic patient record (EPR) to facilitate hospital wide delirium and dementia screening. Completion of the 4AT was mandated by its incorporation into a computer alert targeted at doctors. This alert was generated on all hospital inpatients aged 65 years and over at 24 hours into admission in keeping with the National Institute for Health and Care Excellence guidelines. An option to bypass the 4AT alert was available.

Methods
Multidisciplinary clinical stakeholder workshops informed the design of the electronic cognitive screening alert. An implementation strategy was undertaken using intensive clinical engagement. On June 27th 2018, the 4AT electronic alert was deployed. Data entries from the completed electronic 4AT assessments were extracted from the EPR facilitating descriptive statistical analysis and point prevalence analysis for delirium and dementia. Specialty-based comparisons were also made.

Results
During the first 24 hours post-implementation, 4AT screening assessments were completed in 61% of instances equating to 324 completed assessments. Forty eight percent (n=155) had a score of zero suggestive of normal cognitive status. Notably, 20% assessments yielded a score reflective of possible delirium (four or more). Dementia was a recognised clinical diagnosis in 23% (n=76) of patients. One in two of these dementia patients scored four or more indicative of coexistent delirium.

Conclusion
Electronic patient records can be harnessed to facilitate hospital-wide delirium and dementia screening and improve detection. This also represents a novel method to capture data for the purposes of audit and research as well as to inform and improve future directions in clinical care and resource allocation. Innovative computer-based strategies may offer future directions to augment detection of cognitive disorders in hospitalised populations.