bluuebunny/crossref_metadata_2025_split huggingface dataset:
1607 MULTIDISCIPLINARY STRUCTURED MEDICATION REVIEW REDUCES INAPPROPRIATE POLYPHARMACY AND ASSOCIATED COSTS IN CARE HOMES
Authors: Marchant R , Thorman E , Page E , Worth C , Allcock D , Fraser H , McCracken S , Shipway D 
Published: July 2023

Abstract

Background
Person-centred structured medication review (SMR) is associated with reduced polypharmacy, adverse drug reactions (ADRs), admission to hospital and mortality. Our service development aimed to explore the cost-efficacy of a multi-disciplinary team (MDT) providing SMR as part of a comprehensive geriatric assessment for care home (CH) residents.

Method
We established an MDT consisting of a consultant geriatrician, specialist clinical pharmacist, two general practitioners, clinical fellow, physician associate and frailty paramedic practitioner. Training on SMR was given by the pharmacist to other team members, with further support offered through the pilot.

Results
A total of 785 residents were reviewed across 20 CH sites during the initial 6-month pilot. Overall, polypharmacy was reduced by an average of 1.33 medicines per resident (8.32 to 6.99). The drug classes most commonly deprescribed were laxatives, antidepressants, lipid lowering drugs, opioids, and nutritional supplements. Medicines altered included three classes known to cause 40% of avoidable hospital admissions due to ADRs (1): diuretics (stopped/changed for 42 residents), antiplatelets (stopped for 34 residents) and anticoagulants (stopped/changed for 26 residents). Annual projected medication savings totalled £131,462(net), with an average saving of £169 per resident (range £63- £367). Drg classes with the largest cost impact were nutritional supplements (40% total savings), laxatives (12%), opioids (12%) and anticoagulants (11%). Carbon footprint savings from the 12 inhalers stopped during this phase totalled 1,323,098 gCO2e per annum: equivalent to 4562 car miles.

Conclusion(s)
A multi-disciplinary approach to medication review was shown to reduce inappropriate polypharmacy in care home residents. This intervention was associated with significant projected cost savings. Future work should aim to target SMR to patients with the highest rates of inappropriate polypharmacy.

Reference
1. Howard, R. L. et al. Which drugs cause preventable admissions to hospital? A systematic review. British Journal of Clinical Pharmacology 2007; vol. 63 Preprint at. https://doi.org/10.1111/j.1365-2125.2006.02698.x.
1665 RECOGNISING FRAILTY IN NON-ELECTIVE GENERAL SURGICAL PATIENTS TO OPTIMISE THEIR CARE
Authors: Godfrey-Harris M , Connor J 
Published: July 2023

Abstract

Introduction
In 2021, there were 38,839 adults &gt;65 years living in Brighton and Hove (1) (13% of the local population, compared to 18% in England (2)). However, 56% of emergency laparotomy procedures in the UK (3) are in the &gt; 65s. At the Royal Sussex County Hospital, a consultant geriatrician was appointed to lead a Frailty Liaison Service to respond to the needs of frail older patients undergoing general surgery (GS). No process was in place for the early identification of these patients, so intervention decisions were being made without GS Frailty Liaison input, potentially leading to unnecessary procedures and adverse outcomes such as deconditioning (4), which could potentially be reduced by timely clinical frailty scoring (CFS) and comprehensive geriatric assessment (5).

Objective
This quality improvement project sought to identify all appropriate frail older patients over 70 within 1 week of admission to be seen by the Frailty Liaison Team on the general surgical ward.

Method
We used the Model for Improvement and diagnostic tools (fishbone; stakeholder mapping; driver diagrams) and PDSA cycles to test the impact of junior doctor education on CFS scoring and awareness raising primarily through a newsletter; measured by the number of frailty scores given to patients pre-intervention, remeasured at 3 months after the initial data set. We captured feedback following the education sessions to assess usefulness.

Results
100% of participants felt more confident in identifying frailty in GS patients. The average number of days from admission to identification and first review decreased from 8.29 to 6.36, possibly reducing adverse outcomes. The proportion of appropriate referrals increased, releasing time to care for those who needed it most.

Conclusion
Moving forward, we plan to promote the use of a CFS column on the handover list and continue our education sessions, incorporating real patient cases as requested in feedback.

References
1. Office for National Statistics. Local authority ageing statistics, based on annual mid-year population estimates. 2020. URL: https://www.ons.gov.uk/datasets/ageing-population-estimates/editions/time-series/versions/1.
2. Voices of our ageing population: Living longer lives. Office for National Statistics. 2022. URL: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/voicesofourageingpopulation/livinglongerlives.
3. NELA Project Team. Sixth Patient Report of the National Emergency Laparotomy Audit. London, 2020.
4. Eamer G, Taheri A, Chen SS, Daviduck Q, Chambers T, Shi X, et al. Comprehensive geriatric assessment for older people admitted to a surgical service. Cochrane Database of Systematic Reviews. 2018 Jan 31;2018(3).
1516 CAN AN ADVANCED CLINICAL PRACTITIONER (ACP) LEAD IN THE DEVELOPMENT OF A POPS SERVICE?
Authors: Cross J , Milton J , Boukadida K , Adeyemi T , Aitken E 
Published: July 2023

Abstract

Introduction
Perioperative medicine for the Older Patient undergoing Surgery (POPS) is an established, evidence based medically led service across many Trusts. However, with consultant workforce constraints, the aim was to determine if an alternative ACP led model of care, with consultant geriatrician oversight, delivered the same benefits.

Method

Results
Patient data analysed (n=404) from January to August 2022. Length of Stay (LOS) reduced for patients over 65 years of age living and with frailty by 4 days (17 to 13 days). Variation in LOS reduced from 46 to 26 days. Readmission rate was 6% (26/404). Average Trust rate of 11%. Introduction of POPS improved the National Emergency Laparotomy Audit geriatric specialist input from 10% in Q1 2020/2021 to 91% of patients in Q4 2021/22. Unmeasured benefits include upskilling of nursing staff on the wards identifying frailty and discharge planning. Shared decision making influencing non-surgical treatment for patients for better outcomes. Reduction in calls to medical registrar post POPS introduction.

Conclusion
This pilot successfully demonstrated the role of ACP in service design, care coordination and timely medical review to deliver a reduction in length of stay and readmission rate.
1572 A GREEN QUALITY IMPROVEMENT PROJECT: SUSTAINABLE WASTE DISPOSAL IN A GERIATRIC ADMISSIONS UNIT
Authors: Doak Z , Brodie L , Bostock C 
Published: July 2023

Abstract

Introduction
Following COP26, the NHS pledged a ‘Net Zero’ health service by 2040. Incineration of clinical waste has a negative impact on the environment whilst also being extremely costly. NHS Grampian spends over £1m annually on disposal of clinical waste, whilst 20% of the waste incinerated is unsuitable for that waste stream. An excess of clean plastic packaging from visors, used when managing respiratory viruses, was a particular contributor in our unit. To improve sustainability, the aim of this quality improvement project was to reduce unnecessary disposal of plastic packaging in clinical waste streams by 80% in our Geriatric Assessment Unit.

Method
Using PDSA methodology, data was collected regarding the number and location of clinical waste bins and how many contained plastic visor packaging or any form of ‘non-clinical’ waste. Qualitative data highlighted that staff were aware of disposing waste in the wrong stream, however, struggled to find alternative waste bins located nearby. Selected orange bins were removed and black bins introduced at convenient points. Further PDSA cycles focused on staff engagement and education.

Results
Following PDSA Cycle 1, a baseline median of 57% of orange bins contained clean plastic packaging and 64% contained any form of non-clinical waste. Following staff education, clinical waste bins containing single use plastic dropped to 0%, whilst the percentage containing any form of non-clinical waste remained averaging 35%.

Conclusion
Making clinical waste bins less readily available reduces the amount of unnecessary clean plastic packaging entering clinical waste. We must counteract this through increasing access to general and recyclable waste bins to ensure waste is disposed of correctly. This may be achieved through the creation of “waste stations” in preparation areas, to facilitate readily available access to all waste streams at a single point if required.
1609 IMPROVING STREAMING OF FRAIL OLDER ADULTS FROM THE EMERGENCY DEPARTMENT TO A FRAILTY UNIT
Authors: Connolly A , Oates R 
Published: July 2023

Abstract

Introduction
It is well recognised that frailty is increasing amongst the population and can impact outcomes for patients when admitted to hospital. Frail older adults are more vulnerable to developing complications form continued hospital admissions. National recommendations by GIRFT indicate CFS scores ought to be documented in the Emergency Department (ED) to facilitate early recognition of frailty and stream patient to the appropriate pathway and clinician. The aim of this is to ensure the correct Clinician reviews the frailer adult in the most appropriate setting and thereby reduce risk of deterioration and patient harm. In October 2022 an electronic patient record system (EPR). Bolton NHS Trust has created a dedicated frailty unit staffed by Geriatricians for older frail adults. Therefore, a method of identifying and streaming frailer older adults is crucial to effectiveness of the unit.

Methods
PDSA cycles were implemented. A retrospective audit was performed prior to the implementation of the CFS documentation. A robust education programme was introduced to all clinical staff in the Emergency Department. Online modules were also available. A second audit as part of PDSA cycle was then performed to assess the intervention.

Results
Pre-intervention and EPR documentation tool only 11% of patients had CFS score. Following the intervention, 88% of medical staff included the CFS score in their assessment prior to a Frailty team referral and review. The frailty team have observed an increase in referrals.

Conclusions
Early recognition and documentation has enabled improved streaming and review of the correct patients to the frailty unit. This has enabled Gold Standard of Comprehensive Geriatric Assessment for frailer adults to be completed. Further PDSA cycles to the effectiveness of the unit are ongoing. Initial data indicates with correct identification and recognition of frailty; the average length of stay has reduced.
1642 HOSPITAL FRAILTY RISK SCORE (HFRS) – IDENTIFYING FRAILTY IN THE EMERGENCY DEPARTMENT (ED)
Authors: Burgess A J , Hassan A , Burberry D J , Dorsett N , Bari A , Davies E A 
Published: July 2023

Abstract

Aim
We proposed that the Hospital Frailty Risk Score (HFRS) could identify patients attending the Emergency Department (ED) who would benefit from our Older Persons Assessment Service (OPAS). Identifying older people at risk of adverse outcomes in hospital can allow a system to provide frailty-specific interventions throughout their stay.

Methods
OPAS (ED-based) accepts patients with frailty syndromes aged &gt;70 years. All patients receive a contemporaneous Clinical Frailty Score (CFS) following multidisciplinary assessment. A retrospective analysis of the OPAS databank was conducted using HFRS to divide patients in High/Intermediate and Low Frailty Risk. We considered Age, CFS, Postcode with Welsh index of multiple deprivation, length of stay (LOS) and 12-month mortality.

Results
700 consecutive admissions: 400 High/Intermediate and 300 Low HFRS. High/Intermediate HFRS vs Low HFRS had similar deaths (p=0.2) but significant difference in CFS (p&lt;0.05). HFRS was able to detect frailty in those &lt;75 years old (p&lt;0.01) but not at ≥76 (p=0.08). There was no association between postcode with frailty or Death. HFRS Sensitivity: 0.44, Specificity: 0.83, Positive Predictive Value: 0.66, Negative Predictive value: 0.34, Area Under Curve: 0.39.

Conclusion
The HFRS identified 57% of the retrospective OPAS cohort, with the addition of &gt;80yrs of age, the modified score identifies &gt;85% of service users. Of those admitted, High/Intermediate Frail had median LOS of 28.11 days vs 21.26 days for not frail, with 30-day mortality 10.12% vs 8.90%; potentially suggesting the HFRS can identify a subpopulation of high-risk frail patients. We found socio-economic status, quality of discharge summaries and coding had no relationship to the screening efficacy of HFRS. We have developed an electronic, automated Frailty Flag that operates in real-time to signpost appropriate patients who would benefit from comprehensive geriatric assessment which we have tested in clinical practice. HFRS can be used to measure frailty-specific intervention system efficiency.
1571 A QUALITY IMPROVEMENT INITIATIVE ON ‘INDWELLING URINARY CATHETERISATIONS’ IN HOSPITALISED OLDER ADULTS
Authors: Giridharan K , Bradford D , Lim S , Feroz A , Naeem O 
Published: July 2023

Abstract

Introduction
Indwelling urinary catheters (IUC) are well-known to cause serious adverse outcomes in older adults such as catheter associated urinary tract infections (CAUTI), direct trauma, delirium, deconditioning, falls, restrain, prolonged length of stay etc. (Lee E., Malatt C, 2011). Removal of IUCs as soon as the indication is resolved, results in better outcomes (Dawson et al, 2017). We identified high rates of inappropriate catheterisations as a regular practice or part of sepsis protocol in our hospital. This QIP was designed to compare our practice against the standards set by NICE and Royal College of Nursing.

Methods
Two PDSA cycles of 30 patients each, were completed between 2021-2022 (4 months apart), in Acute Frailty Unit and two Elderly Care wards. New IUCs in patients above 65 years were included. Data were collected on, documentation of IUCs, indications, plans for Trial without catheters (TWOC), appropriate management plans and CAUTI. Interventions post first PDSA cycle were; organised teaching to the nurses and doctors, discussing catheters at by-daily board rounds (BR), displaying flowcharts and reviewing IUCs during ward rounds.

Results
Documentation of IUCs improved significantly from 17/30 to 24/30. There was a small reduction in inappropriate indications from 16/30 to 12/30. Documentation of TWOC plans improved from 4/30 to 11/30. Collection of urine samples for CAUTI’s improved from 11 to 18. Our interventions were shown to produce positive outcomes.

Conclusion
Despite continuous education and BR discussions, there’s still room for improvement. Better understanding of catheter associated harm by frailty teams resulted in positive outcomes. Next steps prior to the 3rd PDSA cycle include educating Emergency and medical teams through wider teaching platforms and integrating changes to hospital electronic systems on appropriate documentation and TWOC plans. Our study would be applicable in similar settings nationally and globally to achieve better catheter care in older adults.

Reference
1. Lee E., Malatt C (2011) Making the Hospital Safer for Older Adult Patients: A Focus on the Indwelling Urinary Catheter 15(1): 49–52.
1513 PRE-FRACTURE MOBILITY ENHANCES PREDICTION OF POST-OPERATIVE OUTCOMES IN HIP FRACTURE SURGERY
Authors: Stubbs T A , Doherty W J , Chaplin A , Langford S , Reed M R , Sayer A A , Witham M D , Sorial A K 
Published: July 2023

Abstract

Introduction
Predicting outcomes after hip fracture is important for identifying high-risk patients who may benefit from additional care and rehabilitation. Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture surgery.

Methods
We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30-days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC).

Results
1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7-5.5-fold higher 30-day mortality (p≤0.001), and 1.9-3.2-fold higher likelihood of prolonged LOS (p≤0.001). Worse mobility was associated with a 2.3-3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p&lt;0.001) and a 1.3-2.0-fold higher likelihood of complications within 30-days (p≤0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733-0.777] to NHFS+mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557-0.611] to NHFS+mobility 0.616 [0.590–0.643].

Conclusions
Incorporating mobility assessment into risk scores may improve case mix adjustment, prognostication following hip fracture, and identify high-risk groups requiring enhanced pre, peri and post-operative care at admission. This implies that Information available at admission could facilitate prognostication, discharge planning, bed management and risk aversion, as well as informing discussions between clinical teams and patients about post-operative recovery.
1524 DRUG-INDUCED POSTURAL HYPOTENSION: CLUSTER ANALYSIS OF CO-PRESCRIPTION PATTERNS IN OLDER PEOPLE IN UK PRIMARY CARE
Authors: Bhanu C , Petersen I , Orlu M , Davis D , Sofat R , Bazo-Alvarez J C , Walters K 
Published: July 2023

Abstract

Introduction
Over 250 medications are reported to cause postural hypotension, associated with serious adverse outcomes in older adults. Studies in the literature and guidelines suggest a harmful cumulative risk of postural hypotension with multiple medication use. However, there is limited evidence on the potential for harm in practice, particularly which drugs are co-prescribed and may increase risk of postural hypotension.

Methods
Retrospective cohort study and cluster analysis using general practice data from IQVIA Medical Research Data (IMRD) in patients aged ≥50 contributing data between 1 Jan 2018 and 31 Dec 2018. Thirteen drug groups known to be associated with postural hypotension by mechanism were analysed and clusters generated by sex and age-band.

Results
602,713 individuals aged ≥50 with 283,912 (47%) men and 318,801 (53%) women were included. The most prevalent prescriptions that might contribute to postural hypotension were angiotensin converting enzyme (ACE) inhibitors, calcium-channel blockers, beta-blockers, selective serotonin reuptake inhibitors and uroselective alpha-blockers. We identified distinct clusters of cardiovascular system (CVS) drugs in men and women at all ages. CVS plus psychoactive drug clusters were common in women at all ages, and in men aged ≤70. CVS plus uroselective alpha-blockers were identified in men aged ≥70.

Conclusion
Distinct clusters of drugs associated with postural hypotension are commonly prescribed in practice, which change over the life course in men and women. Our findings highlight potentially harmful drug combinations that may cause a cumulative risk of postural hypotension in older people. This may guide clinicians about the potential of synergistic harm and to monitor for postural hypotension if using such combinations – particularly in patients aged ≥70 or at high-risk due to comorbidity.
1452 WHAT IS THE SOCIAL NETWORK OF THE MDTEA PODCAST (MULTIDISCIPLINARY TEAM EDUCATING ABOUT AGEING)?
Authors: Gill G , Wilkinson I , Collins S , Preston J 
Published: July 2023

Abstract

Background
The MDTea is a free open access medical education podcast designed for all healthcare professionals caring for older adults. To date there are 120 episodes.

Introduction/Method
The MDTea Podcast has CPD survey logs on its website where listeners who access the website can record their learning and receive a CPD certificate, Listeners provide their professional roles. Listener numbers for episodes were much higher than those recorded in the CPD log, so alternative measures were sought to understand who listens to the podcast. Series 11 was released in January to July 2022 and was themed around ‘A Day in the Life’ of health professionals working with older adults in the hospital environment. The MDTea Podcast Twitter account had 6333 followers before series 11 release and has good discussion and engagement with followers, and is regularly tagged in other geriatrics care from discussion by professionals. Measuring the followership and social network of the account may be useful to understand the MDTea’s place in the social network of UK care of older adults healthcare. Therefore with each episode release the new follower numbers and if available self-identified professional roles of each were recorded and counted.

Results
Over the course of the 11th series, the MDTea Podcast twitter account gained 432 new followers, from 22 different self-defined professional groups who engaged with our social media.121 followers did not identify their title. In contrast 12 self-identified professions were recorded in our series 11 CPD log results from 30 responses.

Conclusion
This work has demonstrated the wide range of professionals that engage with FOAMed resources produced by the MDTea. Given the breadth of professionals working in elderly care roles in both primary and secondary settings, having an understanding content users can enable authors to design content that is appropriate for their audience.