bluuebunny/crossref_metadata_2025_split huggingface dataset:
242 Optimising bone health assessment and management in Parkinson’s Disease: a closed loop quality improvement project
Authors: Gallagher C , Killeen E , McDonough A , Cronin A , Latoza P , Baldestamon G , Kimmage E , Quinn S , Leitch E 
Published: September 2023

Abstract

Background
People with Parkinson’s Disease (PD) are at increased risk of osteoporosis, falls, and fractures. An audit of our age related day hospital’s weekly PD Interdisciplinary Clinic (PDIC) assessment identified suboptimal management of bone health. We subsequently introduced a ‘bone health’ section to the proforma to identify areas of suboptimal bone health management warranting further investigation and/or intervention.

Methods
Cycle 1: Retrospective review of PDIC proformas and charts revealed multiple risk factors for falls and fractures and suboptimal management of bone health. A ‘bone health’ section was introduced to the proforma. Questions related to osteoporosis diagnosis, previous fractures, DXA scans, calcium/cholecalciferol supplementation, and anti-resorptive treatment. Cycle 2: Prospective data collection over four weeks using the PDIC proforma and ‘bone health’ section.

Results
Cycle 1: (N = 33), Cycle 2: (N = 12). Both cycles had similar patient demographics. Over 50% had orthostatic hypotension and/or identified falls risk medications. Over 70% had gait impairment, and over 66% had a history of falls. Cycle 1: 36% had known osteoporosis. Of these, 33% were not receiving osteoporosis treatment. 27% had a previous fragility fracture, 33% of these were not on osteoporosis treatment. 27% had a DXA scan. Cycle 2: 8.3% had known osteoporosis and 8.3% osteopenia. 42% were unsure of osteoporosis diagnosis. 33% had previous fracture, 75% of which were fragility fractures. 33% had a DXA. Areas of suboptimal bone health management warranting intervention were identified in 50% on the ‘bone health’ section. 25% were commenced on calcium/cholecalciferol supplementation. 8.3% were recommenced on denosumab. 8.3% were counselled on correct use of Denosumab. 8.3% had repeat DXA booked.

Conclusion
This closed loop QI project identified suboptimal bone health assessment in PD patients at risk of falls. The ‘Bone Health’ section had a positive impact, implementing low impact interventions to reduce fracture risk and associated morbidity/mortality.
250 Streamlining rehabilitation for hip fracture patients: a pilot quality improvement project
Authors: Sadiq M A , Laffan S , Power M , Corcoran S , Murphy T , O'Regan N 
Published: September 2023

Abstract

Background
University Hospital Waterford (UHW) is a busy trauma unit, serving five counties in Ireland’s South East. UHW treats approximately 400 hip fracture patients annually, 27% of whom are referred for off-site rehabilitation either locally or regionally. The national average Length-of-Stay (LoS) for hip fracture patients is 12 days, whereas in UHW the average LoS is 17 days, higher in those awaiting off-site rehabilitation (19 days). Earlier access to rehabilitation results in reduced LoS, better patient outcomes, and enhanced patient flow through the hospital system.

Methods
We created a pilot six-bedded rehabilitation unit in Kilcreene Regional Orthopaedic Hospital (KROH, an orthopaedic hospital affiliated with UHW) for hip fracture patients. Hip fracture patients for rehabilitation in KROH are identified by the Orthogeriatric team. Weekly multidisciplinary team meetings and wards rounds are conducted by the UHW based Orthogeriatric Consultant and Advanced Nurse Practitioner (ANP). We measured duration of time waiting for rehabilitation in hip fracture patients since this unit’s commencement and compared to data from a previous audit conducted in 2020 in hip fracture patients awaiting rehabilitation.

Results
Since April 19th 2023, seventeen hip fracture patients have been transferred to KROH for rehabilitation, fifteen of whom were transferred on the same day or the day after they were identified as medically fit and rehabilitation ready. To date, the longest wait time for transfer was three days in two patients. Data from 2020 indicated that the median wait for off-site rehabilitation in centres across the south-east was six days.

Conclusion
Early results indicate that this pilot six-bedded rehabilitation unit reduces the wait time for rehabilitation in selected hip fracture patients, enhances continuity of care, and improves patient flow through the hospital system. Our future aims include expansion of the unit and collaborating with regional integrated care services to ensure continuity of care post-discharge.
258 Using participatory co-design to develop recommendations on human rights for people living with dementia in Irish nursing homes
Authors: Donnelly S , Golden F , Keating M , Mackell S , O'Shea J , Paley G , Parfitt R , Quaid K , Quinlan K , Brennan H R 
Published: September 2023

Abstract

Background
Ireland had one of the highest concentrations of Covid-19 deaths in nursing homes globally, with 66% of all deaths in the first waves of the pandemic taking place there. Against this backdrop, the Alzheimer Society of Ireland’s Irish Dementia Working Group (IDWG) became increasingly concerned about the human rights of People Living with Dementia (PLwD) in nursing homes. The IDWG wanted to be a voice for the voiceless and advocate for PLwD in nursing homes. They commissioned the development of a briefing paper that would outline the key issues relating to upholding the human rights and safeguarding of PLwD in nursing homes including concrete recommendations for policy and practice.

Methods
A scoping review of the existing literature on this topic was carried out. Three co-design online sessions were convened with members of IDWG, and one co-design session was convened with members of the Alzheimer Society of Ireland Dementia Carers Campaign Network to develop and co-design general content and recommendations.

Results
30 recommendations relating to the human rights of PLwD in nursing homes were developed (Donnelly et al. 2022). These include having equal and rights-based access to multidisciplinary team support and health and social care services, including access and provision of equipment and mobility aids. It was also recommended that PLwD are cared for in a nursing home with staffing levels that align with the dependency levels of residents as outlined in each Common Summary Assessment Form (CSAR) or Care Plan. There should also be consistency in the carers who are providing day-to-day care to PLwD.

Conclusion
Engagement with key stakeholders such as the Department of Health, HIQA and political representatives is currently being progressed to ensure meaningful implementation of the recommendations developed.
270 FastTraX fracture service: reducing wait time for nursing home residents in the Emergency Department
Authors: Noonan C , Coveney S , Coughlan T , Kennelly S 
Published: September 2023

Abstract

Background
Nursing Home Residents (NHR) are among the frailest of older people requiring a gerontologically attuned approach to care. The introduction of a rapid response service, utilising mobile x-ray, for those patients with possible fracture was the result of a QI project to improve care for NHR. The impact of this service is compared to prior usual care. FastTraX ensures NHR receive optimal orthogeriatric care without Emergency Department (ED) presentation.

Methods
These initial case studies outline the rapid response pathway of a NHR post upper limb fracture compared to patient journey prior to this innovation.

Results
An 86 year old man referred to FastTraX following a fall. A mobile x-ray was done at the nursing home (NH), confirming a clavicle fracture. The images and report were presented by the RANP, with relevant medical and functional history, to the orthogeriatric and orthopaedic team. Consensus decision for was conservative management. A falls and medications review was completed liaising with primary care physicians. A virtual follow up 3 days post fall, ensuring effective pain management, facilitate physiotherapy review, to elicit any adverse events, to organise fracture clinic follow up.
A 78 year old female was transferred from NH to the emergency department post fall. She was triaged and waited to be seen by an ED physician who organised x-ray which confirmed a clavicle fracture. She was then seen by the orthopaedic team, conservative management was decided upon, she was discharged back to the nursing home with analgesia and a follow up fracture clinic appointment in a number of weeks. 12 hours spent in the ED.

Conclusion
This RANP-led integrated response to the conservative management of fractures in NHR has been recently introduced and data collection is ongoing. It has supported NH staff to allow residents avoid transfer to the ED, where appropriate, avoiding the potential risks, and adverse events associated with same.
272 Advanced nurse practitioner -supported nursing home liaison service
Authors: Noonan C , Dowling M , Soh J , Fallon A , Kennelly S 
Published: September 2023

Abstract

Background
Nursing Home Residents (NHR) are the frailest group of older people in society and require a gerontologically attuned approach to address multiple challenges presented to the practitioner. In 2018 we commenced an advanced nurse practitioner (ANP) specialist liaison service with bespoke comprehensive geriatric assessment (CGA) to support NHR admitted to a tertiary referral university teaching hospital. Given the impact of COVID-19 on NHR in particular, in 2020 this service was expanded to include a consultant physician and specialist registrar in geriatric medicine, when full care of NHRs came under geriatric medicine services. This includes a two-week post-discharge virtual clinic with the Nursing Home director of nursing and/or GP.

Methods
Information on all NHRs attending a tertiary referral university teaching hospital was collected from 2018–2023. Data on demographics, presenting complaints, CGA, and outcomes of Length of Stay (LoS), emergency department (ED) recidivism, and mortality were collected. Impact on clinical outcomes of liaison versus full geriatric medicine care are presented in this abstract.

Results
In 2018 there were 353 NHRs admitted from ED who represented 4,170 total hospital bed days. In 2019 there were 329 NHRs admitted with 3,991 total bed days. In 2021, 251 NHRs were admitted representing 2,582 total bed days. As result of the enhanced care model, where full inpatient governance came under the geriatric medicine services, we observed: (1) Readmission rate 37% (2018) vs 12.7% (2021), (2) Reduction in LoS from 2018–2021 from 11.8 to 10.0 days, (3) Halved the overall bed-usage days from 2018–2021.

Conclusion
The high complexity of this cohort of patients requires a timely, comprehensive gerontological approach in order to provide holistic care. Better care with CGA embedded also translates to better use of acute hospital resource.
276 Development of inter-professional simulation-based education in geriatric medicine
Authors: Irvine J , Nelson E 
Published: September 2023

Abstract

Background
Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication required within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) provides insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence.

Methods
We organised a one-day Sim-IPE programme for our Geriatric Medicine ST4+. Faculty consisted of doctors, advanced nurse practitioner, social worker, occupational therapist, physiotherapist and speech and language therapist. Communication scenarios, with faculty as simulated participants, were undertaken including establishing a ceiling of treatment, management of delirium, breaking bad news, ethical feeding dilemmas, complex discharge planning and capacity assessment. Debrief discussions followed each scenario. Mixed-method evaluation was used with questionnaires collected from learners’ pre and post session in a 10-point Likert scale to compare confidence levels. Qualitative feedback was collected from learners and faculty.

Results
Ten Geriatric Medicine ST4+ attended plus nine faculty including two facilitators. Positive feedback was received from learners and faculty. There was improvement in confidence across all six scenarios (one being ‘not at all confident’ and ten ‘extremely confident’). Pre-session average confidence was 7.2, post-session 8.7. All trainees would recommend the programme to a colleague. Common learning themes included gaining feedback from debrief discussions and shared learning from our allied-health professionals. Learners and faculty commented on the enjoyment, usefulness and value of learning within a safe team environment.

Conclusion
Sim-IPE can improve confidence in complex communication scenarios and human factor skills. Feedback highlighted that this programme would be useful for all General Internal Medicine Specialty Trainees.
277 Audit of intentional rounds to measure compliance and explore patient feedback in a rehabilitation hospital for older adults
Authors: McDonnell C 
Published: September 2023

Abstract

Background
Intentional Rounding (IR) is a purposeful and proactive intervention with a strong focus on safety and consistency in delivering essential care to all patients. IR can help reduce falls, pressure ulcer incidence, improve communication and provide reassurance to patients. IR was introduced for Health-Care Assistant (HCA) Staff in our rehabilitation hospital for older adults. In collaboration with the HCA staff, the nurse practice development unit developed an IR check-list for each patient. Following introduction of IR, we carried out an audit to measure compliance with the practice and to gain feedback from patients in terms of how they experience IR.

Methods
An audit tool was developed to measure all elements of the IR practice and check-list. On each ward, 5 randomly selected IR check-lists were audited for compliance with the audit tool. Qualitative data was also collected through engagement with patients during the audit process. HCA staff were involved with the audit process.

Results
The audit revealed some good results in IR practice, notably 2 wards achieved the KPI (90%) and this was positive. Reasons for wards not achieving their KPI in this audit were mainly due to incomplete IR check-lists on night-duty shifts. Qualitative data collected through comments from patients during the audit was very positive. Comments such as ‘Staff are super’, ‘Staff are in every few minutes’, ‘Assistance offered all the time’ were typical of the feedback received. Further support and education are necessary to improve compliance with IR practice on the night-duty shift. It is important to include the HCA staff in auditing the practice and to take ownership of it.

Conclusion
Intentional Rounds provide a pro-active and consistent system for ensuring each patient is checked on regularly to ensure essential care is delivered. Audit is necessary to monitor the practice to ensure compliance and improvement.
279 The experience of designing an integrated service: a pragmatic approach to healthcare delivery
Authors: Flattery V , Lee S Quilter , Donoghue S , Coen M , Hanley O , Flynn C , Martin H , O'Connell C , Ansbro C 
Published: September 2023

Abstract

Background
Staff from nursing, occupational therapy, physiotherapy and social work from CHO2 and the Saolta Hospital Group were brought together. This group had the unique position of having a mandate and funding available to design an integrated service with an egress focus. The SlainteCare vision of ‘right care, right place, right time’ was central to the process. There are significant demands on hospital beds with a growing and ageing population around Galway. A gap exists in the provision of integrated multi-disciplinary interventions following hospital discharge.

Methods
The HSE Change Guide (2018) was used alongside Action Learning Set methodology. These tools allowed for creativity and open discourse. A SWOT analysis identified current practice, opportunities and threats with the culture of the organisations analysed and a context for change vision formed. Stakeholder identification, Influence Mapping Grid and an engagement plan was formulated. A Process Map using service user cases were discussed in relation to services they could receive and what was missing. This renewed clarity and gap analysis showed why change was required. An Options Appraisal to consider possible solutions with ease of implementation being a key consideration.

Results
The solution identified was a HSCP Liaison Team to complement the Liaison PHN service which would identify early discharges from the acute hospital. They would communicate with the Primary Care teams to progress discharge. Point prevalence data gathered during the define and design stages showed an average of 20 service users who would benefit from the proposed service. One network area was decided as the pilot site.

Conclusion
Given time and opportunity to design a service, this team have brought forward a solution that does not replicate services but complements and empowers existing structures and staff. Most importantly this proposed HSCP Liaison team will allow service users to spend more nights in their own beds whilst receiving the necessary HSCP services.
284 Electronic prescribing in a Rehabilitation Hospital for Older Persons: our experience to date
Authors: Prendergast F , Cogan L 
Published: September 2023

Abstract

Background
Electronic Prescribing (E Prescribing) isn’t routinely utilised in Irish Hospitals. We introduced a paperless E Prescribing system in our Rehabilitation Hospital for Older Persons in June 2022. One year after its introduction, we discuss our experience to date.

Methods
The digital transformation of the Irish Healthcare system is underway. E Prescribing represents one small element of this transformation away from paper based drug Kardexes to a fully electronic system. We have utilised an E Prescribing system for approximately one year. We outline the various features and benefits of E Prescribing and how we utilise them in our clinical practice in our Rehabilitation Hospital for Older Persons.

Results
The pros of E-Prescribing far outweigh the cons in our experience to date. The benefits include, for example, the ability to prescribe remotely, eliminating the risk of handwriting errors, medication usage reviews and prescription templates. The downsides include the potential for errors in the initial period of prescribing by Doctors and Nurses without prior experience in E Prescribing.

Conclusion
E-Prescribing is not without challenges, especially in the initial phase of implementation. However, our experience since its introduction in our Rehabilitation Hospital for Older Persons has been very positive. This has the potential to serve as an example of how the technology can be employed in other similar Hospitals and represents just one aspect of the digital transformation currently underway in Irish Healthcare.
288 Carers in transition: a support group for dementia carers whose spouse is transitioning to Long Term Care
Authors: Rychtarik A , Allen J , Hartnett P 
Published: September 2023

Abstract

Background
In Ireland, an estimated 32% of people with dementia (PwD) are about to move to Long-Term Care (LTC). For spousal dementia carers, the transition to LTC is their greatest period of grief. Spousal dementia carers deal with changes in their relationship, identity, and role, when their spouse prepares to enter LTC. The Carers’ Transition Group (CTG) supports spousal carers in processing grief, educates about dementia and what to expect as their caring role evolves, signposts to resources, and supports improvement of overall well-being. The group is comprised of spousal carers of PwD who are currently patients of a Mental Health Service for Older Persons, transitioning to LTC.

Methods
Feedback on the Group was obtained via participant questionnaires and an assessment tool based on the Carer Support Needs Assessment Tool (CSNAT) administered pre-and-post, to ensure both the sessions and associated tools accurately reflected members identified needs.

Results
Group member feedback was very positive in regard to session content, group size and structure, and facilitator communication. Several participants expressed that simply hearing that others had experiences similar to their own as comforting.

Conclusion
The CTG highlights the need for research and development of psychosocial and psychoeducational interventions that provide support throughout the caring journey. Findings indicate an overall positive experience, with respondents expressing that sharing emotions and experiences, and feeling understood as the most beneficial element.
292 Frailty at the front door team compliance with the 4Ms of the international healthcare improvement age-friendly healthcare system
Authors: Fitzgerald R , Coakley E , Condon F , Allen S , Martin L , Leonard A , Cronin L , Pillay I 
Published: September 2023

Abstract

Background
Age-friendly health systems entail assessing the 4Ms (1) what Matters to you (2) Mood and Mental state (3) Medication review and (4) Mobility and functional assessment. This study aimed to measure Frailty at the Front Door team compliance with the 4Ms.

Methods
An abbreviated ‘4MsComprehensive Geriatric Assessment (CGA) was designed. Members of an interdisciplinary team, including geriatric medicine doctors, physiotherapists, occupational therapists, speech and language therapist and dietitian completed CGAs for older patients. Data from scanned CGAs (compliance rate approximately 30%) between January–December 2022 was entered onto Excel by trained administrators. Compliance with the 4Msassessment was retrospectively assessed. Data was analysed using descriptive statistics.

Results
588 CGAs were scanned. 96 excluded due to incomplete data (n = 93), or age under 65 years (n = 3). 493 CGAs included. Mean (SD) age was 83 (7.8) years. Female:Male ratio was 1.4:1. Mean (SD) CFS was 5 (1.2). 83% (n = 412) answered ‘what matters to you’. No answer recorded in 16% (n = 81). Common themes were; home (20%), family/friends/pets (18%), functional independence (7%), health (6%), and miscellaneous (40%). 100% had a 4AT documented, mean (SD) 4AT of 2 (2.9). The presence/absence of dementia was recorded in 73% (n = 364). 80% (n = 395) recorded presence/absence of depression. 11% (n = 57) had current or previous depression. 87% (n = 450) had a medication screen +/− review performed. 27% (n = 126) of presentations were related directly to either medications or falls. 96% (n = 473) had a mobility/functional assessment recorded..

Conclusion
There was 83% or greater compliance across all areas of the 4Ms Cognition, mobility and functional status demonstrated the highest compliance rates. Data capture was incomplete due to the inefficiency of scanning CGAs onto a database. Incorporating age-friendly systems into FFD practice is feasible. Future steps will be to accredit the Emergency Department as an age-friendly healthcare system.