bluuebunny/crossref_metadata_2025_split huggingface dataset:
338 Evaluation of a new clinical pharmacy service model in a University Teaching hospital in Dublin, Ireland
Authors: Williamson Claire , Collins Aisling , Carr Bernard , Melanophy Gail , Byrne Stephen 
Published: September 2019

Abstract

Background
Advances in medicines reconciliation, drug monitoring and patient counselling requirements as well as added non-clinical responsibilities at ward level have led to an increased workload on a ward-based pharmacist. There is a need to optimise the service to meet these demands.
The aim of this study was to audit the current clinical pharmacy services and to implement a New Model of Clinical Pharmacy on four wards to aid in the optimisation and prioritisation of patients during the clinical ward service.

Methods
The study was undertaken in Dublin based, University Teaching Hospital between March and June 2018. The study included the following: (1) a comprehensive literature review, (2) focus groups with key decision makers, (3) the collection and analysis of quantitative data on patients screening and interventions performed pre- and post- model implementation, (4) the final stage involved a satisfaction surveys from pharmacists involved in the study. Local ethical approval was obtained for this study.

Results
The new clinical pharmacy model increased the amount of medicines reconciliation completed (pre-model implementation 77.7% (n=192) versus post-model implementation 81.6% (n=236)), decreased time to medication reconciliation completion on Mondays and Fridays, increased discharge information cards completed and did not show statistical inferiority in the amount of interventions picked up by pharmacists (p value= 0.86; two tailed t-test). Pharmacists in the study felt the model impacted their clinical ward visit positively and aided prioritisation but did not improve on their overall job satisfaction level.

Conclusion
The study shows that a new model of clinical pharmacy can impact positively on a pharmacist’s working day by formalising the prioritisation of high-risk patients, setting clear expectations and structure without impacting negatively on other clinical duties. It is believed that the model developed will continue to support the pharmacists’ decision making and workload prioritisation post implementation of electronic prescribing.
40 Using the Variable Indication of Placement Tool to Drive De-prescribing in the Frail Older Person in an Interdisciplinary Integrated Team
Authors: Vince Athanasiyar , Pillay Isweri , O’Reilly Aine , Cooney Eamonn , Maher Jennifer , Pender Ciara , Ryan Siobhan , Sayers Karen , Donnellan Christina 
Published: September 2019

Abstract

Background
The variable indicator of placement (VIP) tool is designed to identify patients at risk of frailty. The risk of harm in a frail older person increases as the number of prescribed drugs increases. Polypharmacy may be either appropriate or inappropriate. Deprescribing, aims to withdraw inappropriate medication under supervision, in order to improve outcomes.

Methods
50 consecutive patients, attending an emergency department, were triaged with the VIP tool, triggering a single interdisciplinary assessment (SIA) by an integrated care team member. The SIA identified polypharmacy. Drugs which may be causing harm, may no longer be of benefit or were potentially interacting with other drugs, were identified. The Anti-cholinergic Burden (ACB) Score was calculated. Appropriate medication changes were made following interdisciplinary and patient/carer discussion. Patients were selected for one to one pharmacy and patient/carer liaison, which was followed through into their community setting e.g. long term benzodiazepine usage.

Results
The drugs which were identified for gradual withdrawal or cessation were benzodiazepines (n=6), opiates (n=4), genitourinary (n=2), digoxin (n=2), hyoscine (n=2), domperidone (n=2) and amitryptilline (n=1). The total ACB score for 50 patients was 95 pre-assessment and 65 post-assessment. This represented a 32% reduction in anti-cholinergic burden alone for this frail older adult cohort.

Conclusion
The VIP tool if used to trigger an SIA, can target those patients at risk of the adverse effects of polypharmacy. The calculated ACB score can trigger meaningful discussion with patients and carers around what matters to them. A system for supervised deprescribing is necessary to ensure successful reduction in ACB.
41 From Ward to Classroom: Service Evaluation of Education to Increase Awareness of Frailty and Resilience and Encourage Greater Physical Activity
Authors: Travers John , Romero-Ortuno Roman , Lyons Declan , Cooney Marie-Therese 
Published: September 2019

Abstract

Background
Our hospital routinely offers a weekly group discussion session for inpatients on aspects of ageing as part of an ‘evergreen programme’ (EP) of health education. Topics are varied and facilitated by a doctor in an informal, open forum. Feedback from nurses, doctors and patients suggested that the EP was lacking in emphasis on the benefits of exercise to improve the levels of physical activity among inpatients. As part of a local quality improvement (QI) initiative, the EP set out to incorporate the provision of patient education on the reported benefits of strength exercises in delaying and reversing frailty. Here we describe the development of this QI initiative and its evaluation.

Methods
New health education content was added to an EP group discussion to address four key aspects of frailty, namely: definition, risks, screening and interventions. The Socratic health education method was used in the next weekly group discussion (e.g., what does frailty mean to you? What are the consequences? How would you measure frailty? What if it could be delayed or reversed?). An exercise leaflet was provided and strength exercises were demonstrated.

Results
18 of 27 over-65-year-old patients attended the group discussion, mean age 75, 11 female (61%). 2 participants were interested in doing strength exercises at the start of the session (11%, 0 female) when asked. Most participants had not been aware that strength exercises can delay and reverse frailty. 14 participants (78%, 8 female) declared interest in doing strength exercises at the end. Interested participants used the exercise leaflet for independent exercise in hospital and brought it home on discharge.

Conclusion
The EP at our hospital has been improved to include greater emphasis on the benefits of strength exercises in delaying and reversing frailty. QI initiatives can allow translation of research evidence into patient education.
55 A Review of Stroke Demographics and Outcomes at a Regional Hospital without a Stroke Unit
Authors: Pillay Lushen , Galav Kushan , Tulsi Deeptish , McGlynn Joanna , Doherty John , Donnelly Teresa 
Published: September 2019

Abstract

Background
According to the 2017 National Stroke Register Report; 75% of strokes occur in patients aged 65 years and older. Within the audit 19 stroke units reported that 70.6% of stroke patients were admitted to a stroke unit and their median length of stay of 9 days. Numerous studies have shown better outcomes in patients admitted to a stroke unit versus a medical unit leading to national stroke networks and bypass protocols for patients. However, stroke patients can still be found in non-stroke unit hospitals such as our own.

Methods
Demographics from HIPE data was collected on all stroke patients admitted to our hospital between January 1st and December 31st 2017. Basic statistical methods were used to analyse the data.

Results
We analyzed 103 patient records. The average age at presentation was 73 years (range: 35-97) and 60.1% were males. The average length of hospital stay was 16.1 days (range 1- 130 days). Ischemic (77%) events were more common than haemorrhagic events (23%). The three most common co-morbidities were hypertension (45%), hyperlipidemia (30%) and atrial fibrillation (19%). Discharge destination was home (66%), nursing home (14%), national rehabilitation (2%) and an 18% mortality rate within 3 months. The mortality rate was higher in the hemorrhagic (42%) compared to ischemic (11%).

Conclusion
The average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.
60 Opening the Narrative on Deprivation of Liberty for the Older Person in Residential Healthcare Facilities: A Legal and Ethical Dilemma
Authors: Hogan Florence , Ahern Adrian 
Published: September 2019

Abstract

Background
While many people enter residential care of their own free will and because it is their preference, the evidence tells us that there are also many who if they had the choice would remain in their own homes. Lack of appropriate community supports may provide some impetus to enter residential care. According to Care Alliance Ireland, an additional four million hours of homecare needs to be provided to cope with the successful ageing demographics, at a cost of €110 million.
There is no statutory or common-law power to detain a patient in a Healthcare Facility outside of the application of the Mental Health Act 2001. This presents legal, ethical and moral dilemmas for Healthcare Providers when caring for a person who lacks capacity wishes to self - discharge. A duty of care obligates healthcare professionals to act in the best interest of the individual. Under the Health Act 2007 the requirement is to provide for a ‘safe discharge’.
Pending advancement of the Assisted Decision Making (Capacity) Act 2015 which provides a statutory framework to assist and support individuals to make legally-binding agreements about their welfare, their property and affairs we are currently acting under the Lunacy Regulations (1871).

Methods
We developed a ‘Deprivation of Liberty’ form which enable comprehensive Interdisciplinary Team discussion and direction of care. Presumption of capacity, respect for the resident’s wishes and consideration of all possible supportive actions up to and including sourcing community support services were considered.

Results
This format has enabled comprehensive discussion and robust adherence to human rights for three residents thus far

Conclusion
The situation remains that there is no legal framework to guide healthcare providers currently. Using a Human Rights based approach is imperative to guide us while awaiting advancement of the ADMA (2015) and Deprivation of Liberty legislation to be included in this act.
74 GPs Knowledge of and Attitudes Towards the Management of Behavioural and Psychological Symptoms of Dementia: a Descriptive Cross Sectional Study
Authors: Jennings Aisling A , Fatimah Dhuny Sheefah Bibi , Foley Tony 
Published: September 2019

Abstract

Background
Evidence suggests that the current management of behavioural and psychological symptoms of dementia (BPSD) in general practice is sub-optimal. Non-pharmacological strategies are recommended first-line but uptake of these strategies is low. Despite their adverse effects and minimal effectiveness antipsychotics are frequently employed to manage BPSD. The aim of this study was to explore general practitioners (GPs) knowledge of and attitudes towards the management of BPSD with a view to informing future interventions.

Methods
A questionnaire was adapted from existing study. Additional questions were included, informed by the findings of a qualitative study previously conducted by the authors. The questionnaire was piloted with 3 GPs and was posted to a census sample of all GPs in county Cork and county Kerry in the south of Ireland. Statistical analysis was performed using SPSS.

Results
Of the 456 questionnaires sent 168 completed questionnaires were returned (36.8% response rate). The sample was representative of GPs nationally in terms of years of practice (p<0.0001). 62.5 % (105/168) of respondents had a nursing home commitment. The majority of GPs (60.7%) agreed that they required more training to improve their management of BPSD. ‘Lack of resources in the primary care team’ was cited as the main barrier to GPs recommending non-pharmacological strategies in the community. Nursing staff were identified as the group of people that most influenced the GPs prescribing of antipsychotic medications in a nursing home setting. The majority of respondents (84/168) did not monitor their prescribing of antipsychotics to people with dementia. 63.1% (106/168) of GPs were concerned that withdrawing these medications would negatively impact on the quality of life of the person with dementia.

Conclusion
This study identified several factors that influenced the management of BPSD in general practice. These findings will be used to guide future interventions in this area.
83 The Feasibility of an Interdisciplinary Led Community Based Functional Training Group for Frail Older Adults in a Post-Acute Orthogeriatric Unit
Authors: McDaid Edel , Johnston Aoife , Ross Elaine , Cogan Lisa 
Published: September 2019

Abstract

Background
Reduced ability to perform instrumental activities of daily living (IADLs) can lead to a difficult transition from hospital to home, increased dependence and diminished quality of life (1). A novel IADL group for frail older adults ‘Ready Steady Home’ was completed to facilitate transition from hospital to home.

Methods
A single centre prospective study was undertaken in a Post-Acute Orthogeriatric Rehabilitation Care unit. A sample of convenience was recruited over a 3 month period. All subjects invited to participate had been referred for Physiotherapy and Occupational Therapy, medically stable, able to give consent, mobile with/without an aid and had a goal of community ambulation and IADLS. The one hour intervention consisted of a car transfer, outdoor mobility on a busy footpath, road crossing, negotiating a busy shop, completing shopping task and financial management. A self-reported modified Client Satisfaction Questionnaire (CSQ-8) was completed by all subjects post intervention. Data was analysed using descriptive statistics.

Results
Twelve participants (female (12); mean age 83.7 years, mean LOS 32.75 days) completed the intervention and were included in the data. All were frail with a Clinical Frailty Scale score ≥ 5, mild (n=4), moderate (n=7) and severe frailty (n=1). Primary diagnosis was femoral fracture (n=7), hip surgery revision (n=2), deconditioning (n=2) and pelvic fracture (n=1). All used a unilateral (n=5) and/or bilateral mobility aid (n=7). The mean CSQ-8 score was 27/32 indicating high satisfaction with the intervention. No adverse events occurred. Common themes reported were improved confidence with community ambulation, preparation for home and re-integration into the community.

Conclusion
This study indicates that an interdisciplinary intervention addressing community based IADLS was feasible, safe and effective in a frail Orthogeriatric inpatient cohort. Further research is required to evaluate the effectiveness of this therapy intervention in improving hospital to home transition and potential reduction in LOS.
104 Exploring the Utility of the VERA Framework to Improve Communication between Nursing Students and People with Dementia in Long-term Care
Authors: Dorey Amber , Jordan Fionnuala , Casey Dympna 
Published: September 2019

Abstract

Background
Developed by Blackhall et al. (2011), the Validation, Emotion, Reassure, Activity (VERA) communication framework seeks to provide student nurses with a guide to provide person-centred care to people living with dementia. The framework aims to enable the caregiver to communicate with the person living with dementia in a respectful manner, and accept that there is both value and meaning to the person’s speech and behaviour. This paper presents the findings from a small pilot control pre-post study which aimed to explore the impact of the VERA framework to promote person-centred communication between student nurses and older people with dementia in long term care.

Methods
A control group of six students, received standard communication training and ten students received additional communication training using the VERA framework. Data was collected using the non-participant observational tool Quality of Interactions Schedule (QUIS) and three self-assessment questionnaires to assess student nurses’ confidence, dementia knowledge and communication skills.

Results
The results of this study found that those students who received the additional VERA communication training were observed to have a significantly (Mann-Whitney U test; p = <0.05) reduced number of negative interactions with people with dementia than those students who had received standard communication training alone. In addition, student nurses trained in the VERA framework showed a significant increase (Mann-Whitney U test; p = <0.05) in their confidence to care for people with dementia than those who had received standard communication skills training.

Conclusion
The study finding need to be interpreted with caution given the small sample size and the pilot nature of the study. Nevertheless, these findings indicate that the VERA framework has the potential to improve (1) person-centred communication between student nurses and older people with dementia and (2) students’ confidence to care for people with dementia.
107 Quality Improvement in Action! The Development of a Delirium Bay
Authors: Loughlin Elaine , Conry Miriam , Gavin Catherine , Sheil Orla , O'Connor Martina , Comer Anne , O'Connell Karen , Kearns Caroline , Mulkerrin Eamon , Canavan Michelle , Robinson Stephanie 
Published: September 2019

Abstract

Background
As illustrated in a cross-sectional study at a Galway hospital, delirium is common with a 29% incidence in hospitalised older adults. This is associated with adverse clinical outcomes. Guidelines support specialised environments in the management of delirium to reduce morbidity and mortality. A delirium bay is a specialised unit with a standardised approach to comprehensive geriatric assessment for older adults with delirium.

Methods
We aimed to improve the care of the delirious older adult within our existing framework by creating a ‘Delirium Bay’ utilising the principles of quality improvement. An interdisciplinary team completed ‘Quality Improvement in Action’ training run by the Royal College of Physicians of Ireland from October 2018-March 2019. This involved defining our problem statement and ‘SMART’ aim (Specific, Measurable, Achievable, Realistic, Timely). Measures for improvement included the rate of adverse events, the duration of episodes, patient/family satisfaction, and the use of one-to-one supervision of patients.

Results
Stakeholder analysis included nursing, catering, multidisciplinary and healthcare assistance staff. We liaised with hospital management regarding restructuring staffing and maintenance regarding environmental changes. An educational programme on delirium was delivered.. We collected baseline data utilising the ‘Plan, Do, Study, Act’ Model and utilised this to guide our changes. A Standard Operating Procedures document was drafted. We opened our four-bedded delirium bay on 11th March 2019. Preliminary data indicates improved management of delirium with preserved continence, reduced risk of falls and high patient and family satisfaction levels. Interventions have been implemented with minimal funding and infrastructural changes. Staffing reconfiguration involved standardised planning replacing a pre-existing ad-hoc system.

Conclusion
Delirium in hospitalised older adults is common and associated with increased morbidity and mortality, yet amenable to interventions. We demonstrate that a delirium bay can be set up with a quality improvement approach. Pilot data suggests improved management of these patients within the framework of existing resources. Further collection of data on clinical outcomes is ongoing.
121 Patients with Prolonged Lengths of Stay. A Point Prevalence Study
Authors: Short Eimear , D'Alton Maeve , Dolan Eamon , Dunne Aoife , Hartigan Denise , Jones Claire , Morrison Laura , O'Connor Marie 
Published: September 2019

Abstract

Background
A hospital's trolley count is often highlighted as a measure of its performance. However there is a more complex reality for each organisation in accessing suitable resources for often frail older patients to improve care and capacity. Coupled with this is the need for pathways that identify these patients early in their admission and access the appropriate specialist care. In 2018, 65% of this hospital's bed days were occupied by those whose hospital stay was greater than 14 days. Nationally this was 57%. We undertook to review processes locally around the care of older acute patients.

Methods
On the 20th November 2018 we conducted a chart audit of 85 in-patients who had been in the acute setting for more than 14 days. A proforma was completed for each patient by a doctor and multi-disciplinary team member.

Results
The length of stay ranged from 15 – 527 days with the median being 41 days. The average age was 76 years. A history of falls/dementia/“acopia” was recorded on admission in 57%. The mean time for referral to MDT was 5 days. Social history was only documented in 47% of cases. Ward transfers was a significant issue with 69% moving wards at least once and 9% moving three times or more. A care planning meeting had not been held in 49% of cases. Over 17% of charts audited were awaiting home care package hours whilst 20% were awaiting long term care. In 62% of cases there was no ongoing medical reason keeping them in hospital and 56% of this cohort could have been cared for elsewhere.

Conclusion
Deficits in clear communication and appropriate timely planning for patients resulted in significant delays in discharge. The findings of our research informed a decision to conduct a root and branch analysis of discharge planning utilising the Lean Six Sigma model.