bluuebunny/crossref_metadata_2025_split huggingface dataset:
219 IMPROVING DELIRIUM SCREENING AND MANAGEMENT IN POST-ACUTE REHABILITATION: A MULTI-STAGE QUALITY IMPROVEMENT INITIATIVE
Authors: McDaid E , Harte A , Reynolds A , Hearne S , Synnott E , Buckley E , Delaney S , Cogan L 
Published: February 2023

Abstract

Background
There is risk of delirium among older patients on transition from acute care to post-acute rehabilitation (Marcantonio et al. 2003). The 4AT is the recommended delirium detection tool for clinical practice (Tieges et al. 2020). A multi-disciplinary led quality improvement project was undertaken to standardise and improve delirium screening and management in the older person’s rehabilitation service of a post-acute rehabilitation hospital.

Methods
A retrospective audit of medical charts was completed for all patients admitted to a post-acute older person’s rehabilitation service from October 2019 to December 2019. Following that audit, there was a staff education intervention focusing on delirium awareness, screening and management. Furthermore, a dedicated ‘Delirium Champions Group’ was formed with representatives from the multi-disciplinary team. A Delirium Screen pro-forma was developed and implemented by this group. It included an attached 4AT sticker for all new admission medical charts. A post intervention medical chart audit was completed for all admissions to the same ward from October to December 2020.

Results
The pre-intervention chart audit showed 0% compliance with any form of formal delirium screening tool. The majority of patients had at least 2 delirium risk factors at the time of admission. The post-intervention audit recorded 92% compliance with 4AT use at the time of admission as well as full completion of the Delirium Screen pro-forma which included the documentation of risk factors for delirium. The Delirium Champions Group provide ongoing staff education, resources and are now exploring hospital environmental design and its role in delirium prevention.

Conclusion
This initiative lead to a significant improvement in the completion of delirium screening in post-acute rehabilitation. This project had the secondary benefit of prompting the formation of a dedicated delirium improvement group focusing on delirium awareness, screening, documentation, management and ultimately prevention.
222 OLDER ADULT INPATIENTS’ PERCEPTIONS OF PROGRESSIVE RESISTANCE TRAINING IN A SPECIALIST GERIATRIC REHABILITATION SETTING
Authors: Burke C , O'Neill E , Timmons S , Kurian S , Mello S , Fitzgerald M 
Published: February 2023

Abstract

Background
Progressive resistance training (PRT) has the potential to reduce age-related disability and has been proven to benefit the older adult in a variety of ways. PRT is prescribed routinely by physiotherapists for frail older adults in an inpatient setting. To date little is known of their experiences engaging in PRT. This study aimed to explore older adult inpatients’ perceptions and experience of PRT as part of their overall physiotherapy program in a Specialised Geriatric Rehabilitation Unit.

Methods
The study had a qualitative design. Semi-structured interviews explored experiences and perceptions of PRT along with motivators and barriers to participation. Interviews were face to face and conducted in the unit. Data was analysed using thematic analysis. 11 frail older inpatients with orthogeriatric (n = 5), neurological (n = 2), general surgical (n = 2) and general medical (n = 2) diagnoses were interviewed.

Results
The study identified three overarching themes: Acceptability, Facilitators and Barriers. In the category of Acceptability participants identified the subthemes: (1) PRT is challenging, (2) PRT is Rewarding and (3) PRT is Enjoyable. In the category of Facilitators, the following subthemes emerged: (4) Positive outcomes as motivators and (5) Supervision is necessary for engagement. In the category of Barriers, (6) Low self-efficacy beliefs and (7) the Negative effects of PRT, such as pain and fatigue affected participation.

Conclusion
Frail older inpatients find PRT to be an acceptable form of exercise. It is perceived to be challenging, but rewarding and enjoyable for most. Participants were motivated to participate in PRT by the positive outcomes (improved strength, general health, function, independence, confidence) they experienced. They felt supervision from professionals with medical expertise was essential to participation; and had low self-efficacy beliefs surrounding independent practice; fearing falling and causing harm. Pain and fatigue also impacted participation.
231 ESTABLISHING AN INTERVENTIONS BUNDLE TO IMPROVE INPATIENT CARE FOR PATIENTS WITH PARKINSON’S DISEASE: A MULTIDISCIPLINARY QUALITY IMPROVEMENT PROJECT
Authors: Penugonda M , Walsh J , Barry J J , Govern R M , Bradley D , Bolger M , English G , Moore J , Nolan N , Treacy E , Burke J , Dwyer N , Gallagher D , Macken S , McCaffrey S , Moloney S , Murphy R , Murray M , Hanlon E O' 
Published: February 2023

Abstract

Background
Patients with Parkinson’s (PwP) are at a higher risk of complications once admited to hospital compared to their age-matched peers. Medication mismanagement is a well-known obstacle, which puts PwP at risk of sub-optimal treatment leading to an unnecessary deterioration of baseline and potentially increases risk of adverse sequelae.

Methods
Retrospective electronic patient records (EPR)/chart review of 47 admissions was conducted, across three hospital sites.
Data attaining to correct prescribing of medication on admission and discharge, prescribing of contraindicated medications, reasons for medication lapses and complications of inpatient stay were collected. EPR of 17 patients’ were reviewed to assess if Parkinson’s disease (PD) medication administrations occurred within 30 minutes of patient schedule, as recommended by NICE guidelines. Key areas for improvement were identified based on the results.

Results
47 charts (30 Males, 17 Females) with mean age 72 (range:57–90), were reviewed. Average number of co-morbidities:4.5 and Clinical Frailty Scale ranged 5–9 (n = 30). LOS averaged 12.4 days and 43% of patients had ≥2 hospital admissions in the preceeding year.
38% (17/44) of admissions correctly documented patient specific medication times. Only 48% of patients (n = 638) received their medications within 30 minutes of the scheduled time. 47% (22/47) experienced complications attributable to PD. Contraindicated medications were noted in 5 cases. 84% of discharging prescriptions did not mention timing of PD medication and 3 prescriptions had errors with regards to dosage/omission of medication.

Conclusion
We implemented across two sites: 1) Care protocol flag in patient’s chart highlighting simple avoidable complications. 2) Laminated over the bed signpost alerting ‘time critical medication’. 3) ‘Time critical medication’ stickers in drug kardex 4) Education sessions for Medical, Nursing and Ward staff. 6) Establishing out of hours access to PD medications and protocols for NPO/poor swallow. We plan to reassess significance of efforts post intervention.
235 THROMBOLYSIS DOSING AND WEIGHT ESTIMATION IN ACUTE STROKE: A SINGLE CENTRE AUDIT
Authors: Mannion M , Gabr A , Cunningham N , Leahy A , Paulose S , O'Brien I , Saleh A , Prendiville T , Okpaje B , Mohamed A , Ali B , Ryan R , Lyons D , Quinn C , Peters C , Shanahan E , Kennedy C , McManus J , Galvin R , O'Connor M 
Published: February 2023

Abstract

Background
Stroke is a leading cause of death and disability. Thrombolysis with intravenous (IV) alteplase is the mainstay management of ischaemic stroke. It has a narrow therapeutic window with a high potential for adverse outcomes such as intracranial haemorrhage. The efficacy of alteplase is time and dose dependent with weight-based dosing. National clinical guidelines recommend a dose of 0.9 mg/kg, up to a maximum of 90 mg. (Irish Heart Foundation Council for Stroke 2015). In most hospitals in Ireland however, patients are not weighed prior to thrombolysis. Time pressure and lack of available suitable equipment are factors.

Methods
This retrospective clinical audit evaluated the dosing of alteplase, estimated and actual weight for a convenience sample of stroke thrombolysis patients treated between 2016–2020 at an Irish University Teaching Hospital.

Results
107 patients were audited (62 males, 45 females). Actual and estimated weights were available in 92/107. Weight was not documented (n = 15) due to severe stroke/palliative management (n = 6) or omission (n = 9). 21% (19/92) received the correct dose of 0.9 mg/kg. A further 54% (50/92) received a dose within the range of 0.81–0.99 mg/kg (±10%). 25% received a dose outside this range (&gt; ± 10%). 11% (10/92) were under-thrombolysed and 14% (13/92) over-thrombolysed. 17/92 patients had an intracranial haemorrhage. 35% (n = 6/17) of patients who had an intracranial haemorrhage received a higher dose of thrombolysis (&gt;10%).

Conclusion
A quarter of patients received inappropriate dosing of alteplase that was outside the range of ±10% of 0.9 mg/kg. While stroke thrombolysis must be completed urgently, an accurate weight should be determined to avoid errors in dosing. A process evaluation of stroke thrombolysis would provide information on how best to incorporate an objective means of weight measurement without delaying treatment.
236 PREDICTORS OF ADVERSE OUTCOMES IN OLDER PATIENTS DISCHARGED DIRECTLY FROM THE EMERGENCY DEPARTMENT
Authors: Mohamed A , Gabr A , Cassarino M , Leahy A , Ali B , Okpaje B , Saleh A , Mannion M , Carroll I , Hayes C , Peters C , Shanahan E , O'Connor M , Galvin R 
Published: February 2023

Abstract

Background
Over 40% of older patients are discharged directly from the Emergency Department (ED) and this cohort is at increased risk of adverse outcomes.
The purpose of this study was to explore the factors that predict future adverse outcomes in this cohort to inform practice, resource planning and policy.

Methods
A secondary analysis of the OPTIMEND, a single-centre, randomized-controlled trial was completed. OPTIMEND examined the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone (Dec 2018-May 2019). The inclusion criteria were adults aged 65 years and over presenting to the ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.

Results
220 patients were included (median age 79 years; 62% female). Median length of stay in ED was 5.5 hrs. 70 patients re-attended the ED within 6 months with 43 re-hospitalised within 6 months. 9 patients died within six months of discharge.
Multivariant logistic regression was completed. Age was the only independent predictor of mortality within six months of discharge {Odds Ratio (OR) 1.15, p = 0.044}. Past hospitalisation (&lt;6 months) was associated with a lower likelihood of ED re-attendance, and rehospitalization within six months of discharge (OR: 0.452 p = 0.022; OR:0.442, p = 0.046; respectively). Clinical Frailty Score was associated with a significantly higher likelihood of rehospitalization (OR:1.48, p = 0.031) but not with ED revisits (OR: 1.235, p = 0.165).

Conclusion
Older people have a high ED re-attendance rate of 33% after an index visit with 20% hospitalized subsequently. Frailty is a significant predictor of rehospitalisation. Rapid and targeted intervention for frail patients who reattend the ED should be a priority for the integrated care program to enhance admission avoidance.
243 MEASURED FRAILTY AND POTENTIALLY INAPPROPRIATE PRESCRIBING IN ACUTELY HOSPITALISED OLDER ADULTS: A PROSPECTIVE OBSERVATIONAL STUDY
Authors: Randles M , Gallagher P , O'Mahony D 
Published: February 2023

Abstract

Background
Frailty characteristics such as compromised response to stressors and accumulation of deficits in physiological systems may leave frailer older adults at higher risk of adverse outcomes from PIP, compared with their non-frail counterparts of the same age. This study aims to examine the relationship between measured frailty and potentially inappropriate prescribing in older adults presenting acutely to hospital.

Methods
A prospective observational study was conducted. Participants were acutely hospitalised older adults. Inclusion Criteria: Age ≥ 65 years old, acute admission &lt;72 hours, expected length of stay &gt;24 hrs. Exclusion Criteria: &lt;65 years of age, actively dying, direct admission to ICU, inability to provide informed consent and next of kin declined consent, patients in isolation for infection control purposes. Medical chart review was carried out, followed by a short interview using a standardised data collection proforma. Frailty was measured using the Clinical Frailty Scale and the Frail-VIG frailty index. Potentially Inappropriate Prescribing was identified using the STOPP/START criteria. Results are presented for the first 200 participants.

Results
The mean (±standard deviation [SD]) age of study participants was 79.25[±7.14], 56.5% were female. The prevalence of frailty measured using the CFS and Frail-VIG were 61.5% and 50.5% respectively. Applying the CFS, the mean number of STOPP criteria in non-frail patients was 1.03 and 1.87 for frail patients (p = 0.001 CI 95%) and 1.14 and 2.10 (p = 0.001 CI 95%) using the Frail-Vig Index.

Conclusion
Frailty is associated with functional decline, falls, hospitalisation and death. Frail patients had a higher mean number of STOPP criteria. As medication side effects are themselves included as part of the frailty syndrome, in-hospital medication review and patient centred medication optimisation should be guided by patient’s frailty status to reduce adverse outcomes.
248 UNINTENDED CONSEQUENCES: DID THE PANDEMIC LEAD TO REDUCED REHABILITATION LENGTH OF STAY POST HIP FRACTURE?
Authors: McDaid E , Tiernan C , Cogan L 
Published: February 2023

Abstract

Background
The aim of this study was to compare hip fracture rehabilitation outcomes during the COVID-19 pandemic (2020 data) against comparable control data (2015–2019). Variables examined included patient demographics, time to transfer (acute length of stay), rehabilitation length of stay and discharge destination.

Methods
An audit was completed using the local anonymised hip fracture data collected during 2020. This data is collected as part of an ongoing quality improvement initiative to improve the hip fracture rehabilitation pathway. A review of previous local annual hip fracture reports was completed to allow comparison of key outcomes.

Results
For the control period (2015–2019) the mean number of hip fractures admitted per year was 98 compared to 59 during 2020 (periods of closure). During the control period, 78% of admissions were female and mean age was 82 which is similar to 2020 with 83% females mean age of 83. Almost half of patients lived alone (49%) which is similar to the control period (48%). Despite the added complexity to the transfer process (swabbing and isolation) the mean time to transfer from acute was reduced by 1 day. The mean post-acute rehabilitation length of stay significantly reduced in 2020 to 37 days compared to 49 days during the control period. There was a reduction in number of patients who discharged home, 88% in 2020 compared to 93% in control period. This is reflected in the increased number who discharged to nursing home care, 7% in 2020 compared to 4% in control period.

Conclusion
There may be multiple contributing factors that led to the significant reduction in rehabilitation length of stay including increased rehabilitation staffing ratios during the pandemic due to reduced occupancy, expedited home support services, increased community response teams and patient and family wish to accelerate discharge secondary to concerns of risk of COVID-19 exposure in the hospital setting.
26 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC ELECTRONIC NURSING HANDOVER
Authors: Trolan C 
Published: February 2023

Abstract

Background
The COVID19 pandemic highlighted deficiencies in information exchange in nursing handover in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns a multidisciplinary team to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and &gt; 75% return home. Weekly bed turnover is approximately 15%. A revised electronic template was developed to complement an Intermediate Care Framework already in use, based on National Audit of Intermediate Care quality indicators.

Methods
Semi-structured interviews with nursing leaders and a weighted questionnaire for the whole nursing team were used to determine baseline levels of confidence around aspects of nursing handover.
An Ishikawa diagram analysed factors contributing to poor documentation and communication. The ‘Chain Of Care’ vision for care home environments incorporated the need for microsystem-tailored, standardised, integrated nursing handover. Four iterations occurred. A post-implementation weighted questionnaire collated qualitative information on confidence change.

Results
Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence around...: 70%, addressing questions from residents or relatives; 70%, responding to change in a resident’s health status; 70%, giving handover to ambulance crew or doctor or fellow nurse.

Conclusion
Categorical selections across multiple information domains enabled increased/slightly increased confidence in the nursing team in the quality of the information exchanged in nursing handover in an intermediate care rehabilitation care-home setting. Focussed, free-text options permit narrative if required.
A shared electronic template facilitated accessibility and live-time editing in an environment with relatively higher bed-turnover and frequently changing functional mobility and care needs of residents.
Tailoring the nursing handover to the intermediate care environment with mitigation of variation of information provision/accessibility/language were considered in the iterations. Versions are reposited for inspectors.
28 A COLLABORATIVE QUALITY IMPROVEMENT PROJECT BETWEEN AN NHS TRUST AND INDEPENDENT PROVIDER TO DEVELOP A CARE-HOME SPECIFIC MULTIDISCIPLINARY SAFETY BRIEF
Authors: Trolan C 
Published: February 2023

Abstract

Background
The COVID19 pandemic highlighted deficiencies in interdisciplinary risk-communication in an intermediate care unit, based in a 30 bed independent care home, into which the hospital organisation assigns medical, pharmacy, physiotherapy, occupational therapy and social work teams to provide post-acute care rehabilitation for adults. Mean length of stay is 20 days and &gt; 75% return home. Weekly bed turnover is approximately 15%.

Methods
Semi-structured interviews with nursing leaders and a weighted questionnaire for multidisciplinary team were used to determine baseline levels of confidence around environmental and resident-specific risk awareness.
An Ishikawa diagram analysed factors contributing to risk-communication. The ‘Chain Of Care’ vision for care home environments incorporated a Multidisciplinary Safety Brief. Five iterations occurred before reaching standardisation. A post-implementation weighted questionnaire collated qualitative information on confidence change.
The Safety Brief supplements intra-professional group handover processes. Duration ranged 90-120 seconds, occurring at shift commencement and 12.00 h daily. Retained documentation is available for inspectors.

Results
The Safety Brief as a communication tool: 86% of the team found it useful; 71% found that it had the ‘right amount’ of detail; and 62% found that it was of the ‘right duration’.
Areas of greatest ‘swing’ towards INCREASED or SLIGHTLY INCREASED confidence in awareness of...: 72%, deaths in last 24 hours; 68%, planned discharges today; 67%, residents at risk of falling/had fallen within 48 hours; 67%, residents with same name; 66%, bed-availability; 63%, infection risks; 62%, experiencing delirium; 62%, living with dementia; 59%, scheduled appointments today; and 52%, those receiving palliative care.

Conclusion
A Multidisciplinary Safety Brief increased/slightly increased multidisciplinary team confidence in environmental and resident-specific risks in a care home environment. Risk-communication in any environment is complex especially if subject to frequent change. Communication tools need to be tailored to microsystem, systematic, comprehensive, yet brief and intuitive. Generalisability to non-intermediate care, non-geriatrician supported care home environments was considered iteratively.
36 A YEAR WITHOUT THE FLU: MODELLING THE EFFECTS ON CARDIOVASCULAR MORTALITY FROM INFLUENZA IN IRELAND
Authors: Choo E , Harbison J 
Published: February 2023

Abstract

Background
Cardiovascular diseases (CVDs) are consistently ranked among the leading causes of death among older adults in Ireland. COVID-19 and influenza infection are associated with cardiovascular complications. However, percentage of deaths caused by CVD among adults aged 75 and over in Ireland decreased from 32.9% to 31.0% from 2019 to 2020. Government-imposed social distancing measures resulted in abolition of influenza activity (IA). We analysed population data from the 2010/11–2019/20 influenza seasons to estimate the impact of reduced IA on CVD mortality rates during the COVID-19 pandemic season.

Methods
Quarterly mortality data for acute myocardial infarction (AMI) and cerebrovascular disease from first quarter (Q1) 2010 to fourth quarter (Q4) 2020 was obtained from the Central Statistics Office. Weekly data on influenza-like illness (ILI) rates and positive percentages (PP) (i.e. proportion of influenza-positive sentinel respiratory specimens) from week 40 2010 to week 20 2020 was obtained from the Health Protection Surveillance Centre. Excess mortality rate during influenza season was calculated as the percentage difference between Q4/Q1 and preceding third quarter (Q3) mortality rates. We adopted the Goldstein index (ILI rate × PP) as an indicator of IA. Time series analyses, Pearson correlation coefficients (r) and linear regression models were used to evaluate the relationships between IA and excess AMI and cerebrovascular disease mortality rates.

Results
Statistically significant positive associations were observed between IA and excess AMI (r = 0.557, p = 0.011) and cerebrovascular disease (r = 0.858, p &lt; 0.001) mortality rates. Linear regression models predicted 0.072% (95% confidence interval 0.019%, 0.125%) and 0.095% (0.067%, 0.123%) increases in excess AMI and cerebrovascular disease mortality rates respectively per unit increase in IA levels.

Conclusion
Elimination of IA may have contributed towards limiting the effects of COVID-19 on CVD mortality rates, and consequently total excess mortality, among older adults in Ireland.