bluuebunny/crossref_metadata_2025_split huggingface dataset:
245 A PILOT STUDY EVALUATING USE AND ACCEPTABILITY OF A NATIONAL AUDIT TOOL AND MANUAL FOR PSYCHOTROPIC MEDICATIONS IN RESIDENTIAL CARE
Authors: Allen Y , Timmons S 
Published: October 2022

Abstract

Background
Psychotropic medications are frequently prescribed for long-term care residents, even though the risks frequently outweigh the benefits. A draft tool was developed for self-audit of the appropriateness of psychotropic medications prescribed for non-cognitive symptoms for people with dementia in Residential-Care Facilities (RCF). Prior to national use, the audit tool, audit manual and training required piloting.

Methods
The case notes of ten residents with dementia were selected at random within a single RCF. A set of notes were audited by professional staff after online (pre-recorded) audit training, with subsequent feedback by the auditors on the process via focus groups/individual interviews. A second set of notes were then audited, with feedback via a brief survey.

Results
All auditors (7 nurses, 4 doctors, and 4 therapists) gave feedback via a focus group(n=4) or 1:1 interviews; 7 also completed the second-round survey. The pre-audit online training was welcomed but some auditors required additional support during the audit, especially if inexperienced or if there was a gap between training and audit performance. Improvement suggestions for the audit manual included shortening it; adding a glossary of terms, and additional information for decisions on the appropriateness of “as needed” (PRN) medications. Auditors reported difficulties with reading handwriting, locating information in the chart, and determining if a medication was newly or previously prescribed on occasion (due to inconsistencies with prescribing documentation).

Conclusion
Overall, the feedback was positive; all reported that the audit was relevant to their practice, and the manual and online training were useful. Future audits could be facilitated by electronic prescriptions, protected time to complete audits, and site audit leads (senior nursing or medical staff who are familiar with the residents, the audit topic, and with performing the audit). Inexperienced auditors should have, in addition to a training session, a supported auditing session.
246 THE ROLE OF AGEING ON SELF-REPORTED ABILITY ACROSS MULTIPLE SENSES: A LONGITUDINAL ANALYSIS OF DATA FROM THE TILDA STUDY
Authors: O'Dowd A , Hirst R , Setti A , Kenny RA , Newell F 
Published: October 2022

Abstract

Background
During the healthy ageing process, sensory degeneration typically occurs and often in more than one sensory modality. This can present significant challenges to the well-being and quality of life of older adults. However, it is unclear whether senses decline into impaired functioning in a manner that is independent from each other or that is suggestive of a common, amodal mechanism related to the ageing process.

Methods
We used discrete survival analysis to explore the longitudinal (10-year) associations between a number of measures (including age, lifestyle factors and measures of sensory, physical, mental and cognitive health) and the probability of transitioning from normal to impaired sensory function for vision, audition, olfaction and gustation. Sensory impairment was captured as self-report measures for a large sample of older adults (N = 5,066) from The Irish Longitudinal Study on Ageing.

Results
Auditory impairment was most prevalent, followed by impaired vision, olfaction and gustation. Multivariable regression models revealed an increased probability of impairment in one modality for those reporting impairments in other modalities, although this pattern was not consistent for all modality combinations. Visual impairment was associated with socioeconomic status, education, eye disease, smoking and depression. Auditory impairment was associated with age, the sex of participant, hearing aid use and difficulty following group conversations. Olfactory impairment was associated with age, the sex of participant, smoking and difficulty following group conversations. Gustatory impairment was associated with age, smoking and depression. Importantly, self-rated decline in general health was associated with an increased probability of reporting an impairment across all sensory modalities.

Conclusion
Our results suggest that older adults report a decline across multiple senses over time, but the rates are of decline are not consistent. Sensory decline appears associated with both global and modality-specific factors, providing some insights into the impact of sensory health in ageing.
247 QUALITY IMPROVEMENT IN DEMENTIA CARE: STREAMLINING CARE PATHWAYS IN A PSYCHIATRY OF OLD AGE SERVICE
Authors: Byrne R , Elzain M , Amosu E , Lim SA , Walsh A , McLaughlin K , McMorrow S , Matthews K , Sweeney G , McCarthy G , Dolan C 
Published: October 2022

Abstract

Background
Dementia is increasingly considered a public health priority worldwide in the context of predicted increased prevalence. In Ireland, there are an estimated 67,000 persons living with dementia and by 2041 it is expected to rise to 145,000 persons. Challenges in dementia care have been highlighted in health services across Europe and the ineffective structure of dementia care with fragmented non-person-centred pathways has been identified.

Methods
An initial review of the existing cognitive impairment diagnostic pathways in our specialised Psychiatry of Old Age (POA) Service was undertaken. This included surveying the multidisciplinary team to identify challenges, clinical chart review and audit of physical examination equipment. Diagnostic pathway was updated based on findings and informed by the developing national ‘Model of Care for Dementia in Ireland’ and best practice.

Results
Review findings included lack of standardisation of memory assessment, delays in accessing neuroimaging and laboratory results, gaps in staff training. A care pathway document was developed detailing requirements for care from the point of referral through to cognitive impairment diagnosis. Staff training was completed to accompany the introduction of standardised dementia assessment scales. Access to laboratory/radiology booking was enhanced. A cognitive remediation group was developed by Occupational Therapy as part of post-diagnostic supports for service users. Preliminary data indicates improvements in satisfaction of those attending the group. Physical examination equipment audit resulted in quality improvements.

Conclusion
We demonstrate that a quality improvement approach can be implemented to enhance assessment, diagnosis and care provided to support diagnosis of cognitive impairment and dementia in POA service. The enhanced diagnostic care pathways will be assessed over time to assess impact on care of service users. Preliminary findings are positive and it is an approach that can be adopted in other services and inform development of national memory service developments.
250 AUDIT INTO THE USE AND COMPLICATIONS OF MAINTENANCE INHALER THERAPY IN MEDICALLY ADMITTED PATIENTS OVER THE AGE OF 65 YEARS
Authors: Walsh S , Mulroy M 
Published: October 2022

Abstract

Background
Adequate maintenance inhaler use is associated with improved symptom control and reduced exacerbation rates, however, cognitive impairment and limitations in dexterity can be a barrier to inhaled therapy.

Methods
Between the 20th of April and 30th May 2022 patients admitted to our ward over the age of 65 years had their maintenance inhaler technique assessed using the National Asthma Council of Australia checklist. Symptom control was assessed by either the Asthma Control Test (ACT) or the Chronic Obstructive Pulmonary Disease (COPD) assessment tool (CAT). The 4 AT score was used to screen for neurocognitive impairment.

Results
20 patients were recruited to the study. 40% were male. Mean age 81.5 years +- 6.8years. The respiratory diagnosis was COPD in 70%, Asthma 20%, Interstitial Lung Disease 5% and bronchiectasis 5%. 65 % had pulmonary function testing performed. Asthma symptom control was within target in 75% of the asthma patients (ACT score &gt;20). Mean score 21 +- 2.5. COPD symptom control was within target in 31% of patients (CAT score &lt;10) . Mean CAT score of 19.3 +- 8. 4. 20% had a pre-admission diagnosis of neurocognitive impairment. The mean 4AT score of the cohort was 1.2. 35% had audible wheeze at the time of review. 80% of inhalers were prescribed for the licensed indication. 35% had potential complications of inhaler therapy – 25% pneumonia and 10% oral candidiasis. Notably all pneumonias were associated with fluticasone. Inhaler technique was associated with errors in almost a quarter of all patients (24%). Increasing 4AT score correlated with high likelihood of inhaler errors, R = 0.63.

Conclusion
Poor inhaler technique is correlated with neurocognitive impairment. Pneumonia is a potential complication of inhaler therapy and represents an opportunity for deprescribing in patients with COPD.
252 VTUESDAYS: A QUALITY IMPROVEMENT PROJECT TO EMBED THROMBOPROPHYLAXIS REVIEWS IN AN INTERMEDIATE CARE REHABILITATION SETTING
Authors: Trainor R , Atkinson T 
Published: October 2022

Abstract

Background
Venous Thrombo-Embolism (VTE) can be life-threatening. Risk assessment and mitigation is essential to reduce morbidity and mortality in all clinical settings. Northern Ireland Health and Social Care has a standardised, regional thromboprophylaxis risk assessment tool as part of paper-based drug charts in the acute, secondary care setting. Intermediate care setting drug charts incorporate this same tool. The 30-bedded pilot site cares for step-down patients from the acute hospital setting from surgical, orthopaedic and medical specialties, for those aged over 18 years requiring bed-based rehabilitation. Regularisation of reviews of risk assessments to address changes in VTE risk was identified as a need to avoid under-prescribing and over-prescribing.

Methods
Quality improvement methodology was used. Pre-phase, semi-structured interviews with stakeholders took place. An Ishikawa diagram analysed contributory factors to risks. A Sinek circle distilled intentions. A Clinical Value Compass map considered potential outcomes. A vision of “VTuEsdays” was co-designed. Global and specific aims informed driver diagrams. Plan, Do, Study, Act iterations were used in the implementation phase including a decision support tool to guide the appropriateness of deprescribing on the basis of rehabilitation trajectory and changing VTE risk.

Results
We collected baseline data and implemented education of staff working in the intermediate care centre, utilising the ‘PDSA’ Model to guide changes. A bright and easy to use flowchart was used with the title ‘VTuEsdays’. This encouraged the process of VTE risk assessment and weekly review on a Tuesday. There were improvements in: the completion rate of risk assessment tool; the accuracy of this assessment; the under-prescribing and over-prescribing of thromboprophylaxis.

Conclusion
The “VTuEsdays” themed day helped ameliorate under-prescribing and over-prescribing of thromboprophylaxis in an intermediate care bed-based rehabilitation setting. Quality improvement methodology enables a robust approach to risk mitigation. Similar themed days for regularisation of reassessment of clinical risk management in intermediate care settings could improve different aspects of care.
254 AN AUDIT OF DISCHARGE SUMMARY QUALITY AND INTRODUCTION OF A DISCHARGE SUMMARY TEMPLATE IN AN ORTHOGERIATRIC SERVICE
Authors: Rafferty M , Murphy D , Fouhy F , Amumin A , Saidova M , Dukelow T , Ahern E 
Published: October 2022

Abstract

Background
The discharge summary is the main method of communication integrating the care of older adults from the acute hospital admission to their discharge destination. HIQA published standards to ensure high quality and safe information transfer between settings. We designed an audit to evaluate the quality of the discharge summaries from the orthogeriatric service before and after the introduction of a discharge summary template for use by Non-Consultant Hospital Doctors (NCHDs) on the service

Methods
Data were collected anonymously using an excel data collection tool with 51 data points covering the seven key areas outlined in the standards. Initial data collection included patients admitted in November 2021. We introduced a discharge template and education sessions for orthopaedic NCHDs regarding discharge summary completion. We then retrospectively collected data from discharge summaries completed after the intervention in March 2021

Results
We examined discharge summaries of 10 patients in each group. Admission and discharge details, and details of the patient, GP and author met the HIQA standards in all summaries and there was no significant change documented. There was an appropriate clinical narrative included for 8 patients preintervention and all patients after. There was a 70% improvement in documentation of patients’ living circumstances and 90% for details of functional state. Medications on discharge were included for three patients initially and eight after. Specific details regarding medication changes were included for one patient initially and seven after. Details of future management improved in 5, 7 and 3 summaries regarding hospital actions, GP actions and community actions respectively.

Conclusion
High-quality discharge summaries are essential for continuity of care and patient safety. The introduction of a discharge summary template and education of NCHDs significantly improved the quality of the discharge summaries in our unit.
257 THE INTRODUCTION OF THE SSKIN BUNDLE IN A REHABILITATION SETTING
Authors: McDonnell C 
Published: October 2022

Abstract

Background
The SSKIN Bundle is a care bundle in which each component acts as an intervention in preventing pressure ulcers. SSKIN stands for Surface, Skin Inspection, Keep Moving, Incontinence Management, and Nutrition. This quality improvement initiative outlines the introduction of the SSKIN Bundle in an attempt to address the issue of pressure ulcers in a rehabilitation hospital. There is a significant amount of research attesting to the physical, psychological, and economic impact pressure ulcers have on patients, particularly older adults.

Methods
Following the Health Service Executive (HSE) Pressure Ulcer to Zero (PUTZ) campaign (HSE National Wound Management Guidelines 2019), this initiative was introduced to the hospital by an interdisciplinary committee in February 2019. Patients who met the inclusion criteria were regularly assessed using the SSKIN Bundle. Data was visually audited via the PUTZ safety cross and analysed using Run Charts.

Results
Results showed a clear decrease in the number of pressure ulcers following introduction of the SSKIN Bundle. Within a six-month timeframe and following the introduction of the SSKIN Bundle, the incidence percentage of newly acquired pressure ulcers was reduced by 50%. Despite incidences where partial increases occurred, this was quickly rectified by facilitating targeted education sessions to staff and the appointment of a tissue viability nurse.

Conclusion
The conclusions of this campaign ultimately found that the introduction of a SSKIN Bundle helped to improve staff knowledge on the monitoring, recognition, grading, and prevention of pressure ulcers. The visual of the safety cross worked particularly well as a means to tailor this education where knowledge gaps existed.
258 RISING TO THE CHALLENGE: ORTHOGERIATRIC SERVICE IMPROVEMENT AND COVID-19
Authors: Stankard A , Thomas N , Cosgrave N , Conlon B , Monaghan P , Halpin T , English D , Byrne P , McShane S , Sohail I , Grogan AM , Reilly A , Thapa A , Alsubaie N , Rane P , O'Connor J , Gray S , Kaja A , Gehani K , Kovalyshyn V , O'Brien H 
Published: October 2022

Abstract

Background
Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019.

Methods
Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner.

Results
There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery &lt;48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall; 87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding.

Conclusion
Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.
259 AN AUDIT OF DNACPR FORM USAGE IN A LEVEL 4 HOSPITAL FOLLOWING RE-DESIGN AND IMPLICATIONS FOR ITS FUTURE USE
Authors: Brennan F , Higgins M , Russell S , Sands H , Keogh C , Curran C 
Published: October 2022

Abstract

Background
In 2020 during the Covid-19 pandemic our hospital introduced a new green DNACPR form with 2 significant changes. It now specifies if the patient is or is not for resuscitation (as a yes/no choice) and a Treatment Escalation Plan (TEP) has moved to the front of the page from the back. A subsequent audit found that 19% of inpatients had forms completed, of which 68% stated DNACPR and 29% for CPR. 76% of forms had a TEP (versus 56% on the old forms). We repeated the hospital wide audit in 2022 to assess if the improvement in TEP documentation was sustained, and if it was used on all patients or primarily to document DNACPR decisions.

Methods
The hospital-wide audit was performed on the 25.05.2022. Charts were reviewed on medical and surgical wards. ICU patients were excluded. The following data were recorded: Resuscitation status, form completion, presence of a TEP, if the date of admission and form completion were recorded, if the name of doctor and nature of discussion with patient and family were documented, and if the TEP was consistent with the most recent clinical notes. The data was compared to the 2020 audit and against the Hospital’s DNAR & TEP policy.

Results
634 inpatients were identified. 15.7% (100) had a form completed of which 92% stated DNAR. One of these did not have a TEP. The doctor’s name and grade were clearly documented on all forms.

Conclusion
99% of patients who were not for CPR had a TEP indicating sustained improvement since the introduction of the new form. Given 83.3% of patients did not have any documented resuscitation status the approach of documenting yes or no for resuscitation is not being utilised. A return to a dedicated form that indicates someone should not undergo attempts at resuscitation may offer more clarity.
261 HIGH FRACTURE RISK IN OLDER IRISH ADULT FALLERS
Authors: Breslin L , Bradley E , Fitzpatrick D , Laird E , Hoey L , Hughes C , McNulty H , Strain JJ , Ward M , Tracey F , Molloy A , Cunningham C , McCarroll K 
Published: October 2022

Abstract

Background
Fracture risk due to falls depends on several factors including bone density, quality and size, hip geometry (axis length), direction of fall (forward, backwards or sideways), body mass index (BMI), type of surface impacted, body site of impact and mechanism of fall (eg syncope). We aimed to identify the fracture risk per fall in frail older Irish adults.

Methods
Participants were from the hypertensive and cognitive cohort of the Trinity, Ulster, Dept Agriculture (TUDA) study of Irish adults (aged &gt;60) recruited from hospital outpatient services and GP practises. Falls and falls resulting in fracture in the previous year were self-reported so those with an MMSE &lt; 25 were excluded to avoid recall bias. We identified fallers, recurrent fallers and fractures due to falls in the previous year.

Results
892 fallers, mean age 76.3 ± 8.4 yrs, 65.2% female. 23.8% had 2 falls and 24.2% ≥3 falls. Mean timed up and go was 17.3 ± 9.5 seconds. Commonest fracture due to falls were hip (20.1%), upper limb (18.5%) and lower limb (17.9%) with one fracture of neck and skull. Fracture rate per fall was 7.1%: 1.7% for hip, 1.3% for lower and 1.2% for upper limb. Annual fracture rate per faller was 16.5%. The only predictors of fall with fracture versus no fracture were female sex (OR 2.4, 1.6-3.6, P&lt;0.001) and lower body mass index (P=0.001).

Conclusion
We identified similar hip fracture rates (1.7%) due to falls as in other studies. However, one in six fallers had sustained a fracture in the previous year reflecting the high proportion of recurrent fallers. Lower BMI and female sex predicted fall with fracture as both are strongly correlated with risk of osteoporosis. Recent guidelines now factor in recurrent falls when estimating the probability of future osteoporotic fractures.
262 THE IMPACT OF COVID-19 PUBLIC HEALTH MEASURES ON THE SOCIAL RELATIONS OF MEN AND WOMEN IN LATER LIFE
Authors: Sheridan C 
Published: October 2022

Abstract

Background
Despite the burgeoning literature on the impact of Covid-19 on the lives of older populations, gaps remain in our knowledge around the lived experience of social relationship change during the pandemic, and the implications for longer-term relational well-being. Even with the clear significance of Covid-19 for older populations across Europe, research involving cross-national comparisons of these experiences is largely absent. Addressing these gaps is critical given concerns for some older people’s social connectedness, their future relational embeddedness, and our societal preparedness for pandemic and other public health crises. The aim of this paper is to chart the impact of the pandemic on older people’s subjective lived experience of social connectedness across seven countries, and to contrast the differential impact of public health measures, if any, in these jurisdictions.

Methods
The analysis draws on 210 semi-structured interviews with men and women aged sixty-five and over across Austria, Czech Republic, Ireland, Israel, Norway, Spain, Sweden (as part of a wider study into exclusion from social relations), with a focus on direct social distancing measures and people’s response to these measures.

Results
Four themes emerged from the data: reduced informal social contact, depleted social opportunities, fear and lack of social confidence, and relational life course and impacts in context. Given the largely common approach to preventing the spread of the virus, more cross-national similarities than differences, although there were clear exceptions to this in relation to approach, and cultural nuances are evident. Cross-cutting these themes, structural and self-ageism emerged as intensifying formal constraints for some participants, in some settings.

Conclusion
For most participants, public health measures had a negative impact on their subjective well-being, while others experienced disruption to their relational life course trajectories. The data points to a clear need to consider the social infrastructure of older people, particularly in times of crises.