bluuebunny/crossref_metadata_2025_split huggingface dataset:
46 THE IMPACT OF THE INTRODUCTION OF STRUCTURED DOCUMENTATION ON A MULTI-DISCIPLINARY TEAM MEETING AS MEASURED BY CLINICAL AUDIT
Authors: Fitzgerald M 
Published: October 2022

Abstract

Background
The typical method for multidisciplinary teams (MDT) to coordinate care in a rehabilitation setting is by holding weekly meetings. These MDT meetings are not always effective, with poor communication and vague plans of treatment leading to a lack of progress with rehabilitation and even delayed patient discharge.

Methods
The MDT of the older person’s rehabilitation unit aimed to improve their MDT meeting. A series of meetings, open to all members, identified the key issues. These were; variation in the level of contribution from attending disciplines, a lack of clarity on patients’ current status, a lack of SMART goals being set and Predicted Dates of Discharge (PDD) not being set. This was confirmed by clinical audit examining contribution levels of attending disciplines across four questions. The proposed solution was a structured document called the Collaborative Rehabilitation Plan (CRP) booklet for use at MDT meetings, which was designed by a subcommittee with feedback from the full group. The audit was repeated after a one-month trial of the booklet.

Results
The average contribution was highest on the current status of the patient (59%), and this was not changed post-booklet (59%). This was lower regarding the setting of goals (18%), and this improved post booklet (40%). The average contribution was lowest for the goals meeting SMART criteria (4%). This improved post booklet (28%). Improvement was also seen in the setting of PDDs (from 27% to 52%). While the level of contributions from all disciplines improved after the introduction of the booklet (from 27% to 42%) there was still a wide degree of variation.

Conclusion
The development of the CRP booklet was of value in increasing the contributions of the team in a number of key areas. Contributions were still low in some areas and further work is needed to improve this.
63 FRAILTY AND COVID-19 IN HOSPITALISED OLDER ADULTS
Authors: Trueick R , Godson-Treacy M , Donnelly T 
Published: October 2022

Abstract

Background
Frailty is an important factor in clinical decision making for patients with COVID-19. In COVID-19, frailty can better predict outcomes than age or comorbidity. We aimed to establish the extent of frailty in a cohort of older adults admitted to an Irish hospital with COVID-19.

Methods
This is a retrospective observational study of frailty and outcomes in all patients over the age of 75 admitted to an Irish hospital between 01/03/20 - 31/10/20 who tested positive for SARS-CoV2 RNA on PCR during admission. This corresponded with the first wave of COVID-19. Frailty was assessed using the Rockwood Clinical Frailty Scale (CFS). Eligible patients’ charts were reviewed and a frailty score of 1 (very fit) to 9 (terminally ill) was assigned based on multidisciplinary assessment of pre-admission status. The outcomes assessed were length of stay, in-hospital mortality, and change in discharge destination i.e. patients admitted from home requiring discharge to long-term care.

Results
The 45 study participants had a median age of 83 years. 19 (42%) patients were female. The mean CFS on admission was 6, indicating moderate frailty. 12 (27%) patients were residents in long-term care. The average length of stay was 27 days. 14 (31%) patients died. Of these, the median age was 82 and the median clinical frailty score was 6.5. Death occurred in 5 (42%) patients admitted from long-term care and in 9 (27%) patients admitted from home. There was a change in discharge destination in 7 (29%) of the 24 patients who were admitted from home and survived the hospitalisation. Of these, the median clinical frailty score was 5.

Conclusion
Frailty was highly prevalent in this cohort of hospital in-patients with COVID-19. Frailty likely contributed to the high mortality and lengths of stay. Furthermore, this study highlights the harmful impact of COVID-19 by its association with high rates of discharge to long-term care in those who were admitted from home.
65 POLYPHARMACY BURDEN IN THE RAPID-ACCESS FRAILTY ASSESSMENT UNIT (RAFAU)
Authors: Kemple O , Bozic D , O'Keane C , Donnelly T , Doherty J , McGlynn J 
Published: October 2022

Abstract

Background
The adverse outcomes associated with polypharmacy (regular use of five or more medications) are well described. One in three over 65 report polypharmacy in Ireland (The Irish Longitudinal Study on Ageing, 2012). A review of the burden of polypharmacy was carried out in a Rapid Access Frailty Assessment Unit (RAFAU) in a regional Irish hospital.

Methods
Data was collected on each patient presenting to the RAFAU from May 2021 to March 2022. Each patient was categorised based on number of medications taken. It was recorded whether each patient had a change made to their medications during their review. The inclusion criterion was any patient over 65 presenting to the RAFAU with clear documentation of their medications. Excluded were those without medication lists available.

Results
Polypharmacy data was collected in 496 of the total 587 patients attending RAFAU since May 2021. A higher proportion of 59% (n=496) were female. The mean clinical frailty score was four. 100% of the group were reviewed by a doctor.
78.6% of patients were prescribed over five medications. 49.3% of patients were prescribed between 5-10 medications. 22.9% were prescribed 10-15 medications and 6.4% prescribed over 15 medications. 60.8% had a change made to their medication. The incidence of medication changes initiated rose with the increasing number of prescribed medications. 71% of those with more than 15 medications had changes made.

Conclusion
The incidence of polypharmacy in those attending RAFAU is extremely high. The frailty unit is an ideal location to review and reduce medication burden as patients have access to a specialist clinician and multidisciplinary team. Although 60% of our patients had medication changes made, we do not use a standard tool in RAFAU to guide medication reduction in frail patients with polypharmacy. It is planned to introduce routine assessment of polypharmacy utilising the STOPP/START tool and re-audit one year after implementation.
67 TECHNOLOGY TO SUPPORT INDEPENDENT LIVING AT HOME: ONLINE SURVEY OF USER NEEDS AND REQUIREMENTS
Authors: Murphy C , Timon C , Heffernan E , Hopper L , Gallagher P , Hussey P 
Published: October 2022

Abstract

Background
Technology can play a key role in supporting older adults to live independently at home. A User Needs and Requirements study including co-design workshops and an online survey was conducted to inform the development of a technological solution aimed at supporting older adults to remain living independently at home. The online survey component is reported here.

Methods
Eligibility criteria included that respondents were older adults living at home or caregiving stakeholders providing care to older adults at home e.g. family caregivers or health/social care professionals. Recruitment took place throughout Ireland through civil society organisations and age friendly networks in local councils. Quantitative and qualitative data were gathered from June to July 2020. Descriptive statistics were applied to quantitative data and inductive thematic analysis was performed on free text responses.

Results
In total, 380 respondents completed the survey (n= 235 older adults, n=77 family caregivers, n=47 healthcare professionals and n=21 home support workers). Older adults identified key issues where technology might support them to live independently, these included, home security (33% n=77), falls (30% n=69), reduced mobility (23% n=55) and loneliness (23% n=54). Thematic analysis highlighted key areas where technology could assist stakeholders in providing care for older adults living independently, these included, remote monitoring of family members (family caregivers), communication with clients (healthcare professionals) and falls (home support workers). Older adults reported that data privacy and the cost of technology were key concerns. All groups reported a high level of willingness to use technology such as ambient sensors, wearable devices and voice activated assistants to support independent living.

Conclusion
Results of this survey provide insights into user needs and requirements in combination with results from co-design workshops to inform the design, development and trial of a technology system to support independent living at home.
76 HOW BLOGS SUPPORT THE TRANSFER OF KNOWLEDGE INTO PRACTICE IN THE FIELD OF DEMENTIA PALLIATIVE CARE: FACILITATORS AND BARRIERS
Authors: Rukundo A , Fox S , Guerin S , Kernohan G , Drennan J , O'Connor N , Timmons S 
Published: October 2022

Abstract

Background
Blogging can help to maximise the impact of one’s work in academia and beyond by making research findings accessible for multiple knowledge users. As part of the knowledge exchange and dissemination activities of the Model for Dementia Palliative Care Project, this study explored stakeholders’ views of blogs as a means to translate research findings in the field of Dementia Palliative care.

Methods
A web-based survey was developed, piloted, and revised. It was distributed electronically via key dementia and palliative care organisations. Complete responses (N=128) were received from healthcare researchers (n=53), healthcare providers (n=46) and others with an interest in healthcare research (n=29). Data were analysed using descriptive statistics and content analysis

Results
The preferred methods of reviewing research findings were scientific papers, websites and news articles. Respondents read healthcare blogs “sometimes” (39.1%), with &lt;19% reading them “often” or “very often”. Receiving an email notification might increase the likelihood of reading a new blog post for 83% of respondents. Barriers to engaging with blogs included lack of time, preference for other media, lack of awareness regarding available blogs, and concerns about the credibility and source of information. An appropriate length and the author of the blog were key features that encouraged engagement with a blog. Most respondents (37.7 % ‘Yes’ and 23.0% ‘Maybe’) would read Dementia Palliative care blogs by the research team.

Conclusion
Despite respondents choosing a scientific paper as their preferred method to consume research findings, many indicated an openness to reading blogs on their area of interest. Creating concise, relevant, and credible blogs, and suitably promoting them, could increase the impact and reach of healthcare research, such as in the emerging field of dementia palliative care, and thus promote translation of research findings into practice.
78 THE ISIMPATHY APPROACH TO POLYPHARMACY AND ADHERENCE: EXPLORING PHARMACIST AND GENERAL PRACTITIONER EXPERIENCE
Authors: Coyle EJ 
Published: October 2022

Abstract

Background
iSIMPATHY is an EU INTERREG VA funded project, delivering quality clinical care in primary care (Republic of Ireland (ROI) and Scotland) and in secondary care (Northern Ireland). The approach is interdisciplinary, collaborative and centred around pharmacist-led medicines reviews. iSIMPATHY recognises patients as key partners in their own health. iSIMPATHY addresses the challenges posed by polypharmacy and adherence, identified by the WHO as a priority area to focus on to reduce severe, avoidable medication related harm.

Methods
In July 2021, a survey was conducted to obtain structured feedback about GPs and Pharmacists’ experiences of the iSIMPATHY project in participating GP practices in Ireland. The survey identified issues to be addressed and informed the evaluation of the project. Survey topics included barriers and facilitators to success of the project, overall impression and visions for the future for pharmacist roles in primary care in ROI.

Results
33% GPs and 100% Project Pharmacists responded to the survey. They agreed that iSIMPATHY is: Having a positive effect on patient safety, patient quality of life, satisfaction, knowledge and understanding, adherence and quality of patient careImpacting positively on GP job satisfaction, knowledge and understandingPharmacist knowledge and skills, capacity to carry out and follow up on reviews (time available) and pharmacist communication with the patient are facilitating project successProject funding and support, including training of the pharmacists, was felt by most to be a facilitator of project successAll are not only in favour of the continuation of pharmacy presence in their practice beyond the life of this project but they would encourage integration of more clinical pharmacy roles within the primary care setting in the future.

Conclusion
GPs and pharmacists find the iSIMPATHY approach overwhelmingly positive. The project is perceived to benefit patients and GPs and there is unanimity in support for the clinical pharmacist role in project practices and more broadly in Ireland.
84 A PROSPECTIVE AUDIT OF THE MANAGEMENT OF POSTOPERATIVE ANAEMIA IN PATIENTS AFTER OPERATIVE MANAGEMENT OF NECK OF FEMUR FRACTURES
Authors: Awad H , Jeyaseelan A , O'Connor S , Donnelly R , O'Donnell N , O'Regan N 
Published: October 2022

Abstract

Background
There is limited evidence available to guide the diagnosis and management of anaemia and iron deficiency in post operative patients. Numerous guidelines from professional associations exist for the management of pre-operative anaemia. We identified an international consensus statement that provided guidance on patient care with respect to postoperative anaemia and iron deficiency. Our aim was to determine if our practice was consistent with the best practice recommendations of this document.

Methods
We conducted a prospective audit on a convenience sample of patients over the age of 60 with neck of femur fractures who underwent operative management between January and April 2022. We collected data on pre and post operative haematological indices including haemoglobin, serum iron, ferritin and transferrin saturation as well as data on patients who received IV iron and red cell transfusions.

Results
We included 50 patients with neck of femur fractures who underwent hip replacement. All patients had post-op haemoglobin levels performed. Fifteen (30%) patients fulfilled the criteria for diagnosis of postoperative iron deficiency. Only 4/15 of these patients received IV iron postoperatively. Four patients who did not fulfil criteria for post-op iron deficiency received IV iron. Two patients had a post-op haemoglobin between 7-8g/dL and appropriately received red cell transfusions. Four patients received red cell transfusions despite having post-op haemoglobin levels &gt;8g/dL.

Conclusion
Our findings indicated approximately 1/3 of patients fulfilled criteria for post operative iron deficiency while only a small proportion were treated for this. More data is required to establish the impact of post-op anaemia management strategies on functional recovery and quality of life as well as laboratory and interventional endpoints. A local protocol for the management of post operative iron deficiency with and without anaemia will be developed.
85 QUALITY IMPROVEMENT INITIATIVE TO ASSESS FRAILTY AWARENESS AND USE CLINICAL FRAILTY SCALE AMONGST STAFF IN ACUTE AND PRIMARY CARE SITES
Authors: Sweeney M , Thomas I , OReilly A , Duggan J , Conaty J , Smith B , Enaeney AM , Tackney L , Hopkins C , O'Reilly R 
Published: October 2022

Abstract

Background
Frailty describes a condition characterized by decreased physiological reserve and a decreased resistance to stressors, leading to an increased vulnerability to adverse outcomes. Identification of frailty can generate greater complexity in treatment choices, care planning, and costs of care.

Methods
30 inpatient, Emergency Department and Ambulatory Hub charts were audited to assess the presence of the word Frailty. The use of the Clinical Frailty Scale or alternative frailty scale was also audited. A staff survey was completed across four sites, a total of 115 staff were surveyed.

Results
Awareness of frailty across all services is very good ranging from 92% to 100%. The use and awareness of the Clinical Frailty Scale varied with 41% Emergency department and 12% of acute staff respectively but only 25% Emergency Department and 12% of acute staff feeling competent to complete the scale. Conversely, there was a 73% awareness of the Clinical Frailty Scale amongst primary care staff, 33% feeling competent in it's use. The Ambulatory Hub had 100% awareness of the scale with 54% of staff feeling competent.
The chart audit showed that 20% of charts in the Emergency Department identified frailty, all by the Frailty Intervention Team. 26% of the inpatient charts identified Frailty by the Frailty Intervention Team's notes and from one visiting consultant. Frailty was identified and measured using the Clinical Frailty Scale in all cases of the Ambulatory Hub notes.

Conclusion
By identifying frailty at the first point of contact, targeted specialist interventions and services can be planned for the service user. Frailty identification on the acute site was mainly linked to the Frailty Intervention Team with the Ambulatory Hub leading out on frailty identification and measurement in the community. Future initiatives aim to increase frailty identification and awareness in acute and primary care sites.
86 STAFF EXPERIENCES OF COVID-19 MANAGEMENT IN A LONG-TERM CARE FACILITY FOR OLDER PEOPLE IN IRELAND
Authors: Savolainen K , Ahern A 
Published: October 2022

Abstract

Background
Long term care (LTC) facilities for older people have been challenged by COVID-19 in an unprecedented manner. The impact of COVID-19 on health care professionals working in LTC facilities for older people is emerging as a crucial topic. Healthcare workers in LTC for older people were already pre COVID-19 experiencing high levels of stress and compassionate fatigue. The aim of the study was to capture the experiences of staff working during COVID-19 pandemic in a LTC facility for older people in Ireland.

Methods
Semi-structured interviews were conducted with 28 participants who were staff members, both clinical and non-clinical, in a LTC facility for older people in Ireland. Informed consent was obtained from all participants in accordance with the principles of the Helsinki Declaration. Data were interpreted using thematic analysis which allows for patterns of meaning to emerge by creating themes.

Results
21 clinical and 7 non-clinical staff members participated in interviews conducted between June and September 2021. Through analysis four main themes were identified: ‘Fear of COVID-19’, ‘Coping’, ‘Crisis and communication’ and ‘Teamwork’. Themes were interlinked with each other and mainly highlights the high level of adaption by staff in various roles during a time of uncertainty.

Conclusion
The findings are supported by previous studies into staff experiences of COVID-19 in which the level of uncertainty and stress caused by COVID-19 impacted staff on both professional and personal levels. Although positive examples of strong teamwork and a sense of working together were found, there was also fatigue as the pandemic continues. Future studies into staff stress levels and coping with COVID-19 should include the voices of healthcare professionals in LTC facilities for older people.
88 NATIONAL ANTIMICROBIAL POINT PREVALENCE SURVEY IN HSE OLDER PERSONS RESIDENTIAL CARE FACILITIES (OPS-RCFS)
Authors: Clancy A , Regan M , Armitage S , Shah M , Mannion C , Gallagher O , Foran R , Fagan S , Donnelly M , Love B 
Published: October 2022

Abstract

Background
The HALT study in 2016 found that residents in Irish OPS RCFs were twice as likely to be on systemic antimicrobial compared with European average (10% v 5%). National antibiotic prescribing guidelines are available at www.antibioticprescribing.ie and prescribers are encouraged to choose ‘green’ (preferred) over ‘red’ (reserved) agents. HSE Community Antimicrobial Pharmacists (AMPs) have been employed since 2020. We aimed to establish the quality and quantity of antimicrobial prescribing in OPS-RCFs to inform antimicrobial stewardship activities.

Methods
All residents in HSE OPS-RCFs were surveyed between October 2020 and August 2021. AMPs reviewed all medication charts for systemic antimicrobials prescribed within previous 30 days. Medical notes +/- laboratory results were reviewed for persons on antimicrobials. Adherence to guidelines was assessed and information obtained on practices related to antimicrobial use.

Results
The survey included 4,448 individuals in 121 OPS RCFs. 12% were on systemic antimicrobial at time of survey. 27% received an antimicrobial in the previous 30 days. 50% of antibiotic use on survey day was for prophylaxis (6.3% of all residents). Prophylaxis exceeded 6 months in 66% persons, and 12 months in 57%. There was high usage of green versus red agents (65% vs 30%). Co-amoxiclav (red) was most commonly prescribed antimicrobial to treat infection (19%). 42% of sites reported routine use of dipstick urinalysis to support diagnosis of UTI in asymptomatic residents. 36% of sites did not have onsite electronic laboratory access. 61% of facilities did not record residents’ pneumococcal vaccination status.

Conclusion
Key national recommendations: Review all UTI prophylaxis within 6 months of initiation with view to de-prescribing.Cease routine use of dipstick urinalysis to support diagnosis of UTI for asymptomatic persons.Electronic access to laboratory results on-site required to support timely decision-making.All staff should be aware of the national antimicrobial guidelines.Pneumococcal vaccine status should be determined, and provided as necessary.
91 MONITORING FOR CLINICAL DETERIORATION; NURSES EXPERIENCE USING MODIFIED IRISH NATIONAL EARLY WARNING SYSTEM IN AN OLDER PERSON RESIDENTIAL CARE SERVICE
Authors: Hogan FH , Ahern A , Savolainen K 
Published: October 2022

Abstract

Background
We are a 140-bed Care of the Older Person facility. Approximately 50% of Sepsis cases occur in this demographic. The Irish National Early Warning System (INEWS) is an early warning system to assist staff recognise and respond appropriately to clinical deterioration. Currently there is no INEWS for Older Person Residential Services. Challenges for treatment relating to deterioration in our service are; detecting ‘new confusion’, access to doctors, treatment options available and the necessity to transfer a resident to the Acute Care sector if intravenous antibiotics were required. We used the National Clinical Guideline INEWS Version 2 (2020) to develop a clinical monitoring and escalation protocol. This was rolled out December 2021.

Methods
A Nurses Opinion survey was carried out to determine Nurses experience with using the locally modified Early Warning System.

Results
There was a 63% (n=35) response rate. 100% reported improvement in identifying clinical deterioration in a timely manner and effective monitoring for deteriorating residents. 96% reported improvement in confidence with monitoring unwell residents, confidence with transfer out decisions and referring the resident to the doctor for review. 91% noted improvement in communicating residents’ condition to doctors. 87% improvement in clinical practice when monitoring vital signs. 82% improved communication using the ISBAR. On reviewing clinical documentation for all residents who had deteriorated post implementation there was a significant improvement in monitoring and documentation. 23% stated increased time and staffing levels were required for monitoring of residents. 9% stated doctors didn’t always understand the INEWS.

Conclusion
Implementation of the modified INEWS has resulted in considerably improved clinical monitoring, documentation, & Nurses confidence. Significant challenges remain including ethical issues with decision to transfer out a resident for treatment. Recommendations are upskilling of Health Care Assistants to carry out vital signs monitoring, robust advanced healthcare decision making and implementation of an INEWS for Older Person Services.