bluuebunny/crossref_metadata_2025_split huggingface dataset:
28 Training future leaders in geriatrics—an executive leadership academy
Authors: O’Donovan C , Gannon E , James K 
Published: September 2023

Abstract

Background
Medical training has continued to move towards a competency-based framework of education. Leadership, management, and non-clinical skills are core competencies included in the Geriatrics HST training programme however formal training opportunities in this area are often limited. We designed a novel geriatric medicine registrar executive leadership academy with the following aims: (1) Enhance registrar leadership and management skills; (2) Explore non-clinical career interests e.g. research, education and (3) Develop non-clinical skills essential for consultant posts e.g. conflict resolution, service development.

Methods
We organised a consultant led executive leadership academy held once per month November–May. Consultant of the month provided a brief overview of their career and taught on a leadership and management topic. We created an educational needs assessment survey prior to commencement to rank leadership/management topics and assess the baseline level of knowledge and exposure thus far to training/experience in leadership and management. Pre and post-test surveys were conducted to assess for improvements in self-efficacy and knowledge in areas of leadership and management skills following this educational intervention.

Results
12 registrars took part in the program with a range of registrar experience from one to six years. 10/12 completed a pre-program survey with three of these stating they felt ‘very confident’ in their leadership/management skills. Ranking of a list of topics allowed the program to be tailored to the registrars preferences. At the end of the program there was an increase in the registrars’ ability to identify personal areas in need of improvement.

Conclusion
The program was very successful with increased knowledge in non-clinical areas of medicine, increased confidence among trainees in applying for consultant posts and an enhanced relationship with consultants within the department.
33 Audit: delirium recognition on an acute medical ward
Authors: Gibbons C , Casey M , Shanley O , Connolly-Bree M , Lipsett O , Rothwell C , Casey N , Ocsio A , O'Malley G 
Published: September 2023

Abstract

Background
Delirium is a serious medical condition that is common in older adults in hospital settings. Clinical guidelines recommend that this cohort should be routinely screened for delirium. Our aim was to assess whether or not delirium was being recognised and documented on General Medical Wards (GMW) and to trial a multifaceted intervention to improve delirium detection and treatment.

Methods
We completed weekly prospective chart reviews on all patients aged ≥65 years on a GMW over a month-long period. We screened all identified patients using the 4AT. We then completed a multidisciplinary quality improvement initiative encompassing a comprehensive awareness and education program on delirium. We introduced standardised delirium screening using recognised tools and a new management tool for delirium for placement in medical notes. A re-audit was carried out.

Results
We included 37 patients (n = 37) in the pre-intervention study—mean age 81 years; 23 women (62%). 1 (2.7%) patient had a 4AT documented in their chart. We identified n = 5 patients with a 4AT ≥4 consistent with acute delirium. Of these 5, 2 (40%) had been flagged by the CNM and 1 (20%) by the medical team as delirious. We included 39 patients (n = 39) in our post-intervention study with similar demographics. 64% (25) of these patients had a 4AT or SQUID documented during the study period. We identified n = 3 patients with a 4AT ≥4–2 (67%) were flagged by the CNM and 3 (100%) by the medical team. Two thirds (66.67%) were documented as delirious in the medical notes.

Conclusion
Our audit demonstrates that a comprehensive education and awareness program can improve the detection of delirium in older adults on a GMW. This initiative was designed as a quality improvement project to support the development of a standardised program to be rolled out across all relevant units in a level 3 hospital.
35 Age, procrastination, depressive symptomatology, and loneliness: a structural equation modelling approach
Authors: Monaghan C , Power J M 
Published: September 2023

Abstract

Background
Procrastination, the voluntary delay of an intended course of action despite potentially negative consequences, is experienced by individuals of all ages, and yet little research to date has focused on procrastination behaviours among older adults. We wanted to explore the potential association between age and procrastination, and potential causal mechanisms therein.

Methods
We applied structural equation modelling to data from two waves of the United States Health and Retirement Study (collected during 2016–2020). The sample consisted of adults predominantly over the age of 50 (n = 1,320; mean = 64, range = 28–92) who completed measures of depressive symptomatology, loneliness, and procrastination across the two waves. The direct association between age and procrastination was investigated with both depressive symptomatology and loneliness being assessed as potential mediators.

Results
Model fit was acceptable (e.g. Comparative Fit Index = 0.931). The model results showed that age did not have a significant effect (beta = 0.010; p = 0.782) on procrastination. However, an indirect effect was present (beta = −.040; p &lt; 0.001). While age was not directly associated with procrastination, age was associated with increased likelihood of depressive symptomatology, which was in turn associated with increased likelihood of procrastination. No mediating effect of loneliness was observed (beta = −.010; p = 0.371).

Conclusion
We report an indirect effect of age on procrastination via depression, absent of a direct effect (which is not uncommon). Our findings suggest the presence of an inhibiting mediator, one not included in our model. For instance, while age may increase the likelihood of depression, yielding a positive effect on procrastination, age may also be associated with increased time management skills, or wisdom, which would potentially be associated with lower procrastination likelihood. Results are discussed in relation to potential implications for procrastination behaviours beyond retirement, and for potential sequelae such as financial decision-making or health behaviour.
41 Prevalence of delirium among older patients attending a Frailty service in an Emergency Department
Authors: Sheil O , Okon M , Roche E , Duffy P , Small C , Shortt C 
Published: September 2023

Abstract

Background
Delirium is a common clinical syndrome in older patients attending the emergency department and its incidence increases with patient age, disease severity and baseline cognitive impairment. However delirium is frequently unrecognised in emergency departments. The 4AT is a simple and short delirium detection tool designed for easy and effective clinical use. Early proactive recognition of delirium in the ED may improve outcomes such as length of stay and discharge to patients own home.

Methods
We undertook a retrospective study of 92 patients who attended the Frailty service in the ED between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and screened for frailty using the CFS with additional data collected to define age, sex, presenting complaint, length of stay and readmission rates.

Results
The 4AT was completed for 92/94 patients. 21/94 scored positive for delirium indicating a delirium prevalence rate of 22% among our Frailty service cohort. The average age of the patients was 84 years and 57% were female. Clinical Frailty Scale ranged from CFS 4–7 reflective of service parameters. The primary presenting reasons were fall (38% of patients) and infection (LRTI or UTI) for (38% of patients). The average length of stay was 8 days and the readmission rate was 12%. Baseline cognitive impairment was present in 71% of cases. 53% of patients were discharged to their own homes.

Conclusion
Delirium prevalence in the ED among frail older persons is 22%. The 4AT is a useful tool to quickly detect delirium in the ED. Delirium prevalence is greater in patients with baseline cognitive impairment.
42 Resolution of delirium upon discharge & mortality rates among frail older persons attending an Emergency Department frailty service
Authors: Okon M , Sheil O , Roche E , Patricia D , Shortt C , Small C 
Published: September 2023

Abstract

Background
Delirium is an acute confusional state, frequently associated with older hospitalised patients and has been found to be related to several adverse outcomes including longer length of stay and mortality. Better baseline cognition has been linked with a lower risk of delirium however those with high baseline cognition may experience greater cognitive decline post delirium.

Methods
We undertook a retrospective study of 92 patients who attended the Frailty service in the Emergency Department between 01/01/2023 and 31/01/2023. We screened for delirium using the 4AT within 12 hours of presentation to the ED and collected additional data collected to define baseline cognitive status, delirium resolution, and length of stay and discharge disposition.

Results
Delirium prevalence in this cohort was estimated at 22%. Overall delirium had resolved for our patients at discharge in 56% of cases. In the cognitively intact at baseline group (29%) delirium had resolved at discharge in 33% of cases only. For patients with baseline cognitive impairment (71%) delirium had resolved in 50% of cases. The mortality rate for patients with delirium was 14% with average CFS of 6. All patients who died had cognitive impairment at baseline. The mortality rate for patients without delirium was 1.4%. Length of stay ranged from 0 to 80 days. Length of stay for patients with delirium & baseline cognitively intact was 39 days. Length of stay for patients with delirium and baseline cognitively impaired was 8 days.

Conclusion
Two thirds of patients who were cognitively intact at baseline experienced longer length of stays & non resolution of delirium at discharge. There may be a need for dedicated follow up of these patients post-acute discharge. There was a higher mortality rate for patients with delirium and baseline cognitive impairment. Future studies may address illness acuity, delirium severity and duration & emergency department length of stay as influencers on mortality rate.
63 Introduction of an older persons comfort cart to an emergency department
Authors: Sheil O , Patricia D , Eavanna R 
Published: September 2023

Abstract

Background
Increasing numbers of older persons are presenting to our emergency department with complex needs. There has been a 13.8% increase in ED attendances by patients aged 75 years and over since 2019. Patients aged 75 plus spent on average 13.75 hours in the ED. Poor vision and hearing, functional decline, cognitive impairment and impaired communication can be exacerbated by the busy ED environment. The Frailty service identified a gap in our ability to provide comfort & communication items to our older patients in the ED.

Methods
We administered pre-intervention surveys to both older adult patients and ED staff to identify the level of interest in access to non-pharmacological comfort-enhancing resources & what items they wanted included in the cart. The cart included items to aid safety, comfort, mobility, memory, hearing, vision and activity. We measured the effectiveness of the comfort cart through a patient and staff survey.

Results
95% of surveyed patients strongly agreed that the comfort cart items improved their comfort, aided sleep, helped them to communicate and aided their overall ED experience. 100% of surveyed staff strongly agreed that comfort cart items improved patient comfort, increased staff satisfaction in providing care and improved efficiencies in accessing comfort items such as eye masks, earplugs, grippy socks etc.

Conclusion
The introduction of an older person’s comfort cart improved satisfaction of older patients in the ED and increased staff’s perception of patient comfort, as well as enhanced communication through availability of hearing devices & glasses. Helping our older patients feel comfortable and valued is what we set out to do with this quality improvement project and we hope it will continue to have a positive effect on our older patient’s experience in the ED. Other areas of the hospital are now rolling out similar carts for their patient cohort.
64 Driving positive ageing at home: older adults’ engagement with ALONE support services
Authors: O'Reilly A , Petrie N G , Bennett C , Geoghegan C , Gallagher J , Power J M 
Published: September 2023

Abstract

Background
It is estimated that by 2050 approximately 1.6 million Irish people will be aged 65 or over. This dramatic shift in population highlights the importance of supporting positive ageing, and the need to develop medical and non-medical infrastructure and services that can meet the needs of this growing age group. ALONE is a national organisation that aims to transform ageing in Ireland, by supporting older adults to age within their own homes and communities positively and securely. This research aims to provide a descriptive portrayal of the response of older adults to ALONE’s services. Specifically, this study examined the demographic and clinical characteristics of older adults who seek support from ALONE and described the implications of these findings for policy and service delivery.

Methods
Data from older people who engage with ALONE services are captured through an online system designed to record salient clinical and service delivery information. Data analysed for this study included demographic characteristics, presenting needs, and nature, duration, and frequency of service engagement.

Results
Most older people engaging with ALONE were female, aged 76–85 years and were referred to ALONE from the HSE, hospitals and primary care centres. Older people living in non-owner occupied homes, and reporting a recent fall and mobility issues were overrepresented in the data whilst social isolation, physical health issues and housing needs were commonly reported. Visitation support and befriending represented the highest area of need among older people, who generated an average of 3.4 interventions.

Conclusion
The findings from this research provide insights into older people’s needs and contribute to our understanding of emerging features of innovative health service delivery for older people. These findings will support policymakers and service providers in creating and implementing integrated psychosocial and medical community services for older people.
67 Audit of discharge summaries on a geriatric ward against the Health Information and Quality Authority (HIQA) National Standard
Authors: Radhakrishna K , Ratna A , Geraghty T , Hughes G , O'Shea D , Connolly W 
Published: September 2023

Abstract

Background
Discharge summaries are integral for safe transition of patient care. Complete, precise and succinct documentation can ensure improved quality of care and patient safety.

Methods
Retrospective data were collected from e-discharge summaries that were generated over a 7-month period from June-Dec 2022. A total of 20 samples were selected at random and assessed against the HIQA National Standard. The samples were compared to the physical medical records to countercheck if relevant information were present or omitted. There was a total of 78 outcomes measured as per the national standard.

Results
There were 8 (40%) discharge summaries with the complete clinical courses, in that they contained the main complaint, relevant clinical findings, relevant investigations results and the complete treatment courses. There were 4 (20%) summaries that had omitted documentation of inpatient complications or adverse events and 8 (40%) summaries had omissions present on medication prescriptions. There were 5 (25%) summaries whereby the list of stopped medications and the reasons for stopping the respective medications were omitted. There were 5 (25%) summaries with incomplete documentation of future plans. Only 4 (20%) discharge summaries had all the relevant information present.

Conclusion
Efforts to implement E-prescribing and electronic health records should be prioritised. The Irish Medical Council plans to introduce Entrustable Professional Activities (EPA), which are essential tasks that a trainee can be trusted to perform without direct supervision, once sufficient competence has been demonstrated. An entire EPA unit is dedicated to competent patient handover and discharge. A Discharge Summary Flowchart which highlights the inclusion of all the essential components of a complete discharge summary was introduced as a guide for the team. Finally, there is an ongoing continuous audit by Senior House Officers and Interns to assess the quality of discharge summaries after the recommendations have been implemented.
76 Improving medicines management of inpatient Parkinson’s Disease patients by making pharmacy interventions
Authors: Knipe M , Conyard E , Donovan M 
Published: September 2023

Abstract

Background
Hospital admissions of Parkinson’s Disease (PD) patients can result in disruptions in medication regimens causing adverse effects for PD patients. Evidence shows that interventions can reduce medication-errors and administration of contraindicated medicines in PD patients.

Methods
Three interventions (priority medicines reconciliation, stock optimisation and staff education) were implemented over a one month period. A ‘baseline’ audit was completed prior to intervention implementation measuring patient demographics, delay in 1st dose post-admission, medication-errors, pharmacist medicines reviews and time until completion and patient outcomes. A post-intervention audit identical to the ‘baseline’ audit was completed.

Results
The ‘baseline’ audit (mean age 81 years, 24 patients, 1,611 doses) and the post-intervention audit (mean age 80, 30 patients, 1,840 doses) were compared and analysed. Medicines reconciliations increased from 79% to 97% (p = 0.042) and these were completed 38.7 hours (p &lt; 0.001) sooner post-admission. A reduction in 1st dose delay was seen (13.5 vs 4.4 hours [p &lt; 0.001]), along with reductions in delayed (5% to 1% (p = 0.037)) and missed doses (8% to 2% [p &lt; 0.001]). Omitted pre-admission PD medications reduced from 16% to 2% (p = 0.011). Staff education contributed to recorded due times increasing from 44% to 97% (p &lt; 0.001). Contraindicated medicines were administered at reduced rates in the post-intervention audit. The length of admission was shorter due to the combination of interventions (19 vs 15 days [p = 0.475]). These improvements resulted in a reduced prevalence of falls, delirium episodes and rigidity. Patients were more able to interact with allied health professionals in the post-intervention audit (46% vs 100%). Improvements in non-oral PD medicines prescribing occurred in ‘nil by mouth’ patients.

Conclusion
This study showed that the introduction of the pharmacist-led interventions, staff education, priority medicines reconciliation and stock optimisation, can improve PD inpatient outcomes, by reducing medication errors, decreasing the administration of contraindicated medicines and preventing delays in the administration of PD drugs.
77 Introducing a Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR) and treatment escalation plan (TEP) guideline in an acute hospital.
Authors: Brolly A , Hanlon J 
Published: September 2023

Abstract

Background
In hospital cardiopulmonary resuscitation has a 13–20% survival rate to hospital discharge. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders reduce resuscitation activity in people who are unlikely to survive due to underlying co-morbidities. The project aimed to identify current DNACPR practice and cardiac arrest calls in an acute care hospital and to improve communicating and documentation of DNACPR decisions.

Methods
A baseline audit of 20 medical charts identified variable practice on documenting DNACPR, inappropriate cardiac arrest calls and poor communication between the multidisciplinary team and patients on DNACPR decisions. A sub-committee of Medical Clinical Governance developed a hospital wide Guideline and Proforma for DNACPR that included a treatment escalation plan (TEP). Using quality improvement methodology and plan-do-study-act cycles the DNACPR proforma and decision support framework was refined and tested. Implementation strategies included stakeholder engagement, education, re-formatting documentation and recruitment of ward champions over a six month period. Post implementation audit measured compliance with completing the proforma and resuscitation calls.

Results
Clinical audit in February 2023 of 33 patient medical records identified 100% (n = 33) of patients with a DNACPR decision had the correct form in use. 96% documented communication with patients. All proformas were signed by a senior decision maker, included a TEP and were filed correctly in the patients notes. There was a 25% reduction in cardiac arrest calls. Only 56% of proformas were signed by nursing staff.

Conclusion
Implementing a standardised DNACPR proforma was feasible and improved documentation, visibility and ease of locating DNACPR decisions. It promoted timely communication with patients and families setting realistic goals of care in the TEP. In turn there has been a reduction in cardiac arrest calls. Nurses role in the process remains sub-optimal and there is a need to understand the experience of patients and families.
86 Meitheal programme (MP) phase 2 supporting the needs of nursing home staff delivering palliative care (PC) to the older person
Authors: Richardson J , Diver E Sweeney , McTeggart M , McElhinney J 
Published: September 2023

Abstract

Background
There was a need identified within residential settings to build staff awareness of palliative care, to improve PC provision and to reduce inappropriate hospital transfers of residents. Acknowledging the absence of training undertaken in palliative care, the MP was designed to facilitate and support staff to integrate an early PC approach. This is undertaken by the Meitheal Clinical Nurse Specialist (CNSp) attending the residential setting, facilitating education and clinical support.

Methods
A structured programme was designed offering flexibility, in recognition of the many demands within a nursing home setting. The Meitheal CNSp facilitates multi-modal interactive education through workshops and support sessions, including live case scenario discussions of residents’ care. Informal clinical support facilitates further learning and integration of person-centred PC to enhance better quality of living. Resources to support and help sustain the programme learning are provided.

Results
Our current programme was adapted from the results of the Evaluation of the Meitheal Programme Phase 1. This highlighted five main themes: (i) Support, (ii) Teamwork, (iii) Communication, (iv) Knowledge and (v) Quality of life. Participants reported: (i) Strong need for support for all, including bereavement, (ii) Enhanced awareness of importance of teamwork and recognition of roles, (iii) Improved communication with residents and families and less fear of sensitive conversations, (iv) Increased confidence, knowledge and understanding of early palliative care and (v) Greater understanding of appropriate medications and earlier intervention for symptom management.

Conclusion
The Meitheal Programme is different to other PC programmes, as it provides ‘onsite’ education & ‘on the ground’ clinical support. The Meitheal CNSp is present within the nursing home, enhancing the application of theory to practice in real time with real case scenarios. It is evident that the Meitheal Programme has initiated significant improvements to date. However, there are many challenges to overcome as we continue Phase 2 Meitheal Programme delivery and rolling evaluation.