bluuebunny/crossref_metadata_2025_split huggingface dataset:
680 IMPROVING COMMUNICATION IN THE TIME OF COVID-19 - USING A DEDICATED COMMUNICATION SHEET
Authors: Misquitta O , Angeles G , Overin D , Green L 
Published: March 2022

Abstract

Title Improving ease and consistency of communication with Next of Kin (NoK) on an Acute Frailty Ward.

Background
A dedicated Communication Sheet was introduced on an Acute Frailty ward at the Royal Surrey County Hospital (by a Nurse-in-Charge and foundation doctors under the supervision of a Consultant Geriatrician) to improve communication between the Multidisciplinary team(MDT) and patients’ NoK/families.

Introduction
Communication with patients’ NoK is an essential part of providing holistic care & has become important given the COVID-19 visiting restrictions. Multidisciplinary Team (MDT) members were facing difficulties in knowing the following while updating NoK: 1. The correct contact details of the Next of Kin and other significant persons involved in care. 2. When the last NoK update was done and what was discussed. 3. If the patient has consented to NoK updates. This led to dissatisfaction and complaints from families regarding the frequency and consistency of updates. To make this easier for staff, a communication sheet was introduced.

Methods
A Plan-Do-Study-Act Method: was used. Following discussion at a ward governance meet, a survey was conducted to assess the difficulty faced by MDT members in NoK updates. A Communication Sheet designed by a Nurse-in-Charge and Foundation Doctors was trialled for 1 month. The sheet was updated following feedback. A repeat Survey was conducted to assess if NoK updates were easier after the intervention.

Results
After the Introduction: of the Communication Sheets, the number of staff facing ‘significant difficulty’ in the above-mentioned parameters reduced and those facing ‘no difficulty’ increased. Feedback from MDT members suggested that they found the intervention useful.

Conclusion
Dedicated communication sheets made updating families/NoK easier. This ensures consistent updates especially when visiting is restricted. This fosters a better patient-clinician relationship. Given its success, we plan to share this with other frailty wards to scale up this intervention.
687 FLUID MANAGEMENT OF PATIENT ADMITTED IN ACUTE ELDERLY CARE MEDICINE WARD: A RE - AUDIT AND COMPARISON TO STANDARD RECOMMENDATION
Authors: Farhana T , Noble J 
Published: March 2022

Abstract

Introduction
There is considerable pressure for monitoring and recording of fluid intake in the elderly care unit We conducted a re-audit of our practice measured against standard recommended fluid intake and implemented measures following initial audit to determine an improvement of the patient care in our unit.

Method
A prospective analysis of recording and total fluid intake of 16 patients in a given day, data was collected from electronic records and outcomes compared to our previous audit. Standard daily fluid intake was considered in male 2000 mL and female 1,600 mL [1].
Result Patient demographics were comparable, including M: F ratio 6: 10 (previously 9: 5), median age 84.5 years (previously 85.5 years) and median clinical frailty score 6 (previously 7). Median fluid intake of male group 1,300 mL (previously 750 mL) and female group 1,000 mL (previously 700 mL). The entries of fluid recording throughout 24 hours showed day shift 81% (previously 26%), evening shift 100% (previously 95%) and night shift 94% (previously 86%).

Conclusion
There is evidence of improvement of fluid management in our unit following implementation of some measures however issue with daily fluid intake is lower than the recommended standard.

Reference
1. Fluid (water and drinks) - British Dietetic Association - UK.COM. https://www.bda.uk.com › resource › fluid-water-drinks.
694 IMPROVING OPIATE PRESCRIBING IN OLDER ADULTS WITH HIP FRACTURES TO COMBAT THE IATROGENIC FALLOUT
Authors: Hudson M A J , Atkin J , Lumley G , Singh S , Varma S , Shenoy D , Morgan C , Peck G , Fertleman M , Koizia L 
Published: March 2022

Abstract

Background
The number of opioid prescriptions in older patients has increased dramatically and it is recognised that opioids are the fourth most likely drug to cause preventable hospital admissions. The adverse effects of opioids occur more frequently in the geriatric population. Little is known about the impact of postoperative pain in older adults. NICE recommends paracetamol with additional opioids if there is insufficient postoperative pain relief. Multidisciplinary management with early and then daily physiotherapy is critical. We have assessed pre-morbid, immediate and prolonged use of opioids in patients following hip fracture. Local problem Pre-intervention analysis identified 79% (57/72) of all patients being discharged on opiates. At 4-months, 37% (17/46) of those were still using them. This represents 28% (17/61) of all patients.

Methods
Analysis of all patients (excluding poly-trauma) with hip fractures over the age of 60 years admitted to St Mary’s Hospital. Interventions Development of local guideline on analgesia prescribing; particularly focusing senior geriatrician led decision making. Prescribing oxycodone for first 72-hours and initially using nerve block. Avoidance of transdermal preparations and withdrawing stronger opioids prior to discharge. Clear instructions for GP’s on a stop date and need for community review. Patient information leaflet dispensed with all discharge opioid prescriptions.

Results
Post-intervention cycle; 17% (11/63) of patients were taking prescribed opioids prior to admission (similar to the pre-cohort). 52% (33/63) were discharged on opiates, down from 79%. At 4-months, of those discharged on opioids, 30% (9/30) were still using them; lower than in the first cycle (37%). Overall reduction from 28% to 16% of patients on opioids at 4-months.

Conclusion
The use of specific hip fracture analgesia guideline, senior geriatrician decision-making and support to community colleagues can reduce in-patient and community opiate prescribing, and stem the growing problem of opioid addiction, misuse and iatrogenic re-admission.
710 IPC STOCKINGS FOR VTE PREVENTION IN STROKE: BENEFITS OF INTRODUCING ELECTRONIC PRESCRIPTIONS AND WARD ROUND PROMPTS
Authors: Ross K , Kattakayam F , Hall E , Barker J R 
Published: March 2022

Abstract

Background
A fully completed audit cycle, performed by doctors on the Stroke Unit at Royal Lancaster Infirmary (RLI) which is a combined acute and rehabilitation ward in a university teaching hospital.

Introduction
Deep vein thrombosis (DVT) and pulmonary embolism (PE) are common complications of hemiplegic stroke. Evidence shows that IPCs (intermittent pneumatic compression devices) reduce the risk of DVT. Recent data from SSNAP reports that IPCs are only used in 33% of all stroke patients. We aimed to improve our local standards in the prescription of IPCs for stroke patients within 3 days of admission, thus reducing the incidence of VTE (venous thromboembolism).

Methods
Data was collected retrospectively from patient records of all stroke patients discharged over a one-month period for each of 2 audit cycles. Prescribing is electronic based at RLI. After the first cycle we initiated a prompt on the electronic VTE pro forma to initiate prescribing. We also changed the prescribing default to regular instead of when required, requiring staff to document when they were not given and the reasons why.

Results
Between the first and second cycle, completion of VTE proformas improved to 100% and VTE incidence reduced from 7.6% to 0. Overall, there was a large improvement in prescribing IPCs within the first 3 days of admission. 71% of patients reviewed in the second cycle had IPCs prescribed compared to 37% in the first.

Conclusion
Adherence to local standards in prescribing of IPCs within 3 days of admission markedly improved after the Introduction of electronic ward round prompts and prescriptions and the incidence of VTE decreased to zero. The prescribing prompts encouraged increased documentation of administering of IPCs. There are still some issues concerning documentation and prescribing of anticoagulants which will be tackled by implementing teaching sessions and updating our electronic prescribing prompts.
712 EVALUATING AN ‘ACUTE FRAILTY TEAM’ MODEL OF CARE IN IMPROVING OUTCOMES FOR PATIENTS WITH FRAILTY ACUTELY ADMITTED TO HOSPITAL
Authors: Thompson J , Gusev V , Dervin P , Tevendale E 
Published: March 2022

Abstract

Introduction
In frailty, Comprehensive geriatric assessment (CGA) has benefit in improving patient outcomes, including hospital readmissions and institutionalisation. We looked to evaluate the effectiveness of our newly initiated multi-disciplinary, acute frailty team (AFT) in improving acute care. This team works on the Acute Medical Unit (AMU), delivering early CGA alongside the existing acute medical care.

Methods
The AFT initially targeted identification of frailty using the Rockwood clinical frailty score (CFS) through local quality improvement work. A standard operating procedure, encompassing CGA for all patients with frailty (define as a CFS 5 to 8 or, 4 with a frailty syndrome) was introduced. This assessment was additional to usual acute medical care. The impact was measured by retrospective case note review of 100 AMU admissions with frailty prior to the team being in post (Jan-March 2020) with a subsequent 100 patients seen by the AFT (March–April 2021). The 2 groups were matched for age, gender, frailty scores and pre-admission residence. These 2 cohorts were compared against key performance indices.

Results
The mean age of patients in the Pre and post AFT cohorts were 85 years and 84 years respectively with an average CFS of 6. The identification and documentation of frailty improved in the AFT intervention cohort from 31% to 100% and screening for delirium with 4AT improved from 27% to 91%. The number of patients in the AFT cohort discharged directly from AMU increased from 5% to 14% with the average length of in-patient stay reducing from 10.2 days to 7.8 days. Thirty day remission fell from 23% to 16% in the AFT cohort, and the number of patients discharge to new 24 hour care declined from 21% to 9%.

Conclusion
Our AFT alongside existing acute medical care improved outcomes including, frailty identification, delirium screening, length of stay, re-admissions and institutionalisation.
713 COLLABORATION WITH CARE HOMES TO PROVIDE APPROPRIATE MEDICAL CARE IN THE PANDEMIC
Authors: Kelly S , Griffiths B , Davies A , Adenwalla F 
Published: March 2022

Abstract

Background
The Acute Clinical Team (ACT) in Neath Port Talbot is a well-established hospital at home service that provides treatments in the community. During the COVID 19 outbreaks, the team proactively telephoned the care home managers on a regular basis to enquire about the residents wellbeing and establish if input was required. This proactive approach worked well with some homes. Where crises developed, we were able to provide hands on support to provide appropriate medical care.

Methods
A collaborative effort from community teams and volunteers assisted ACT to provide nursing and medical interventions in care homes which accepted our help. Interventions included intravenous (IV) antibiotics, parenteral fluids, IV/oral dexamethasone, low molecular weight heparin, oxygen (up to 10 L face mask), communication with families and palliative care.

Results
Data is presented from 7 care homes for which ACT provided input; patients who were unwell requiring additional help were referred to the team. Comparative data from a care home in the same area where ACT was not involved is presented. Data was collected from 01/11/20-10/02/21. Table 1 Care homes with ACT involvement (190 patients) Care home without ACT involvement (85 patients) Patients assessed Patients not assessed No. with COVID-19 infection (%) 96/190 (51%) 94/190 (49%) 27/85 (32%) Acute hospital admission related to COVID-19 (%) 3/96 (3%) 7/94 (9%) 8/27 (30%) Died within 28 days of positive test(%) 37/96 (39%) 20/94 (21%) 15/27 (56%).

Conclusion
ACT had a vital role during the outbreak in supporting the local community. The team was able to provide a range of interventions and prevent avoidable admissions. The team received excellent feedback ‘We couldn’t have survived without the ACT teams input. They were our lifesavers. The whole team were amazing and came to our rescue where everyone else who knew we had COVID bolted to the hills’ Manager.
716 A MULTIDISCIPLINARY SIMULATED TEACHING PROGRAMME ON TREATMENT ESCALATION PLANNING IN THE CONTEXT OF FRAILTY
Authors: Corson C , Fair K 
Published: March 2022

Abstract

Introduction
We designed a simulated teaching session to enable participants to learn more about Treatment Escalation Planning (TEP) and do not attempt resuscitation (DNACPR) orders in the context of frailty and to simulate communication of these decisions with the patient/relative.

Method
We designed a teaching session which started with discussion of the participants individual learning Objectives. The session involved group discussion surrounding frailty and ways to assess it, communication skills and tools and TEP/DNACPR. We also discussed specific communication issues during the pandemic. The session then moved onto simulated conversations with a patient/their relative using the skills just discussed. Every participant had the chance to complete the scenario. Each participant also had a ‘debrief’ lead by the authors and valued input from a Resuscitation Officer. To date, 5 sessions have been completed with 13 participants. Participants were medical doctors, advanced nurse practitioners and acute care of the elderly practitioners.

Results
The mean overall rating of the session was 9.4/10. Participants recorded confidence scores in 4 main areas pre and post session. We found that, by participating in the session, confidence improved in all 4 areas; confidence assessing level of frailty, how to agree TEP decisions, initiating conversations around TEP, discussing potential treatment options with patients/relatives.

Conclusion
We have developed a simulated teaching session, which has been rated highly and is shown to be effective in increasing the confidence of participants when discussing TEP in the context of frailty. Our next steps will be to expand the programme to deliver further sessions.
737 STOOLS FOR STOOLS - COMBINING MEDICAL AND CONSERVATIVE TREATMENTS TO REDUCE CONSTIPATION IN THE ELDERLY INPATIENT POPULATION
Authors: Roth N , Khalil N , Moore-Gillon C , James D , Gilby L , Morgan C 
Published: March 2022

Abstract

Introduction
Constipation is a common cause of morbidity in the elderly. Its management is particularly challenging in the inpatient population, where many factors exacerbate constipation. We describe a Quality Improvement Project to reduce the rates of constipation on a female Medicine for the Elderly ward.

Aims
Our aim was to increase bowel chart documentation (nursing and doctor entries) and increase patient frequency of bowel motions to at least once every two days. In particular we focused on conservative measures such as the use of footstools to optimise posture when using commodes and toilets [R Hari Krishnan, Proc Inst Mech Eng H, 2019, 233(4):464–475].

Method
• Weekly monitoring of ward inpatients. • Measurements taken were: days since last bowel motion, laxatives prescribed, bowel chart and ward round documentation, and episodes of diarrhoea over the past week. • One episode of diarrhoea was defined as 3 motions of type 6 or type 7 stool in 24 hours. • A new intervention was introduced every two weeks, over a total of 2 months. Interventions: 1. Recording bowel motions at the daily ‘Board Round’ Multi-Disciplinary Meeting. 2. Ward staff education sessions. 3. Footstools for use with commodes and toilets. 4. High-fibre foods to patients with constipation.

Results
Level of constipation was successfully reduced, with 100% patients moving bowels every 2 days from a baseline of 68%. Ward round and bowel chart documentation improved to 100% and 93.3% respectively (from 41.3% and 33.3%). However, incidence of diarrhoea increased from 0 episodes/week to 8 episodes/week, with laxative prescriptions similarly increased from 50% to 86%.

Conclusion
Constipation improved with our interventions, but at the unintended cost of laxative-associated diarrhoea. Our next steps will be to reduce laxative prescriptions in favour of conservative measures, in order to reduce episodes of loose stool while maintaining our improved constipation rates.
744 3 YEAR FOLLOW-UP OF SEDATIVE PRESCRIBING FOR RESPONSIVE BEHAVIOURS IN NURSING HOME RESIDENTS, AN IRISH STUDY
Authors: Killeen E , Horan S , Pollock A , Lee A , Martin A 
Published: March 2022

Abstract

Introduction
Sedative medications are commonly prescribed for older adults; these include neuroleptics, benzodiazepines, opioids, ‘z’ drugs and trazadone. The prevalence of sedative drug prescriptions is increasing (1). Nursing home residents are three times more likely to be prescribed benzodiazepines (2). Regular medication review and education have been shown to reduce rates of sedative use in nursing homes (3). We previously demonstrated a significant reduction in prescription of these target medications at an Irish nursing home with specific focus, within scheduled medication reviews, on reduction or discontinuation of the target drugs in combination with education on management of Behavioural and Psychological symptoms (BPSD). This audit examines the prescribing patterns 3 years on from the initial audit.

Methods
Point prevalence study of sedative prescriptions and BPSD of all 95 nursing home residents on 6/5/21. Comparison with data from two previous audits in the same unit. All data was anonymised. Data analysed with SPSS statistical software.

Results
Sustained significant drop in quetiapine use from 30% of residents to 14% post-intervention in 2018 and three-year follow-up (p = 0.06). Borderline significant reduction in overall neuroleptics (from 39% to 25%, p = 0.06). Significant rise in ‘z’ drug prescription (from 8% to 17%, p = 0.03). BPSD reported in 33%, compared to 49% pre-intervention.

Conclusion
Regularly scheduled medication reviews can effectively rationalise sedative prescription rates in nursing home residents. Increasing ‘z’ drug prescription likely represents the appropriate replacement of neuroleptics. Reduced BPSD may be due to reporting bias of staff since regular education has been introduced or changing cohort of residents. References numbered above not included given limited word count.
756 ORTHOPAEDIC SURGEONS CAN PRESCRIBE LAXATIVES & ANALGESICS TOO - A QUALITY IMPROVEMENT PROJECT SPANNING 7 YEARS
Authors: Kim K K B , Gibson P 
Published: March 2022

Abstract

Background
Patients admitted with age 60 years and over with a hip fracture admitted to a District General Hospital.

Introduction
The aim was to improve the prescribing of regular laxatives and analgesia at the time of admission to hospital.

Methods
There were repeated PDSA cycles. Data was collected on consecutive patients (by admission date) identified from the National Hip Fracture Database. Data was collected at baseline (10 patients in November 2013) and after Phase 1 intervention (20 patients, December 2013—January 2014), after Phase 2 (20 patients, February 2014), after Phase 3 (39 patients, April—June 2017) and after Phase 4 (September—October 2020). The interventions were as follows: Phase 1: Prompts at new doctor induction (‘Induction’) + prompts in hip fracture admission document. Phase2: Phase 1 intervention + flow diagram in fracture admission document. Phase 3: Prompts at Induction + electronic prescribing protocol (including laxatives and analgesics) + removal of flow diagram from admission document. Phase 4: Phase 3 intervention + more effort to explain to new locum doctors.

Results
Laxative prescribing: Baseline = 40%, Phase 1 = 80%, Phase 2 = 80%, Phase 3 = 56%, Phase 4 = 74% (24 hours post-admission = 90%). Paracetamol prescribing: Baseline 100%, Phase 1,100%, Phase 2,100%, Phase 3 64%, Phase 4 82% (24 h post-admission = 90%). Regular strong opioid prescribing: Admission: Baseline 60%, Phase 1 90%, Phase 2,100%, Phase 3 44%, Phase 4 80% (24 h post-admission = 90%).

Conclusion
1. Orthopaedic Surgeons can prescribe laxatives and analgesia well—given sufficient prompts 2. The electronic solution is not always sufficient—locum doctors may not be aware of it. 3. Do not assume continued success Future Plans Re-introduce flow diagram to admission document. Acknowledgements Many people have helped with previous phases & will be acknowledged.
757 ASSESSING THE READMISSION RATES OF THE OLDER PERSON’S ASSESSMENT AND LIAISON ACUTE FRAILTY TEAM AT GOOD HOPE HOSPITAL
Authors: Brice H G T , Sheikh S , Quigley T 
Published: March 2022

Abstract

Introduction
The Older Person’s Assessment and Liaison (OPAL) team at Good Hope Hospital (GHH), part of the University Hospitals Birmingham NHS Foundation Trust, provides multidisciplinary, patient-centred comprehensive assessment to patients presenting to the hospital front door. The team takes a ‘home first’ approach and where possible aims to discharge patients home with support by community teams. The service is part of the Birmingham wide Early Intervention programme. A front door OPAL service therefore enables early discharge for frail patients who would otherwise be likely to have a prolonged hospital admission. This has to be balanced against ensuring readmission rates do not exceed that of a comparable hospital inpatient population.

Method
We measured the 7 and 28-day readmission rate of all patients who received OPAL input and were discharged from A&E, the Medical Admissions Unit or the Acute Medical unit from July 2020—January 2021. This was compared with an inpatient short stay frailty unit however data was not available beyond November 2020 due to changes in response to the Covid-19 pandemic.

Results
2096 patients were discharged by OPAL with a 7-day readmission rate of 9.2% (95% CI 4.6–13.7%) and a 28-day readmission rate of 20.2% (95% CI 14.0–26.4%). From July—October 2020 the short stay frailty unit at GHH had a 7-day readmission rate of 9.7% (95% CI 3.1–16.3%) and a 28-day readmission rate of 25.2% (95% CI 8.2–42.2%). In the same period OPAL had a 7-day readmission rate of 8.7% (95% CI 3.2–14.2%) and a 28-day readmission rate of 19.9% (95% CI 13.3–26.5%).

Conclusion
The OPAL service enabled the early discharge of patients without compromising readmission rates. The readmission rates for patients discharged by the OPAL team were better than the inpatient frailty unit with over 20% fewer 28 day readmissions.