bluuebunny/crossref_metadata_2025_split huggingface dataset:
1646 CAN USE OF SENSOR TECHNOLOGY PREVENT HOSPITALISATIONS IN FRAIL OLDER PEOPLE AT HIGH RISK OF HOSPITAL ADMISSIONS?
Authors: Lowe G M , Arora A , Lockett A 
Published: July 2023

Abstract

Introduction
There has been significant developments, investment and ambition to use modern technology in admission avoidance in hospitals. Sensor technology has been one area of development.

Method
We used My Sense to improve outcomes for a cohort of High Intensity Users (HIU) frail older patients and compared hospitalisation rates before and after employing Sensor technology. HIU patient consent criteria is 3 Admissions with 40 days Length of Stay.
Introduction of MySENSE:

Aim
Fifty randomly selected HIU patients consented to use My Sense from November 2021 to June 2022. HIU monitors usage via a dashboard with the aim to intervene and reduce the likelihood of deterioration caused by inactivity or illness. HIU contacts the key responders, include liaising with family members, GP, other health/care professionals if unusual patterns or no activity is recorded. For example - bed/chair/toilet/kettle/tap sensor not being activated for some time. Indicators for potential UTI’s, constipation, dehydration, reduced mobility and other conditions if not addressed may result in admission.

Results
• Admissions prior to installation 84 post 54; • Length of Stay prior to installation 909 post 724; • Cost saving = £64,750.00; • Cost of equipment £399 with a monthly subscription fees £39.99 per month.

Conclusion
• Useful to detect any changes to normal pattern improving patient safety
• Early identification of deterioration and early deployment of help for earlier intervention
• Raised patient, family and staff satisfaction/reassurance
• Reduced reliance on acute care
• Reduced level of physical social care support / greater independence
• Useful tool but more detailed studies are needed.
1499 REDUCING HYPOGLYCAEMIA ON THE CARE OF THE ELDERLY WARDS: A MULTIDISCIPLINARY TEAM FOCUSED QUALITY IMPROVEMENT PROJECT
Authors: Vourou P , Campbell N , Nethaji C , Lim J 
Published: July 2023

Abstract

Introduction
Older adults with diabetes are at increased risk of hypoglycaemia during inpatient hospital stays. It was noted that a large proportion of diabetic patients on the care of the elderly wards at North Middlesex University Hospital were experiencing hypoglycaemia so a quality improvement project was devised to address this issue and improve patient safety.

Method
Baseline data was collected in October 2021 by monitoring the glucose levels of 21 diabetic inpatients across three care of the elderly wards over a 72-hour period. The project consisted of 3 interventions introduced on one of these wards. The initial intervention was a poster reminding doctors to check the HbA1c results of diabetic patients. The second was the introduction of a bedtime snack for diabetic patients. The final intervention was the inclusion of a hypoglycaemia report in the nursing handover.

Results
In the baseline data collection 3/21 (14.2%) patients had a recorded episode of hypoglycaemia. Following the introduction of the poster, 0/9 (0%) and 1/9 (11%) patients experienced episodes of hypoglycaemia at 2- and 4-weeks post-intervention respectively. Following the introduction of a bedtime snack, 1/5 (20%) patients experienced an episode of hypoglycaemia at 2-weeks post intervention. Following the introduction of the nursing handover report, 1/8 (12.5%) and 0/5 (0%) patients experienced an episode of hypoglycaemia at 4- and 5-weeks post-intervention respectively.

Conclusions
The high rate of hypoglycaemia in elderly diabetic inpatients is likely to be multifactorial and therefore a multidisciplinary approach is essential. The sample size was too small to draw clear conclusions, but the results suggest that a simple nursing intervention could be effective at reducing the frequency of hypoglycaemia. The next steps will be to formally introduce the nursing handover intervention to the other care of the elderly wards and monitor its impact.
1522 THE IMPACT AND INTERVENTIONS OF A FRAILTY PHARMACIST WITHIN EMERGENCY DEPARTMENT FRAILTY TEAM OF AN ACUTE NHS HOSPITAL TRUST
Authors: Organista L , Rai R , Gaddu R 
Published: July 2023

Abstract

Introduction
Older patients admitted to the emergency department (ED) do not have a pharmacist-led medication review within the comprehensive geriatric assessment (CGA), yet the presenting complaint can be attributed to overprescribing and problematic polypharmacy. Taking ten or more medications increases the risk of hospital admission by 300% due to adverse drug reactions (ADRs)1, therefore a medication review can reduce this outcome by optimising current therapy 2. Responsibility of safely transferring this medication information between care settings is a healthcare professional's duty, as the rate of error is 30 - 70%3.

Method
Patients were identified by the ED Frailty Team according to local frailty criteria, including patients &gt; 65 years presenting with delirium, a fall and/or multi-morbidities. Medicines reconciliation was carried out by the frailty pharmacist, and medications optimised to reduce future harm with investigations prompted where needed. Interventions were categorised. A summary plan was written to the General Practitioner (GP) and each patient was followed up after 4 weeks to assess if received and actioned appropriately.

Results
73 medication reviews were conducted for patients (mean age 84.4 years) from June to September 2022, majority presenting with fall (69%). High-risk medication review was most common intervention (90%), followed by counselling (50%). 92% patients required a pharmaceutical intervention (n=208). GP plans were actioned for 65% patients in Primary Care.

Conclusion
ED frailty pharmacist's input reduced inappropriate polypharmacy and optimised medication for this patient cohort, with majority of care plans carried out appropriately following discharge. A future study could examine re-admission rates of patients in comparison to those without a frailty pharmacist's input.

References
1. Payne RA et al. British Journal of Clinical Pharmacology 2014; 77: 1073–82.
2. Department of Health and Social Care, 2021. Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1019475/good-for-you-good-for-us-good-for-everybody.pdf. Accessed 19/1/23.
3. Department of Health, 2011/2012. Available at: www.wp.dh.gov.uk/healthandcare/files/ 2011/01/outcomesglance.pdf. Accessed 19/1/23.
1562 LET’S TALK ABOUT DEATH: IMPLEMENTING GUIDANCE ON LEARNING FROM DEATHS AT HOMERTON HOSPITAL
Authors: Teranaka W , Harrod I 
Published: July 2023

Abstract

Introduction
The National Quality Board published the first Guidance on Learning from Deaths in March 2017, which stated the aim of mortality review processes across NHS Trusts and provided a framework in identifying, reporting, investigating and learning from deaths in care. Homerton Healthcare NHS Foundation Trust considered how best to implement the Guidance: record mortality reviews, increase engagement within the Trust and disseminate learning.

Method
Whilst paper-based mortality reviews had already been conducted by some specialties, there was no Trust-wide process to record data and learnings. In 2018, an in-house electronic Mortality Review Tool was built by clinicians and IT team incorporating the use of CESDI (Confidential Enquiry into Stillbirths and Deaths in Infancy), a scoring methodology used to document quality of care and impact on outcome. Ongoing training for the tool is provided to medical staff and is now used by all specialties. A quarterly multidisciplinary mortality newsletter entitled “Let’s Talk About Death” was launched and is now published on the intranet, available for all members of the Trust. Anonymised clinical case examples are used to illustrate learning points and teaching on death and dying.

Results
Percentage of completion of mortality reviews across the Trust increased from 82% to 99% with the implementation of the electronic Tool in comparable quarters (Q1 2018/2019 to Q1 2022/2023). Consultant-led CESDI scores rose from 76% to 98% over the years (2018/2019 to 2021/2022). The newsletter has led to regular collaboration with all teams involved in supporting a patient with life-limiting illness; has encouraged multidisciplinary focus on dying and has provided a leadership opportunity to geriatric medicine trainees who edit the newsletter.

Conclusion
The Trust’s response to the Guidance has resulted in measurable improvement in data recording and engagement with mortality reviews across all specialties and has reinforced the culture of learning from deaths.
1581 POSTURAL HYPOTENSION – A QUALITY IMPROVEMENT PROJECT
Authors: Mahenthiran M , Easosam M , Ahmad S , Li K Y , Kar S 
Published: July 2023

Abstract

Introduction
Postural hypotension (PH) is an identifiable and potentially reversible cause of falls in elderly patients. The National Audit of Inpatient Falls recommends lying and standing blood pressure (LSBP) measurement for patients aged over 65. Our project aims to review current clinical practice and to develop a standardised approach to correctly investigate and manage PH in patients admitted following a fall to the geriatric department.

Method
We performed two cycles of retrospective data collection across three geriatric wards, looking at percentage of patients investigated for PH and the use of correct technique for LSBP measurements as recommended by the Royal College of Physicians (RCP) guidelines. Between cycles, formal and informal educational strategies were implemented and the RCP LSBP measurement guidelines were displayed on doctors’ noticeboards and blood pressure monitoring devices. A PH sticker was designed to ensure correct technique was used and documented.

Results
Following the interventions, the percentage of patients who had LSBP measurements performed improved from 28% to 96% [p&lt;0.00001(X2 test)]. Introduction of the PH stickers improved use of correct technique from 12% to 37.5%. Performance and documentation of medication reviews for patients diagnosed with postural hypotension improved from 0% to 87.5% and lifestyle advice given and documented improved from 0% to 37.5%.

Conclusions
Our study highlighted the need for further training on investigation and management of PH. Our results demonstrate that educational interventions and a standardised sticker to ensure clear documentation can significantly improve diagnosis of PH. The local Falls Prevention Team are keen to promote use of the sticker across the Trust and we have produced patient information leaflets to ensure that all patients receive lifestyle advice.
1599 DOCUMENTED NEUROLOGICAL EXAMINATION IN PATIENTS PRESENTING WITH FALLS
Authors: Smith N , Mulligan L , Jones K 
Published: July 2023

Abstract

Introduction
In Scotland, more than 18,000 older people are admitted to hospital after a fall each year. One in three people over the age of 65 experience a fall at least once each year (1). Neurological examination is an essential part of the initial assessment of these patients in hospital and can determine the cause of falls such as stroke, peripheral neuropathies and Parkinson’s disease. Local anecdotal evidence suggested that this was often not carried out, with the potential for delayed diagnosis and treatment.

Method
Baseline data was collected from clinical notes of admissions to the care of the elderly (COTE) wards at University Hospital Hairmyres (UHH) over a 1-month period. Multiple departmental education sessions were arranged to highlight to medical staff the importance of neurological examination in patients presenting to hospital following a fall. Following these sessions the data collection cycle was repeated. A poster has now been designed highlighting common causes of falls and in particular emphasising the importance of performing a neurological examination, with a further cycle of data collection planned.

Results
36.8% of patients admitted to COTE wards in August 2022 were admitted with falls, with only 23% of patients having a neurological exam documented on admission. Following the initial intervention, 30 patients’ notes were reviewed in January 2023. 56.7% of patients were admitted with falls and frequency of documented neurological examination had increased to 58.8%.

Conclusion
Educational sessions resulted in a 156% increase in documented neurological examinations for patients admitted with falls. We hope this improvement will lead to earlier identification of causes of patients’ falls, allowing prompt management. Our project is ongoing, with planned implementation of posters as a secondary intervention, with further data collection in due course.

Reference
1. NHS Inform. Why Falls Matter. Available from: https://www.nhsinform.scot/healthy-living/preventing-falls/why-falls-matter (accessed 27 November 2022).
1629 IMPROVING THE DOCUMENTATION OF BEST INTEREST DECISION MAKING AND SKIN CHECKS IN THE USE OF MITTENS
Authors: Tyler A , McWilliams E 
Published: July 2023

Abstract

Introduction
Mittens are used to facilitate necessary interventions safely in patients who lack the mental capacity adhere to them. A serious incident (SI) occurred at our Trust when a patient, with delirium, developed pressure ulcers to their wrists as a result of prolonged use of mittens. A subsequent investigation revealed that there had been inadequate skin checks and insufficient documentation, from the medical team, directing the use of mittens.

Method
A multidisciplinary QIP was initiated:
After the QIP, a notes review was completed for all patients over the age of 65 years who had a mittens checklist completed before and after the interventions. Notes were assessed for documentation of a mental capacity assessment, communication of a best interest decision, prescription of mittens and completion of a daily skin assessment.

Results
Documentation of a capacity assessment improved from 9% to 47%. Communication with relatives improved from 0% to 35%. Prescription of mittens, on the drug chart, improved from 0% to 24%. Documentation of a daily skin assessment Increased from 0% to 94%

Conclusions
This QIP brought about improved documentation of best interest decisions related to mittens and ensured regular skin checks. The next stages will involve expanding the QIP to other departments within the hospital and reinforcing messaging about communication with relatives and prescription of mittens.
1545 THE EFFECTS OF DIETARY NITRATE SUPPLEMENTATION ON PHYSICAL PERFORMANCE IN OLDER PEOPLE – A SYSTEMATIC REVIEW
Authors: Renji R , Robinson S M , Witham M D 
Published: July 2023

Abstract

Background
Dietary nitrate (inorganic nitrate) supplementation has been proposed as an intervention to improve muscle function via increased nitric oxide (NO) availability. Although some studies show benefit in younger adults, the effects in older people are unclear. This systematic review evaluated the effects of dietary nitrate supplementation on physical performance and muscle strength measures in older people.

Method
The review was conducted according to a prespecified protocol by two reviewers. We included interventional studies using dietary nitrate supplementation, mean participant age 60 and over, with or without sarcopenia or impaired physical performance. Outcomes of interest were physical performance and measures of muscle strength and mass. Risk of bias was assessed using a structured tool. Results were grouped by intervention and outcome measures and were described by narrative synthesis.

Results
Our search strategy found 1174 titles; 25 studies were included in the review. Study size ranged from 8 to 72 participants. Data on baseline functional status were not available, but 7 studies were in healthy older adults. The intervention duration ranged from a single dose to twelve weeks. Most studies had high or unclear risk of bias; three had low risk of bias. One hundred and nineteen outcomes were reported; 62 were physical performance measures and 57 were muscle strength measures. Twenty-nine outcomes showed significant improvement, two showed significant worsening and 88 showed no statistically significant difference. Results that showed significant improvement did not group together under any particular outcome measure, supplementation product or duration. Meta-analysis was not possible due to heterogeneity of populations, intervention duration and outcome measures.

Conclusion
Current evidence suggests that increasing intake of dietary nitrates may be beneficial for physical performance and muscle strength in older people, however data are limited. Future studies should be longer, larger and target older people with sarcopenia or impaired physical performance.
1483 REDUCING DOOR TO NEEDLE TIME THROUGH SIMULATION-BASED EDUCATION
Authors: Irvine J , Bowman M , Dynan K , McCallion C , Thompson J , McDowell V , Williamson K 
Published: July 2023

Abstract

Background and Aims
Many medical specialty trainees report a lack of confidence in hyperacute stroke management, contributing to inefficient patient care. We identified a lack of knowledge of our pathways, as well as difficulty managing human factors, particularly communication and teamwork. We hypothesised that the implementation of a simulation-based education programme could address these issues amongst medical specialty trainees and lead to improvements in our door-to-needle (DNT) times.

Methods
We organised a scenario-based simulation education session for our trainees led by a multi-disciplinary faculty. We addressed the management of acute ischaemic stroke, intracerebral haemorrhage, and basilar artery occlusion, as well as thrombolysis complications. Learners were surveyed before and after each session to gauge improvements in knowledge and confidence using a Likert scale. Free text feedback was sought from both learners and faculty to identify areas for improvement. We measured the mean DNT 3 months before and after our session.

Results
We improved both the knowledge and confidence of trainees in managing hyperacute stroke presentations and the human factors involved in a stroke pathway. We received feedback regarding the staffing of our on-call team and improving communication, including the use of lanyard cards and single point of contact devices. We also noted an improvement in our mean DNT amongst trainees who attended our training from 51mins to 34mins. Our resources were trialled in two other healthcare trusts to refine them further, before expanding the programme locally and regionally to improve training across all healthcare trusts.

Conclusions
Simulation education is beneficial in improving knowledge and confidence in the management of hyperacute stroke and can contribute to reduced DNT.
1527 DELIRIUM ON HOSPITAL ADMISSION IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS WITH A HIP FRACTURE: THE IMPACT DELIRIUM STUDY
Authors: Penfold R S , Hall A J , Anand A , Duckworth A D , Clement N D , MacLullich A M J 
Published: July 2023

Abstract

Aim
Delirium is associated with adverse outcomes following hip fracture, but large-scale routine data studies investigating pre-operative delirium are lacking. Our aims were to assess delirium prevalence on hospital admission and, in patients admitted from home, determine associations with: (i) mortality; (ii) length of stay; (iii) post-discharge level of care, and (iv) hospital readmission within 180 days.

Methods
This retrospective cohort study was conducted in a major trauma centre using routine clinical records and validated audit data. Consecutive patients aged ≥50 years admitted with a hip fracture between 01/03/20-30/11/21 were included. Admission delirium status was determined by 4’A’s Test score≥4. Patients with missing scores were excluded. Associations of delirium with mortality, discharge to higher care and readmission with 180-day follow-up were assessed using multivariable logistic regression adjusted for age, sex, deprivation, and ASA grade.

Results
A total of 1821 patients (mean age 80.7 years; 71.7% female) were admitted, 1383 (mean age 79.5; 72.1% female) from home. 87 patients (4.8%) were excluded due to missing 4AT scores. Delirium prevalence in the whole cohort was 26.5% (460/1734): 14.1% (189/1340) in patients from home, 68.8% (271/ 394) in the remaining patients. In home-dwelling patients, delirium was associated with a 3 day longer median acute stay (p&lt;0.001). In multivariable analyses, delirium was independently associated with higher mortality at 180 days (Odds Ratio (OR) 1.69, 95% Confidence Interval (CI) 1.13-2.54; p=0.013), discharge to higher care (OR 2.82, CI 1.99-4.00; p&lt;0.001), and readmission within 180 days (OR 1.77, CI 1.01-3.11; p=0.046).

Conclusions
More than one in four patients had delirium on admission. More than one in seven admitted from home had delirium; this was associated with adverse outcomes. Routine admission delirium assessment could guide prognostication, targeted peri-operative management, and proactive care planning. Research should focus on identifying potentially modifiable risk factors and mediators of adverse outcomes following delirium.
1456 FACTORS INFLUENCING ADHERENCE TO CHRONIC DISEASE MEDICATION AMONG OLDER ADULTS IN INDIA: ANALYSIS OF WHO - SAGE2
Authors: Tolley A , Grewal K , Weiler A , Papameletiou A , Hassan R , Basu S 
Published: July 2023

Abstract

Background
There is a growing number of older adults in India and accordingly a rising burden of non-communicable diseases (NCDs). Poor medication adherence among patients with NCDs is prevalent in India and is associated with adverse outcomes, increased mortality and consequently increased patient and healthcare system costs. Understanding the factors which influence adherence across India is vital to guide interventions towards improved adherence. This study examined the factors influencing medication adherence in older adults (50 years or older) with NCDs in India.

Method
Data analysis was conducted from the second wave of the World Health Organisation’s ‘Study on global AGEing and adult health (SAGE)’ to identify socioeconomic, health-related, geographical and social support variables that influence medication adherence in adults with NCDs. Bivariate analysis and multivariate logistic regression modelling were conducted.

Results
The average medication adherence rate was 51% across 2840 patients with one or more NCDs. The strongest factors predicting non-adherence were multimorbidity (odds ratio 0.49, 95% CI 0.41-0.58) and feelings of depression (0.48, 95% CI 0.32-0.70). Rural living (0.71, 95% CI 0.48-1.05), tobacco use (0.75, CI 0.58-0.97), never having attended school (0.75, 95% CI 0.62-0.92) and feelings of anxiety (0.83, 95% CI 0.67-1.02) were also independent associated with poor adherence. Older age (1.89, 95% CI 1.40-2.55) was associated with improved adherence while there was a weak association between increased wealth and medication use.

Conclusion
Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and low educational status.