bluuebunny/crossref_metadata_2025_split huggingface dataset:
50 Employing Shared Decision Making (SDM) to reduce NSAID-related harm and hospitalisations, in at-risk patients in primary care
Authors: Kinahan C 
Published: September 2023

Abstract

Background
10% of hospital admissions in Ireland are Adverse Drg Reaction (ADR) related, and 71% of these are potentially avoidable. NSAID-related ADRs have been implicated in up to 30% of all ADR-related admissions. Addressing NSAID related STOPP criteria may prevent hospital admissions with bleeding, Cerebrovascular (CV) events and renal impairment. If stopping NSAID is not possible, dose reductions or drug switches can minimise the risk of harm. Preferred NSAIDs are naproxen (lower CV risk) or ibuprofen &lt;1,200 mg/day (lower CV and gastrointestinal bleed risk).

Methods
Patients aged ≥65 years with valid prescriptions for NSAIDs were identified via software search using the M01 ATC classification system code. Each patients file was reviewed for NSAID related STOPP criteria. Specific software searches using additional ATC classification system codes were undertaken to identify those at high risk of harm e.g. NSAID with anticoagulant. Patients were engaged in Shared Decision Making (SDM) with the practice pharmacist and prescription changes were agreed and enacted by the GP.

Results
63 patients&gt;65 yrs had a valid prescription for an NSAID. 42 had ≥1 NSAID related STOPP criteria. 35 were deemed appropriate for intervention. 7 were prescribed a preferred NSAID and had mild hypertension only. 23 were deemed at high risk of harm. Software searches identified the same 23 high risk patients. 35 patients were engaged in SDM. 100% of these agreed to a change to their prescription. 51% stopped their NSAID whilst 40% changed or dose reduced their NSAID and 9% agreed to addition of gastroprotection. This achieved an overall 60% STOPP resolution rate. A higher average 91% resolution rate was achieved in the higher-risk patients.

Conclusion
SDM achieves higher STOPP resolution rates in patients at higher risk of harm who are identifiable though specific GP practice software searches. These software searches can be employed annually to effectively and efficiently prioritise patients for SDM interventions.
52 ‘I remember when. . .’—environmental, event-based and personally relevant objects that support reminiscence in virtual reality and other digital settings
Authors: Collins R , Tsabary C , Hopper L 
Published: September 2023

Abstract

Background
Limited but growing evidence is emerging to support technology-supported reminiscence. Although some studies involved older adults, few included people with dementia. Little guidance is available for facilitators regarding the themes and objects that best support reminiscence in a digital environment or those that are best used with a cognitively impaired population. This study aimed to address this research gap.

Methods
Thirty-seven older adults, with and without cognitive impairment, collaborated with our research team across two rounds of participatory workshops; held in each of two locations (urban and rural town). The first involved capturing and probing memories from young childhood to present day. Workshop discussion and outputs were thematically analysed, themes with higher levels of engagement were identified and content analysis of each theme identified associated objects. These results were reviewed in the second workshop and recommendations were made as to how they could best be used in digital environments.

Results
Engaged and positive reminiscence experiences were supported by: Environmental Objects—prompting memories closely linked with specific settings (e.g. school, childhood home, playing on the street, old shops); Event Objects—triggering memories relating to specific occasions of types of events (e.g. holidays, dances, sports, hobbies); and Meaningful Objects—items with personal relevance for individuals (e.g. first bike, record player, telegram). Object-rich digital environments were deemed to best support VR reminiscence, rather than single item interactions which can be effective for in-person sessions.

Conclusion
Objects recommended for use in digital VR reminiscence support the limited findings that are available from previous research. Fewer cross cultural differences were noted, and we recommend that this research is extended to learn more about reminiscence prompts in more ethnically diverse groups. Nevertheless, a catalogue of objects, environments and meaningful events are now available to support clinical and technical developers of digital reminiscence.
65 A review of the Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)
Authors: Kruis A , McNamara R 
Published: September 2023

Abstract

Background
The conventional paradigm of emergency care may not address the multifaceted care needs of older patients, who present to the emergency department with multiple comorbidities, geriatric syndromes, and health determinants, complicating diagnosis and therapy. OPRAH was introduced in 2019 to meet the needs of our changing population. The unit was initially developed out of existing resources within the ED but more recently expanded with the addition of a Geriatric ANP, additional ED GEM (Geriatric Emergency Medicine) consultants, an occupational therapist and a physiotherapist to the team.

Methods
The electronic records of all patients seen by the OPRAH team were reviewed to determine the impact of the service. The data collected included the patient’s age and outcome of the patient (admission vs discharge).

Results
From 1st of January to 30th of April 2023, 1,118 patients were assessed. Three hundred and forty patients were admitted to a hospital (30.41%). Of those, 264 patients were admitted to X (23.61%), 64 to Y (5.72%), 10 to Z (0.89%) and two patients in A (0.17%). The remaining patients were either discharged back home or referred to convalescence in a nursing home. The mean age was 82, ranging from 35 to 103.

Conclusion
The expansion of OPRAH in the ED has improved access for all patients living with frailty to short-stay ED-led care. The implementation of integrated care had led to patient-centred care with the timely discharge of suitable patients to either their own homes with support structures in place or onward referral to more appropriate settings (e.g. a nursing home or step-down facility with MDT) when admission to an acute hospital was not required.
74 Making mobility falls prevention and management everyone’s business
Authors: Brolly A , Buckley M 
Published: September 2023

Abstract

Background
Falls in hospital are detrimental to patient safety and the highest reported patient safety incident. The falls committee undertook a review. It identified a need for improved processes around the identification of falls risk. There was a need for a succinct multi-disciplinary approach to falls prevention following the identification of falls risk. Staying mobile and having clear visible mobility goals while in hospital was targeted as a strategy. This was appropriate as reduced mobility is a modifiable risk factor for in-patient falls.

Methods
PDSA quality improvement methodology was used. A mobility and falls policy was developed. The policy provides a framework of three algorithms for falls risk identification, prevention and management. Additionally, referrals to health and social care professionals were streamlined to reduce time from risk assessment to referral. Falls prevention information leaflets were developed to help make patients partners in the process. Whiteboards were used behind patients beds with magnets to clearly show falls risk. Mobility status and goals were written on the whiteboard. This ensured a succinct joint approach to patient mobility. Education and staff engagement enabled implementation. Excellence was awarded with a certificate for display on the wards quality boards. Clinical audit was used to measure results.

Results
Review of audit data between October 2022 and January 2023 recognised improved processes in the identification and management of falls. Outcome measurement showed up to 100% increase in communication between healthcare professionals in relation to patient mobility status and goals.

Conclusion
In conclusion, we learnt that identifying and communicating falls risk was not enough. A clear succinct multi-disciplinary plan of action was required. Patients must be partners in that plan.
75 The COVID-19 pandemic and social frailty: an evaluation of Occupational Therapy practice in a day hospital
Authors: Webster C , Brennan B , O'Donoghue N , Manning Z 
Published: September 2023

Abstract

Background
Restrictions imposed to limit transmission of COVID-19 and to protect vulnerable persons led to loss of roles and routines, social isolation, sedentary lifestyles, increased anxiety, depression, and increased frailty among older people. In Occupational Therapy (OT) literature, ‘occupational deprivation’ describes this state of enforced disengagement in meaningful occupations which negatively impacts wellbeing. Clients attending a Day Hospital for Comprehensive Geriatric Assessment (CGA) reported residual elements of occupational deprivation and negative effects of COVID-19 restrictions with associated social frailty. OT practice was evaluated to determine the extent of services offered to remediate or improve social frailty and overall wellbeing.

Methods
During CGA, OTs assess clients’ occupational performance including cognition, mood, mobility, social environment and engagement in meaningful occupations. Routine (quantitative) data collected to evaluate the service was inputted and analysed using Microsoft Excel. OTs logged numbers of clients referred to services to remediate social frailty including day centres, social prescribing and an OT-led anxiety management group in the Day Hospital. Six months of data in 2023 was analysed.

Results
288 clients received CGA by OT. The average age was 83. 33% were referred to Memory Technology Resource Rooms. 6% were referred to Day Centres or Active Retirement. 7% were referred to OT anxiety management group in the Day Hospital. 3% were referred to ALONE befriending. As part of routine OT practice, almost all clients were advised to continue with or to re-engage with previously enjoyed (meaningful) occupations such as attending mass, playing bridge, and visiting friends.

Conclusion
Occupational deprivation experienced by older adults during the COVID-19 pandemic contributes to increased social frailty. Older adults attending a Day Hospital received routine OT intervention focusing on enhancing their wellbeing and reversing social frailty associated with the COVID-19 restrictions. Assessment and management of social frailty is vital to understand the effects of the pandemic on older people and provide appropriate services.
80 ‘Before you go’: ensuring thickener is prescribed on discharge
Authors: Ward C , Cheannabhain A Ni 
Published: September 2023

Abstract

Background
Dysphagia prevalence in the acute setting is 30%. Managing dysphagia can reduce mortality, length of stay and increase overall quality of life. Use of thickener for patients with dysphagia should be the last alternative. However, in the acute setting due the patient’s respiratory or cognitive status, thickener use is required to manage the risk of aspiration and ensure patients improve clinically. The goal is for discharge prescriptions to contain all the necessary information for patients. The aim of this audit is to investigate the rate of prescription of thickener on patient’s discharge.

Methods
Two retrospective chart audits of discharge prescriptions were completed (December 2022 and May 2023); pre and post implementation of a new communication strategy for thickener being prescribed. All patients discharged from hospital on thickened fluids were included as identified via Speech and Language Therapy database. The audit investigated the rate of thickener on discharge prescription and documentation in the Kardex.

Results
Initial audit was completed in December 2022. 20 patients were included. 0% of patients had thickener prescribed on discharge with no (0%) documentation in the Kardex. Re-audit was completed in May 2023, following the implementation of a new communication strategy involving SLTs place a sticker on the Kardex, included 13 patients 77% (10 patients) had thickener prescribed on discharge with the same number (77%; 10 patients) having documentation in the Kardex.

Conclusion
Improved communication between healthcare professionals results in better patient outcomes and reduces the risk of re-admission. The use of instrumental assessment has enabled SLTs to truly identify those who require thickener, particularly during an acute admission. The SLT department is striving to reduce the use of thickener for patients, however, in those who do require this management option, it is imperative that it is included on their discharge prescription.
81 Does premorbid frailty status affect rehabilitation outcome?
Authors: Salawu A , Fan C W , Glynn M 
Published: September 2023

Abstract

Background
Frailty is associated with poorer rehabilitation outcome in functional gains, Length of Stay (LoS) and discharge destination. The aim of the study is to determine if pre-morbid frailty status affect functional gains, LoS, and discharge destination of patients undergoing rehabilitation.

Methods
188 men and 241 women were (age 81+/− 10 years) admitted for rehabilitation with median LoS of 36 days. All data were collected as part of routine physiotherapy. Age, Clinical Frailty Score (CFS), functional gains [change in Berg Balance Score (BBS) and de Morton Mobility Index (DEMMI)], LoS and discharge destination (home or non-home) were recorded. 392 (91%) had CFS, 331 (77%) BBS, DEMMI 325 (75%) recorded. Patient with CFS category 1–4 were defined as Non-frail, Category 5–7 as Frail. Results are presented as mean (SD). Statistical tests included unpaired t-test, paired t-test and chi-square test. Significance is set at p &lt; 0.05.

Results
Of the patients, 76% were living with frailty and were older (83.6 [7.9] years vs 78.4 [8.1] years) than the non-frail group (p &lt; 0.0001), had longer LoS (49.1 [34.2] days vs 41.0 [31.8] days, p = 0.044) but just as likely to return home (71% vs 78%, p = 0.14). Patients living with frailty had lower pre and post-BBS and DEMMI score, both groups had significant functional gains (p &lt; 0.0001). Pre and post-BBS in Frail group and Non- frail groups were (19 [13] vs 26 [15]) and (30[15] vs 42[13]) respectively. DEMMI in Frail and Non-frail group pre vs post were 32(15) vs 45(16) and 43(17) vs 60(18) respectively. While there was no difference in functional gains in BBS between groups (p = 0.17), the difference in DEMMI score were lower in frail group (p = 0.018).

Conclusion
Our study showed that both frail and Non-frail patients made functional gains with rehabilitation and patients living with frailty are just as likely to return home.
85 I DO, I CARE: implementing delirium screening for older people to improve care, awareness and recognition in the emergency department
Authors: Mupada B , Mocke C , Pillay I , Costello J , Scanlon S , Naughton C 
Published: September 2023

Abstract

Background
Delirium is prevalent (7%–20%) in older patients in emergency departments (ED). The diagnosis is often missed (57%–83%). This Quality Improvement (QI) project aimed to improve delirium screening by 30% in the ED, in keeping with the HSE’s ‘Early Identification and Management of Delirium in ED (2021) and to identify barriers to sustain screening.

Methods
The Institute for Health Improvement Quality Improvement essentials toolkit was used. Patients ≥75 years with Manchester triage category of 2–5 were included. Plan Do Study Act cycles included auditing 110 patient charts in a weekly rapid cycle audit was performed. Actions included 1) formation of an organisational oversight group 2) triage nurses and healthcare assistants placed ‘Screen me with 4AT’ stickers on charts 3) ED Doctors screened with 4-AT 4) 4AT tool was incorporated into all adult proforma 5) 5 face to face information sessions with ED nurses 6) 8 individualised information sessions with ED nurses 7) EM registrar education of junior doctors 8) 4-AT lanyard reminder card 9) twice-weekly WhatsApp group sharing of results 10) Informal feedback invited from doctors who did not complete the 4AT. Data was entered onto Excel and analysis done using descriptive statistics.

Results
The mean (SD) age was 84 (5.6) years, the mean (SD) Manchester triage was 2.6 (0.6) and 56% were female. At baseline 1/20 (5%) charts contained a completed 4-AT. On average the 4-AT completion improved to 38% (42/110) (range 10% to 60%). Delirium was diagnosed in 38% (16/42). Barriers identified pre and post implementation included knowledge deficits, no out-of-hours referral pathway, low priority above competing demands, and fluctuations in ED staffing.

Conclusion
The QIP achieved the target but sustainability due to doctor’s rotations is questionable. Senior clinical leadership and role modelling, nursing team buy-in, education, and referral pathways are required to build on current progress.
93 Reduce falls rates in care homes by replacing falls risk screening with a Multifactorial Falls Risk Assessment Tool
Authors: Wellwood A , Brophy N , Huele N , Mohandass H , Joseph B , Johny S , Thomas T , Williams N 
Published: September 2023

Abstract

Background
Following a review (Nov 2022) of 203 residents across four locations, it was noted that falls risk screening tools were used to identify falls risk status. This resulted in a proportion of residents identified as low (5%) and medium risk (28%). New falls prevention guidelines incorporating care homes, recommend against falls risk screening (Montero-Odassa et al, 2022). The guidelines recommend that all residents in care homes should be considered at high risk of falls and use of a Multifactorial Falls Risk Assessment Tool (MFRAT) is preferable in falls prevention. Our aim is a reduction in falls rate by discontinuing the use of falls risk screening tools and implementing a MFRAT. Embed this change within a new standardised falls policy and deliver staff education sessions to support this change.

Methods
Stakeholder engagement and development of a falls committee with seven representatives across each location including nursing, management, quality and patient safety advisor and falls coordinator was undertaken. Communication strategy of weekly online meetings developed a standardised falls policy, tailored MFRAT and audit tool to monitor compliance. Reported falls were cross referenced with our national incident management system. Falls rate calculation across each location was used to measure the impact of change.

Results
Results demonstrated a 29% reduction in falls rate for the first quarter of 2023, compared to 2022. 100% compliance with policy implementation across all locations, with 68% of staff trained through education sessions face to face and online.

Conclusion
Implementing a MFRAT, aligned with new world guidelines, supported by staff education, and associated falls prevention interventions provides a reduction in fall rates in care home residents. The process of falls rate calculation across locations provides ease of evaluation.
96 Implementing Multifactorial Falls Risk Assessments in the community for older adults at high risk of falls
Authors: Wellwood A , Duffin G , Cusack S , Browne V , Devitt A , Doherty A , Byrne R , Wade R , Burke K , Kelly N , Power S , Stephenson G , Keeley C , Forde B , Harty C 
Published: September 2023

Abstract

Background
Falls prevention improves health outcomes and reduces healthcare costs. New world guidelines for falls prevention and management in older adults exist. Older adults identified at high risk of falls should receive a Multifactorial Falls Risk Assessment (MFRA). A review of the use of MFRA across community healthcare divisions was undertaken in November 2022. It was noted that many variations of falls risk stratification existed, and implementation of a MFRA was not routine. This study aimed to implement a MFRA on all identified at high risk of falls.

Methods
Stakeholder engagement and project team (n = 14) development of physiotherapy, occupational therapy, podiatry, dietetics, and nursing was undertaken. A falls pathway was developed, outcome measures agreed, and a service user education booklet designed. Inclusion criteria incorporated older adults over 65 referred due to a fall, fall-related injury or through opportunistic case finding. A survey and focus group were undertaken. Qualitative and quantitative data was collated.

Results
186 participants were risk stratified resulting in high (56%), moderate (29%), low (24%) risk. A MFRA was completed on all identified as high-risk. Their profile encompassed, 57% aged 80 and above; 35% opportunistic screening; 70% fell at home; 14% sustained a fracture; 64% presented as frail. Service user engagement themes; importance of good information ‘booklet very helpful’; under-reporting of falls ‘I feel embarrassed’.

Conclusion
Results highlighted 56% of older adults identified as high risk crossed all divisions of our healthcare system, indicating falls risk stratification and implementation of MFRA is every healthcare professional’s responsibility. Opportunistic case finding is necessary as older adults (35%) may not present following a fall. Good sources of information are needed to engage in falls prevention behaviours.
104 Oxygen prescription on a specialist geriatric Ward
Authors: Murphy B , Mulroy M 
Published: September 2023

Abstract

Background
Oxygen delivery is an extremely useful tool in treating hypoxaemia. While it has beneficial effects when administered at correct doses it can also lead to serious adverse outcomes when not delivered correctly. Given this, oxygen should be treated as any other drug we use in practice and prescribed accordingly. Studies done around the world show very poor rates of appropriate oxygen prescription. This is particularly important on a ward which specialises in care for the older adult, where neurocognitive disorders, delirium and multi-morbidity is common.

Methods
An audit was carried out on all patients admitted to the specialist geriatric ward over a two week period, documenting whether the patient was receiving oxygen therapy and if so whether it was charted appropriately. Following this education was provided to staff on the ward and posters were hung at the oxygen ports as a reminder to ensure oxygen was prescribed in the Kardex. A re-audit was then carried out, measuring any change in practice.

Results
Following the initial audit, 120 new patients were admitted to the ward, 25 of which were receiving oxygen therapy (21%). Of the 25, only 7 had oxygen prescribed (28%). Following staff education and the introduction of reminder posters at the oxygen ports a reaudit was carried out. 103 new patients were admitted to the ward, 18 of which were receiving oxygen therapy (17%). Of the 18, 17 had oxygen prescribed appropriately (94%).

Conclusion
Simple reminders can influence behaviour greatly. Appropriate oxygen prescription improved three-fold with an inexpensive, simple intervention.