bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Roadmap for Assisted Decision-Making Capacity Assessment: Developing a Guide for Occupational Therapists in an Acute Setting
Authors: Webster Cara 
Published: September 2024

Abstract

Background
The Assisted Decision-Making (Capacity) Act (ADMA) has been in effect since April 2023. Under the ADMA, Occupational Therapists (OTs) are a prescribed class of healthcare professionals capable of assessing a person's decision-making capacity (DMC). OTs must adapt their practice to comply with the new legislation. OTs in an acute hospital reported poor understanding and low confidence using the ADMA. The aims were to enhance OTs knowledge and understanding of the ADMA, how to adapt their practice and to improve OTs documentation of DMC assessment in healthcare records.

Methods
OTs were surveyed to ascertain their current understanding of the ADMA, confidence using its guiding principles and to identify specific learning needs to address in education sessions. A multi-modal approach including tailored in-service education and 1:1 coaching sessions enhanced OTs knowledge and confidence in using the ADMA. Template documents were developed to guide OTs documentation of DMC assessment in healthcare records. A post-education survey was administered to determine if education sessions and guidance documents had benefitted OTs.

Results
Knowledge in using the ADMA improved post-education. 67% reported their understanding as ‘good’ compared to 14% pre-education. 0% reported knowledge as 'poor' or 'very poor' post-education compared to 24%. Confidence improved with 8% reporting they feel ‘very comfortable’ assessing DMC post-education compared with 0%. 0% reported 'not at all comfortable' post-education compared to 18%. 100% of OTs who availed of 1:1 coaching reported benefitting from mentoring. 100% of OTs reported guidance documents benefit their practice. 85% reported the education met their expectations.

Conclusion
OTs are continuing to learn how to use the ADMA in their practice. OTs require ongoing education and training to improve their skills in DMC assessment and documentation of this process. Changing practice in accordance with the ADMA may take time as this change needs to occur at a national and local level.
Swallow Screening in SUH Acute Stroke Service
Authors: Carney Margaret , Moffatt Una , Finnerty Cliona , Nolan-Shaw Dorothy , Hickey Paula 
Published: September 2024

Abstract

Background
Irish National Audit of Stroke [INAS] (2021) found that 68% of patients with a stroke received a swallow screen and 43% had it completed within 4 hours of admission. Figures are below the key quality indicator (KQI) metric of 100% for both targets set by INAS. Recommendation from the National Clinical Programme for Stroke recommends a QI project to improve swallow screening rated.

Methods
From HIPE data, KQI for swallow screening in all stroke patients in Sligo University Hospital (SUH) stood at 86% compliance and KQI for swallow screening within 4 hours of arrival at hospital was 33% compliance. QI project commenced in June 2023 and completed in Oct 2023. Aim for the QI project was to achieve 100% compliance in KQI for all stroke patients receiving a swallow screen in SUH.

Results
Cycle 1 was 100% compliance, cycle 2 was 100% compliance, all stroke patients admitted to SUH receiving swallow screen assessment. KQI for swallow screens completed with 4 hours of arrival to hospital, percentage of compliance increased. Starting compliance was 33% and in cycle 2 this increased to 60%.

Conclusion
Main reasons for the success of our QI project:
Advancing Specialist Geriatric Medicine Training: A Successful Introduction to Simulation-Based Training
Authors: Buckley Emily , Dennehy Karen , O'Regan Niamh , Cooke John 
Published: September 2024

Abstract

Background
Simulation-based education (SBE) has been adopted by various specialties and is used to complement other aspects of education. Geriatric medicine is a diverse specialty, requiring healthcare professionals (HCPs) to navigate complex social, medical, and ethical issues, necessitating a multifaceted and interdisciplinary approach making SBE the ideal vehicle to train geriatric medicine trainees. SBE is currently not a formal component of geriatric medicine training in Ireland and trainees experience varying levels of exposure to SBE. To address this, WICOPSIM in collaboration with the Royal College of Physicians (RCPI) facilitated a study day for geriatric medicine trainees demonstrating the design and implementation of gerontological SBE.

Methods
A faculty consisting of RCPI Irish Clinician Educator Track (ICET) training fellow, WICOP simulation fellow and two Consultant Geriatricians coordinated the event. All geriatric medicine trainees were invited to a one-day SBE event hosted by WICOPSIM. Lectures on simulation theory and application preceded a simulation scenario demonstration focusing on the interdisciplinary management of a patient whose capacity was in question; followed by a SBE participant workshop.

Results
Fifty-two trainees attended the event. Forty-five trainees completed the post-event survey. 98% (n=44) were satisfied with the variety of topics presented and felt more prepared to design and run a scenario. The simulation demonstration, debrief and design workshop met 100% trainees’ expectations. All trainees indicated that SBE should be a routine element of geriatric medicine training. 69% (n=31) intend to run SBE within their own department in the future.

Conclusion
This event successfully introduced geriatric medicine trainees to the design principles and practices of gerontological SBE. SBE offers trainees the opportunity to practice the technical and non-technical skills required to navigate complex, interdisciplinary and challenging scenarios, in a protected environment. The positive feedback generated suggests SBE is a useful tool to enhance the specialist geriatric medicine training experience and warrants further exploration.
Implementation Of A Novel And Integrated Community Flexible Endoscopic Evaluation Of Swallowing (FEES) Service Model For Older Persons
Authors: Clancy Monica , Curran Sarah , Kerins Elaine , Cregg Paula , Hayes Kate , Whelan Elaine , Deane Una , Galvin Rose , Griffin Anne , McGowan Caoimhe Hunter , Quinn Colin , Ryan Stephen , McCarthy Oonagh , Manning Molly 
Published: September 2024

Abstract

Background
FEES is a gold standard Speech & Language Therapy (SLT) led diagnostic instrument that facilitates evidence-based dysphagia care. A novel community-based FEES service for older persons’ services was recently established in Ireland's Mid-West. New pathways, integrated across divisions, were designed and implemented to complement existing dysphagia pathways within Integrated Care Programme for Older Persons (ICPOP), inpatient rehabilitation for older persons and primary care. An integrated pathway was also established with acute services (Otolaryngology). The aim of this abstract is to describe the implementation process for this novel community FEES service.

Methods
An SLT-led FEES team engaged with a range of community- and acute-based stakeholders across policy and practice: SLTs, Otolaryngologists, management teams, ICPOP teams, Gerontology Consultants, General Practitioners, Infection Prevention and Control (IPC) teams. Normalisation Process Theory (NPT), an empirically tested and theoretically-sound implementation science framework, scaffolded discussion across a range of implementation and consultation activities including co-design workshops and educational presentations and training, using Health Service Executive (HSE) Change Management tools.

Results
Stakeholders co-developed a shared understanding of current and new pathways to identify and enact implementation strategies at individual, discipline and system-levels. The project involved stakeholder mapping, communication/engagement planning, risk management, resource planning, and large-scale targeted education/training across settings and disciplines. A FEES working group was formed to coordinate, sustain, monitor, and futureproof implementation activities.

Conclusion
This collaborative project generated interdisciplinary vision and action to enact an innovative dysphagia care pathway for older people in the community. Articulated through an NPT lens, the project provides insights into the collaboration needed to implement truly integrated care and to identify enablers at individual, disciplinary, and organisational levels. Such knowledge is essential for enhancing integrated care and enacting change and innovation in the Irish health service.
Discharge Destination, Mortality Outcomes and Rehabilitation Utilization, a One Year Follow Up of Frail Older Medical Inpatients
Authors: McCarthy Kate , Healy Liam 
Published: September 2024

Abstract

Background
Patients with increasing frailty constitute a large proportion of acute hospital admissions. Deconditioning is a known complication of acute medical admission. This study reviews the outcomes for a population identified as frail during their admission, including utilisation of formal rehabilitation and discharge destination. Mortality rates at 6 and 12 months are also reviewed to assess if frailty could be used as a prognostication tool.

Methods
The patients selected were included in a hospital wide point prevalence study in 2023. Patients included were over 70 years of age and admitted under a medical team. Clinical frailty scale (CFS) score was recorded on all patients. The hospital electronic record provided information on transfer for formal rehabilitation, discharge home with home care package or discharge to long term care. The cohort were coded based on discharge destination. Mortality outcome at 6 and 12 months were also obtained via electronic record and RIP.ie.

Results
233 patients were included, 177 (75.9%) were identified as frail. Only 8 (3.43%) of the group were discharged to formal rehabilitation. 52 (22.3%) were transferred directly to Long term care from hospital without a trial of formal rehabilitation. 8 of this group had specific rehab needs documents, all 8 were alive at 6 and 12 months. Approximately 40% of the total group had died within 12 months.

Conclusion
Rehabilitation benefits the individual patient and the health service as a whole, by impacting care needs and facilitating discharge home (Van Craen et al., 2010). This study has shown that approximately 1 in 4 patients over 70 were discharged directly to long term care without appropriate rehabilitation. Just over 3.4% of the group received formal rehabilitation outside of the acute hospital. This has highlighted the need to radically act on egress pathways to provide appropriate rehabilitation and care for our patients.
Retracted: Do Specialised Geriatric Wards Improve Patient Outcomes
Authors: Lynch Amy , Cormican Niamh , Cashen Aoife , Chan Kei Yen , Devaney Kathy , Robinson Stephanie , Small Cliona 
Published: September 2024

Abstract

Background
Older adults demonstrate a unique set of needs in an acute healthcare setting. Admissions increase risk of hospital acquired disability including delirium, infections and functional decline with heightened risk of institutionalisation. As per national guidelines, acute hospital care of older patients should be carried out on a specialised geriatric ward (SGW). This aligns with Slainte cares “right care, right time, right place”. An organisational change project was implemented to set up an SGW in a tertiary centre. Assessment and documentation of delirium along with length of stay (LOS) were assessed as a surrogate marker for improvement in patient outcomes.

Methods
A retrospective assessment of patient demographics, LOS and delirium documentation for a 3-month period in 2023 was reviewed and compared to the same 3-month period in 2024 post inception of the SGW as part of a service development project.

Results
Mean age was 83 in both groups. 11% (18/157) pre SGW and 30% (40/134) post had dementia. 91% (122/134) had a collateral history and CGA during their stay on the SGW compared to 78% (123/157). 89% (119/134) had a 4AT documented at any point in the admission post SGW compared with 16% (26/157) previously. 80% (107/157) had a 4AT documented by nursing compared with 0% prior. It was estimated that there were 1,514 bed-days saved.

Conclusion
The implementation of a novel SGW is a complex service development project that utilised organisational development and had a focus on the people underpinning the project at all levels in planning for success. A significant improvement was seen in delirium recognition and documentation using the 4AT at all levels. The most significant improvement was seen in nursing documentation of the 4AT. A significant improvement in “bed days” and patient LOS was observed. This project serves as the business case for further development and sustainability of our SGW.
Frail Patients Referred to a Community Specialist Team- What Were Their Frailty Scores?
Authors: Ryan Sheila , Lynch Paula , McDonnell Fergal , Ryan Siobhan , Mathai Vimal , Hassett Patricia , Farrell Claire , Morriarty Eoin , Shanahan Elaine , Bourke Bill 
Published: September 2024

Abstract

Background
Frailty is synonymous with older patients, where multiple body systems slowly lose their reserves and lead patients to become more vulnerable. When developing the inclusion criteria for our integrated care programme for older persons (ICPOP), the limited resources and large geographical area played a role. In order to maximize the outcomes for patients we targeted those with a Rockwood Clinical Frailty Score (CFS) between 4 and 6. We perceived that these patients would benefit from multidisciplinary intervention.

Methods
All patients referred to ICPOP were reviewed from November 2022 to April 2024. Our electronic patient database records information on ICPOP patients. Using this database we searched for the word “frailty” in the reason for referral field. We also correlated this with any patients who had a CFS recorded. The level of frailty in older patients with the scores ranging from 1 (very fit) to 9 (terminally ill) was recorded.

Results
182 patients were found during the database search. 55 patients were referred for frailty alone, 64 patients were referred for frailty with balance/mobility issues, 47 patients were referred for frailty with falls, 16 patients were referred for frailty with memory issues. CFS were available for 132/182(73%) patients. 119/132(90 %) patients with a CFS score were classified as scoring between 4 and 6 on the Rockwood scale. 3/132(2%) scored 2, 6/132(5%) scored 3 and 4/132(3%) scored 7 on the CFS.

Conclusion
The national ICPOP framework prioritise improving care of frail older patients. A measure of a persons’ frailty level is subjective and dependent on clinical judgement along with a good understanding of the term “frailty”. Overall, our findings highlight that the referrers to our service have a good knowledge of frailty as a term. Our ICPOP hub is also effectively targeting the appropriate cohort of patients as per our inclusion criteria.
To Investigate the Prevalence of White Coat Hypertension in Community Dwelling Older Adults Referred for a Falls Assessment
Authors: Ryan Sheila , Ryan Siobhan , Mathai Vimal , Lynch Paula , Alamin Mohammed , Shanahan Elaine , Bourke Bill 
Published: September 2024

Abstract

Background
Falls and frailty are the main focus in our integrated care programme for older persons (ICPOP). Office blood pressure (OBP) measurements are commonly used in practice although out of office recordings are proven to be a better predictor of cardiovascular risk (Myers et al, 2018). The European Society of Cardiology guidelines (ESC, 2018) have proposed BP values for the classification of hypertension (HTN).

Methods
We retrospectively completed a chart review on older adults’ who attended ICPOP with a referral for a falls assessment from November 2021 to April 2024. OBP were obtained after the patient was in the hub for approximately one hour following their comprehensive geriatric assessment (CGA). The OBP was documented following a supine period of 5 minutes. We compared the OBP and ambulatory blood pressure monitor (ABPm) average readings to assess the prevalence of HTN based on the ESC guidelines.

Results
75 charts were reviewed. 3 ABPm recordings were unsuccessful due to cognitive impairment or not tolerating the ABPm. These were excluded from the audit. No patient had hypotension on either their OBP or ABPm recordings. On their OBP recordings, 29/72 (40%) had a normal reading while 43/72 (60%) had HTN. On their ABPm 54/72 (75%) had a normal reading while 18/72 (25%) had HTN. When we looked at antihypertensive medication use in those who had a normal reading on their ABPm, 47/54 (87%) were on antihypertensive treatment. All patients with HTN on their ABPM were on antihypertensive treatment.

Conclusion
Our findings suggest that OBP readings greatly increase the numbers of patients diagnosed with HTN compared to ABPm (60% versus 25%). Therefore, we suggest that all patients should have an ABPm as a gold standard to falls assessment to avoid over-treating white coat HTN.
Optimizing Opioid Prescriptions in Geriatric Populations at Nottingham University Hospitals Foundation Trust (NUH)
Authors: Ali Haider , Venkatesh Hari 
Published: September 2024

Abstract

Background
Severe pain is associated with adverse outcomes in the geriatric populations (Ref -Pain and Mortality in Older Adults: The Influence of Pain Phenotype - PubMed (nih.gov)).
Currently it is recommended in local and national guidelines (Ref -Guidance on the management of pain in older people | Age and Ageing | Oxford Academic (oup.com), Clinical Guidelines Policy (koha-ptfs.co.uk)) that the following be implemented to geriatric patients being prescribed strong opioid medication

Methods
A multi-disciplinary team involving doctors, pharmacists, nurses and the NUH quality improvement team was involved in all aspects of this project. Initial data collection was done between 1st August 2023 to 1st March 2024. We intend to carry out further data collection between April and August 2024 after our proposed interventions. Data collection was carried out using the EPMA prescribing platform.

Results
Data collected from 1st August 2023 to 1st March 2024 only 70% of patients in health care of the elderly (HCOE) wards had correctly prescribed oxycodone as their strong opioid analgesia. It was noted that 37% of HCOE patients have had morphine incorrectly prescribed at least once during their admission. Only 11% of strong opioid prescriptions on HCOE wards in NUH had a review scheduled. A. Whilst 73% of patients had laxatives co-prescribed only 25% had anti-emetics co-prescribed.

Conclusion
From our initial results there is an obvious need for improvement in terms of guideline adherence. We will aim to collect further data and we will put into place interventions in a ‘PDSA’ manner to improve this.
Preventing Emergency Department Visits: Success Of A Community Dementia Care Model
Authors: Bradley Eoin , Mills Donna , McEvoy Marie , Moodley Kevshni , Conneely Aoibheann , O'Toole Ronan , Nee Rory 
Published: September 2024

Abstract

Background
Advanced dementia care in the community is an extremely complex task. NICE guidelines 2021 suggested that a gap in care was evident bridging between clinic attendance and end of life care. Secondary to a required need- a new advanced dementia care model was created in 2021.This was co-developed by an ANP with a specialist interest in gerontology, an integrated care team for older persons (ICPOP) consultant and palliative care in the community. Joint governance remains to this day. My aim is to review unexpected emergency department (ED) attendances of patients accepted to this pathway.

Methods
Patient records were reviewed of all cases accepted for review and managed under this model of care, time frame Jan 2023- May-2024. All patients &gt; 65. Outcomes of management interventions were assessed. Those found to have an ED attendance during their time engaging with this model of care had closer review of their notes to assess reason why.

Results
81 patients. Of which 75% were female. Average age – 89. Of these 48% died at home and are 37% still alive. Of the 81 patients only 5 (6%) had ED attendances. Of these 5 patients - 3 had unexpected traumatic falls- 2 resulting in hip fracture and 1 in humeral fracture. 2 were admitted with worsening delirium.

Conclusion
The advanced dementia care model has proved very successful in preventing ED attendances prior to direct end of life care engagement. Of those who were admitted – fractures appropriately warrant admission and the remaining 2 cases, had families who were resistant to accepting overall aims of treatment. This interdisciplinary model of care saves bed days. Expanding this care model further to ensure appropriate management of complex dementia cases is maintained in the community would further reduce hospital overcrowding and grant many patient and family wishes.
“Conversations with Friends”: A review of communication between two services
Authors: Davis Aisling , Staunton Ruth , O'Kane Aoibheann , Doyle Cliona , Smith Finola , Doran Arthur , Hilery Patrick , Namara Rosa Mc , Boyle Nicola 
Published: September 2024

Abstract

Background
EDITH (Emergency Department in the home) is a rapid response team consisting of a doctor/ANP and OT who assess patients in their home to avoid an ED attendance. The Integrated Care Team for Older People (ICPOP) is a community-based specialist multidisciplinary team that provides assessment and intervention for frail older adults in order to facilitate them to remain living at home. These two teams work collaboratively to keep older adults out of hospital and refer a high volume of patients between the two services. It is imperative to reflect on current communication practices in order to future proof these services and ensure optimum patient care.

Methods
An electronic survey was designed to evaluate the service and was circulated to members of both teams. Quantitative data was captured via likert scales and qualitative feedback was analysed via thematic analysis. There was a total of 13 respondents.

Results
One hundred percentage of participants rated confidentiality of communication “average” and “above average”. 92% rated accuracy and accessibility of communication as “average” and “above average” while 15% rated speed of communication as “below average”. Key themes such as “prompt communication”, “friendly working relationships” and “using therapy specific language” emerged as areas that are working well. Area for improvement include “close loop communication/referral process” and “lack of a shared electronic healthcare record”.

Conclusion
Overall, the feedback from both teams appears to be positive and it is beneficial to reflect on communication processes. It is important to build on good working relations between acute and community teams as it likely results in better patient outcomes. Key areas for improvement have been highlighted and an action plan to address same can be formulated.