bluuebunny/crossref_metadata_2025_split huggingface dataset:
159 DOES SHARED DECISION MAKING (SDM) ADDRESS POTENTIALLY INAPPROPRIATE PRESCRIBING (PIP)?
Authors: Kinahan C ,   iSIMPATHY Project Team
Published: October 2022

Abstract

Background
Potentially Inappropriate Prescribing (PIP) as identified by STOPP/START criteria is associated with poor patient outcomes. The objective of this study was to investigate the extent of reduction in PIP achieved by Shared Decision Making (SDM) employed by pharmacists delivering, comprehensive, person-centred medication reviews as part of the EU INTERREG-VA funded iSIMPATHY project. The relationship between reductions in PIP and improvements in the iSIMPATHY Patient Reported Outcome Measures (PROMs) was explored.

Methods
This study was conducted across 3 General Practice (GP) practice sites. List of eligible patients aged ≥65 years and on ≥10 regular medications were generated from practice software. Patients were contacted by phone and offered iSIMPATHY reviews and consented to data collection. The first 100 iSIMPATHY reviews actioned by the GPs and for which post review PROM data was collected were included. Data was independently reviewed and analysed by the Medication Safety, Quality Improvement Division of the Health Service Executive.

Results
At least one STOPP/START criteria was identified in 93% of study participants and an average of 4 per patient, were found. 76% of these were resolved within the study timeframe. 88% of patients reported an improvement in at least one PROM domain. 76% reported an improvement in their Understanding, 54% in their experience of Adverse Drug Reactions (ADRs), 21% in their Activities of Daily Living (ADLs) and 8% in adherence. 68% of STOPP/START criteria were resolved for the 53% patients reporting improvements in 0-1 PROM domains, whereas 85% were resolved for the 47% reporting improvements in 2-4 domains.

Conclusion
Delivery of the iSIMPATHY medication review service in the Irish GP practice setting significantly improves both medicines appropriateness and Patient Reported Outcome Measures (PROMs). There appears to be a positive relationship between the extent in reduction in PIP achieved by SDM and reported improvements in PROMs. The relationship between PROM outcomes and individual PIP criteria warrants further investigation.
161 CLEAR DISCHARGE PRESCRIBING IN STROKE PATIENTS: A RETROSPECTIVE AUDIT OF DUAL ANTIPLATELET DURATION AT FIRST FOLLOW-UP APPOINTMENT
Authors: Higgins M , Healy A , Eakins S , Brennan A , Cregg K 
Published: October 2022

Abstract

Background
The risk of further ischaemic events post stroke and TIA is high in the following weeks. Short term treatment with Dual Anti-Platelet Therapy (DAPT) in appropriate patients has been shown to decrease the incidence of recurrent ischaemic events. However continuing DAPT longer than six weeks increases the risk of haemorrhagic complications.

Methods
Retrospective analysis of patients admitted to the Acute Stroke Unit over 4 months in a tertiary referral centre, reviewing discharge summaries and follow-up Outpatient Department (OPD) clinic letters on the online hospital computer system.

Results
We analysed data from 205 patients. 57 patients were discharged on DAPT. Of those, 18(31.6%) did not have a recommended duration of DAPT documented in their discharge summary. 40 patients returned to OPD for review, 16 patients had no documented follow-up, 11 were repatriated to a referring hospital for follow-up locally. The average time of OPD review was 4 months post discharge. Of those 40 patients who attended OPD follow up appointment, 33(82.5%) had documented evidence of a medication review in clinic. 9 of those patients (27.3%) were still inappropriately on DAPT, 5 of whom (55.6%) had no DAPT duration instructions documented in the discharge summary.

Conclusion
Treatment with DAPT puts patients at risk of haemorrhagic complications with longer term use. Clear documentation of treatment duration and communication with the patient and the patient’s GP is vital to ensure medication errors and unnecessary complications for the patient are avoided. Intervention: Following these results, we organised an education session for the Stroke Department staff and re-designed the stroke discharge summary template to highlight instructions on DAPT duration. We also emphasised the importance of communication with the patient’s GP and medication counselling with patients.
163 AN AUDIT OF STAFF NAME BADGE VISIBILITY ON A STROKE UNIT IN A LARGE TEACHING HOSPITAL IN IRELAND
Authors: Ryan K , Healy L , Crowley P , Aherne D , O'Donnell M , Murphy J 
Published: October 2022

Abstract

Background
The National Patient Experience Survey highlighted the importance of name badge wearing in hospitals, with patients noting that badges made it easier to remember staff and refer to them by name. Based on her experience of identification, the #hellomynameis campaign was initiated in 2013 by Dr. Kate Granger to reinforce the importance of name badge wearing. In an era where mask wearing further inhibits communication and identification, clear identification has never been as important. This audit aims to assess the adherence to name badge wearing on a stroke unit.

Methods
An observational audit was carried out in March 2022 over one morning. Staff were not notified in advance of the audit. Inclusion criteria: Name badge placed on uniform in a visible place with/without photo. Exclusion criteria: Lanyards with swipe card identification due to small font and difficulty in viewing name and photo. The standard for this audit was for 100% compliance with name badge wearing as name badges are a crucial element of communication in best patient care.

Results
24 people across 11 different professions were identified on the ward. Seven staff members (29.16%) were wearing name badges of which 5 included photos therefore the standard set for this audit was not met.

Conclusion
There was an overall poor compliance with name badge wearing on the stroke ward. Compliance varied amongst the different professions with Speech and Language therapists, Occupational Therapists and nursing staff having a higher compliance with wearing name badges compared to other professions. Most staff members had identification in the form of swipe cards on lanyards, but did not wear clearly legible name badges. Education around the importance of name badges and distribution of name badges to all staff members is planned prior to a re-audit phase.
164 OLDER PATIENTS AT THE PREOPERATIVE ASSESSMENT CLINIC: CHANGING THE FOCUS FROM FIT FOR SURGERY TO OPTIMISATION FOR SURGERY
Authors: McGarvey C , Larkin J , Costello R , Connor MO 
Published: October 2022

Abstract

Background
The Pre-operative Assessment Clinic (PAC) is run by the Anaesthetic Department and assesses older patients undergoing elective orthopaedic surgery. The aim of this study was to examine how PAC currently assesses older patients and how effective it is in assessing for likelihood of postoperative complications and requirement for rehabilitation.

Methods
A single-centre, retrospective study that received approval from the local ethics committee. Data were collected on all patients post elective orthopaedic surgery admitted to the on-site specialist rehabilitation unit for older persons, between 1st May 2020 and 31st December 2021. Data were collected from hospital Information Technology platform, Bluespiers.

Results
Seventy-six patients (58 female; median age: 80 years) were included. Median time from PAC to surgery was 95 days. Functional assessment was completed in 63.16% of cases, formal cognitive assessment was done in 13% of cases. Number of falls in the preceding year was recorded in 31% of patients. Baseline mobility was recorded in 93% of cases. Whilst smoking and alcohol history was recorded in 96% of cases, number of units was not calculated. 45% (n=34) of patients were correctly identified as likely to require post-operative inpatient rehabilitation. PAC did not record sarcopaenia, polypharmacy or delirium risk factors. From our dataset, at least 13% had sarcopaenia, 80% had polypharmacy and 23% required opiate medications. Post-operatively, 16% of patients developed a delirium and 12% had an acute kidney injury.

Conclusion
In its current format, PAC fails to optimally risk stratify frail, older patients. Attention concentrates on fitness for surgery rather than optimisation of patients. Failure to record frailty, sarcopenia, cognitive impairment and risk factors for delirium is leading to missed opportunities in terms of delirium prevention, and peri-operative optimisation of older patients as well as discharge planning before surgery. Collaboration with specialist geriatric services at PAC should improve patient outcomes.
165 PHARMACIST-LED MEDICINES RECONCILIATION: AN OBSERVATIONAL STUDY TO EVALUATE INFORMATION SOURCES AS A QUALITY INDICATOR OF THE SERVICE
Authors: Hadzic D , Ryan T , Murphy D 
Published: October 2022

Abstract

Background
Medicines Reconciliation (MR) involves obtaining a Best-Possible Medication History (BPMH) and is essential for reducing medication errors and adverse events. Recommendations on how best to undertake MR range from utilising the patient alone to using ≥2 sources (in addition to the patient). Few studies evaluate the use of &gt;1 source as a measure of MR quality.

Methods
This observational study was undertaken in a major teaching hospital that provides a dedicated pharmacist-led MR service. Eligible patients (aged ≥65 years, admitted through the Emergency Department) were randomly recruited. MRs were compiled using 2 sources and compared to individual 1-source MRs (both in addition to patient/carer interview). Additional Medication Discrepancies (AMDs), or differences between 1-source and 2-source MR, were assessed and potential predictors analysed.

Results
A total of 114 patients were included. Community pharmacy was the most frequently used and most accurate source (full agreement in 97.4% of BPMHs). Two-thirds of MRs would not differ if either of the two sources were used in isolation, alongside patient/carer interview. The remaining MRs identified a total of 85 AMDs (1–6 per MR). The majority were drug omissions (49.4%). Most were deemed “low” potential clinical significance (59%). Higher patient/carer reliability was associated with lower incidence (p=0.001) and fewer AMDs (p=0.001).

Conclusion
Contrary to some international guidelines, using &gt;1 source (in addition to patient/carer interview) does not add value to the BPMH in the majority of cases.
166 INAPPROPRIATE PRESCRIBING IN COMMUNITY-DWELLING OLDER ADULTS: A CROSS SECTIONAL REVIEW USING THE STOPP/START CRITERIA
Authors: McDermott CM , Shanahan E 
Published: October 2022

Abstract

Background
Older adults are a heterogenous cohort of patients, often with multiple comorbidities and prescribed numerous drugs. Polypharmacy, defined as use of five or more medications, and inappropriate prescribing are risk factors for adverse outcomes. STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) are criteria that facilitate medication review in older people to aid better prescribing and health outcomes. This review aims to identify inappropriate prescribing in the community-dwelling older adult attending Integrated Care Programme for Older Persons (ICPOP).

Methods
We performed a cross-sectional review of patients attending the ICPOP Hub between January 2022 and May 2022. Patients’ prescriptions were obtained from pharmacies and/or General Practitioners (GP) and cross checked against the medications brought to their appointment. Patients’ past medical history was obtained from the patient, GP and hospital letters. Their prescriptions were analysed using the STOPP/START criteria.

Results
This study included 68 patients. The mean age was 83.5 years. Polypharmacy was present in 94%, with an average of 9.5 drugs prescribed. Common medications identified via STOPP criteria were hypnotic z-drugs in patients with falls (13.2%); loop diuretics for pedal oedema without heart failure (11.8%) and benzodiazepines for &gt;4 weeks in patients with falls (10.3%). Common medications identified to commence via START criteria were vitamin D supplement in those with falls (32.4%); bone anti-resorptive therapy in those with osteoporosis (13.2%); laxatives in patients taking opiates (11.8%) and acetylcholinesterase inhibitors in those with memory impairment (8.8%). 48 participants had medications commenced with 46 having medications stopped. Only 9 patients required no change to their medication prescription. Following STOPP/START, there was an overall reduction in prescribed medications by 0.12 (p=0.494).

Conclusion
Applying STOPP/START criteria lead to a reduction in inappropriate medications prescribed in our multi-morbid older people cohort while identifying appropriate treatments to improve health outcomes.
169 THE SPECTRUM, ASSESSMENT AND DIAGNOSIS OF NEUROVASCULAR OPHTHALMIC PRESENTATIONS REFERRED TO AN ACUTE MEDICAL UNIT
Authors: Mensch R , Dahab T , Barry P , Murphy J 
Published: October 2022

Abstract

Background
Ocular emergencies may require urgent intervention to prevent vision loss. Physicians must be confident in recognizing their presentations. However, literature published in this area is lacking.

Methods
This study assesses the consistency of the assessment of patients with neurovascular ophthalmic conditions in the Acute Medical Unit (AMU) at an Irish tertiary healthcare centre . Conditions of interest include retinal artery and vein occlusions, ischaemic optic neuropathies, and cranial nerve palsies (III, IV, and VI). Research questions to be addressed: 1. The percentage of patients referred from Eye Casualty Services (ECS) to the AMU with neurovascular ophthalmic presentations 2. The investigations performed to diagnose neurovascular ophthalmic conditions 3. How the diagnostic approach used in the AMU compares to that recommended by the literature 4. The accuracy of ECS referral diagnoses. This is an audit of 164 patients attending the AMU during a one-year period who were diagnosed with ophthalmological conditions.

Results
Of patients studied, 58 (35%) were diagnosed with conditions of interest. The most common neurovascular ophthalmic diagnosis was cranial nerve palsy (21, 36%). Among neurovascular patients, routine laboratory investigations were performed in over 90% of cases. Routine imaging was performed in over 80% of cases. Referral diagnoses from the ECS accompanied 13 (22%) of neurovascular patients, all of which were accurate.

Conclusion
Neurovascular ophthalmic conditions represent a significant proportion of ECS referrals to the AMU, and most aren’t diagnosed until after leaving the ECS. Laboratory and imaging investigations may be inappropriately utilized in some cases. More research is needed in this area.
170 DELIRIUM SCREENING CONCURRENT AUDIT UTILISING THE 4AT ASSESSMENT TOOL IN THE EMERGENCY DEPARTMENT
Authors: Mupada BM 
Published: October 2022

Abstract

Background
Delirium is an acute onset of clinical serious conditions associated with poor outcomes, seen in older patients in Emergency Department (ED). Despite its seriousness, delirium can be missed by 57-83% and 25% with unrecognised delirium discharged from ED. The audit aim is to improve delirium screening for older people in ED using the 4AT assessment tool.

Methods
Criteria included patients over 75 and under 75 with complaints of new confusion, history of dementia and cognitive impairment presented to ED over 20 day period in January 2022. Exclusion criteria included patients with alcohol and drug withdrawal, trauma and critically ill. Data collection through concurrent chart review using self-designed tool performed by two auditors. 30 patient charts gathered through consecutive sampling accessed in IMS Maxims (electronic patient record system) for 3 random days approved by Assistant Director of Nursing and data collected with respect and in accordance with General Data Protection Regulation. Algorithm of Early Identification and Management of Delirium in ED/AMAU (HSE 2021) and ED Delirium Screening Bundle (University Limerick Hospital Group 2021) were standards used.

Results
70% were screened using the 4AT tool and 4 cases identified with delirium. 9 patients were not screened implying 30% variance against the national standard. 100% expected level of compliance but 50% failed compliance standard. Results discussed at staff meeting, daily huddles and poster presentation in ED information board.

Conclusion
The audit shows satisfactory results on the awareness and importance of delirium screening and moderately poor compliance on documentation. Strategies to improve practice and maintain sustainability include staff re-education, increase awareness in triage by adding blue-colored sticker “Screen me with 4AT” and rewarding staff with Delirium Champion of the Day to promote use.
174 DEVELOPING THE ROLE OF THE OLDER PERSONS ADVANCED NURSE PRACTITIONER
Authors: Farrelly A 
Published: October 2022

Abstract

Background
Advanced Nurse Practitioners (ANP) for Older Persons have advanced clinical skills and work with the Multidisciplinary Team, patients and carers. They practice with a high degree of autonomy under the clinical governance of a Geriatrician. These new roles have been developed in line with the emergence of clinical care pathways and an ageing population. Many are in the area of frailty assessment in the Emergency Department setting. This audit examined the development of the role of Older Persons ANP in a level three hospital.

Methods
Inclusion and exclusion criteria for ANP caseload were developed. ANP referral pathways were established. Referrals and interventions were captured by Audit. Data collection was both quantitative and qualitative

Results
Referrals to the ANP are generated in ED using a Variable Indicator of Placement (VIP) score and via consults from medical teams. 245 inpatients aged over 75 years were seen in 2021. Half referrals were generated by VIP and the other half by consult. Clinical Frailty Scale (CFS) of patients ranged from 4 to 9 but were predominantly 6,7 and 8. The ANP undertook a comprehensive geriatric assessment for these patients. Interventions included medication adjustment, social assessment and specialist advice to the MDT. The ANP “pulls the story together” (Cowley, 2016) providing a holistic link between all parties. Ongoing support is provided in an outpatient setting.

Conclusion
The ANP is well placed to lead holistic care for older people in conjunction with the MDT. In this level three hospital, the ANP role has made a significant impact on the wards as part of the wider specialist geriatric team. This is novel in that many hospitals to date have placed the role in the ED. Variables such as impact on patient outcome, length of stay, readmission rates and service quality are worthy of exploration as the service progresses.
178 THE ROLE OF THE RAPID ACCESS FRAILTY ASSESSMENT UNIT (RAFAU) IN PATIENTS REFERRED WITH COGNITIVE IMPAIRMENT
Authors: Lynch O 
Published: October 2022

Abstract

Background
The ageing population in Ireland is rising, as is the need to access specialized services. As a result, the RAFAU commenced in February 2021 at a level 3 hospital, to provide clinics for rapid comprehensive assessment of frail patientsd In this audit we set out to examine the role of the RAFAU in older persons referred with cognitive impairment.

Methods
Data collection was quantitative. We examined patients referred with cognitive impairment. The data collected included: Clinical Frailty Scale, medication use, the medical and multidisciplinary interventions and follow up arrangements.

Results
From February 2021 to May 2022, 584 new patients attended the clinic. Of these, 154 older people were referred for cognitive issues. The majority had a Clinical Frailty Scale of between 2 and 5. 154 patients saw a Doctor and 13 were seen by the candidate Advanced Nurse Practitioner (cANP). 39 people were assessed by the Occupational Therapist. 46 were assessed by the Physiotherapist. Polypharmacy was prevalent, with 88 people taking between 5 and 15 medications. 99 of the 154 people seen had changes to their medications. This included memory medications and adjustment to medications for Behavioural and Psychological Symptoms of Dementia (BPSD). Diagnostic tests included CT Brain, cardiac investigations and bloods. Follow-up included: return clinics to the Geriatrician and ANP and referral to primary care and voluntary services. A small number of patients were admitted to hospital.

Conclusion
Over 26% of the RAFAU referrals were for cognitive issues. The Clinical Frailty Scale suggests that this population is physically robust. RAFAU offers a multidisciplinary assessment in a one stop shop setting. This audit highlights the prevalence of cognitive issues in a frail older population and the interventions undertaken by the multidisciplinary team to address identified needs. Future research on the patient's perception and experience of the RAFAU service in their ongoing care needs would be beneficial.
191 THE DEVELOPMENT OF A COGNITIVE COMMUNICATION PROGRAMME FOR OLDER PERSONS IN THE EARLY STAGES OF REDUCED COGNITIVE FUNCTION
Authors: McCusker C , Cawley T , Cannon E , Cullen C 
Published: October 2022

Abstract

Background
Research indicates that cognitive and language stimulation activities can promote the maintenance of skill set. The Speech and Language and Occupational Therapy Service on an Integrated Care Team for the Older Person’s and Reablement team developed and implemented a six-week cognitive communication stimulation programme aimed at targeting cognitive and communication functions in older people in the early stages of cognitive decline. The programme outline targeted the following four domains: Memory, Attention, Language and Problem Solving. These areas have been identified as imperative skills for successful engagement and communication in everyday tasks. It was developed during the pandemic with an awareness of the social isolation and reduced opportunity for engaging with cognitive and language activities for older persons locally.

Methods
The programme was targeted within the person’s home in order to optimise the best outcomes for generalisation of skills. The implementation of the programme was supported by therapists and therapy assistants. The impact of the project was measured by a 10-point scale targeting the Older Person’s perceived skills in each cognitive domain pre and post programme implementation. The Mini-Cog was also completed pre and post-programme implementation.

Results
Preliminary results from 20 participants demonstrated positive outcomes for older persons who engaged in the programme. Older persons' reported feeling more confident in managing the skills required to maintain cognitive functions.

Conclusion
Cognitive and language stimulation activities can support the maintenance of cognitive skills when targeted in the early stages of cognitive decline. There is a greater likelihood of skill maintenance when targeted within the person’s home context.