Posters

Background: This improvement project was done within the Geriatrics/ Stroke department and aims to meet the following adapted standards: all discharged patients must leave with the original DNACPR document, and clear documentation of their DNACPR and review status in the immediate discharge letter to their Primary care provider. Local problem: Firstly, not all discharged patients leave with the original DNACPR document and secondly, their DNACPR status was not communicated to their Primary care provider which highlights a communication gap which exists between secondary and primary care

Background: Accurate documentation of medication suspension is crucial for patient safety, especially during transitions such as out-of-hours discharges. In early 2023, an audit in our hospital’s elderly care ward revealed a significant number of medications were suspended without proper documentation, raising concerns about continuity of care, medication errors, and patient outcomes. This Quality Improvement Project (QIP) aimed to improve the consistency, clarity, and quality of documentation in the ward to enhance patient safety and reduce risks associated with incomplete information

TITLE: Improving the Practice of Measuring Lying and Standing Blood Pressure Among Nursing Staff at a District General Hospital INTRODUCTION: Postural hypotension is a significant cause of morbidity in the frail and older population, contributing to falls and related injuries. Accurate measurement of lying and standing blood pressure (LSBP) is essential for identifying patients at risk. This quality improvement project (QIP) aimed to address gaps in LSBP measurement practices among nursing staff by aligning them with Royal College of Physicians (RCP) guidelines. The project sought to raise

Local Situation: 2023 audit showed 57% of Parkinson’s disease medications were given within acceptable time frame of thirty minutes of prescribed time. The target for this project is a sustained improvement (demonstrated by a run chart showing improvement over two months) with a minimum of 80% of these medications being given in 30 minute time window. Methods: Effective strategies from other centres and Parkinson’s UK resources were adopted to trail as PSDA interventions in our hospital: visual bedside timing reminder aids, educational sessions for nursing and medical teams, posters to raise

Background Constipation causes morbidity, delays discharge, and is treatable. Aims Reduce constipation to minimise risk of sequelae. Objectives 1. All patients to have a stool chart to a given standard 2. Improve doctors review and reaction to charts Methods Weekly ‘snapshot’ of all ward patients on a geriatric ward in a large teaching hospital. Exclusion: gastrointestinal tract stomas. All patients' computer notes were assessed to determine: presence of stool charts, level of quality, and whether action was required or had taken place. Days to laxative (from admission or last bowel opening)

Delirium is an acute, fluctuating syndrome of encephalopathy causing disturbed consciousness, attention, cognition, and perception. Development of delirium significantly increases morbidity, mortality, length of hospital admission, risk of readmission, and risk of institutionalisation on discharge. National data suggests that delirium affects up to 50% of patients in UK acute hospitals over the age of 65 (NICE 2010). It is well established that the fundamental management of delirium is the identification and treatment of underlying pathophysiological causes. The causes of delirium are varied

Introduction: Delirium is a common and serious complication in frail older patients undergoing emergency hip fracture surgery, often resulting in prolonged hospital stays, increased morbidity, and a greater risk of long-term cognitive decline. Recognizing and managing delirium effectively is critical in improving patient outcomes. However, initial assessments indicated variability in the confidence and capability of surgical postgraduate doctors to assess and manage delirium appropriately. A baseline survey revealed that 50% of staff were not familiar with hospital delirium guidelines, and 62%

Introduction: Parkinson's disease (PD) is associated with an increased risk of osteoporosis and fractures to factors like falls resulting from postural instability, polypharmacy, and muscle weakness. Reduced bone mineral density (BMD), often caused by vitamin D deficiency, disease severity, and low BMI, further elevates fracture risk in PD patients. This project aims to improve awareness and bone health testing in PD patients by focusing on vitamin D, bone profile assessments, DEXA scans, and FRAX scores for fracture risk evaluation and management. Methodology: This QIP involved two cycles

Title: Inpatient falls audit in the Orthogeriatric ward in Princess Royal University Hospital Introduction: Inpatient falls for elderly inpatients are an ongoing concern as they can lead to poorer clinical outcomes including fractures, patients’ distress, and prolonged hospital stay. Effective prevention strategies, such as multifactorial risk assessments (MFRAs), are crucial for enhancing patient safety and care quality. Aim: Determining the extent to which the MFRA is conducted for all inpatients in the orthogeriatric ward pre and post falls Method: Data were collected in retrospective

Background Advanced care planning (ACP) allows patients to discuss their wishes for future care. In London, the Universal Care Plan (UCP) allows ACPs to be shared digitally between healthcare professionals in the community and secondary care. Inpatient admission provides an opportunity for ACP discussions, and documentation via a UCP on discharge. Methods We audited pre-existing UCPs in all patients admitted to an inpatient geriatric ward between May and October 2024. We then conducted 3 PDSA cycles to promote ACP discussions during admission, and documentation via new or updated UCPs. - PDSA

Background: Urine retention is a common reason for catheterization in elderly patients in hospitals. Early focus on regular bowel movements, and bladder or prostate issues can facilitate timely TWOC planning. Inaccurate or incomplete documentation leads to unnecessarily prolonged catheter use, and extended hospital stays. Identified problems were –1: Fragmented documentation across different Portals.2: Dual Documentation Systems- paper and digital 3: Lack of documentation at Admission.4: Delayed TWOC planning. Aims: 1. Standardization of Documentation: Transition to using the NerveCentre

Background: In 2022, the QEUH opened an acute short stay frailty unit. Previous QI projects had shown that the 7-day readmission rate was above the national average. Implementing future care plans was thought to be a way of reducing unnecessary readmissions to hospital. Aim: To ensure that all patients on the acute short stay frailty unit, over a 12 month period, have a Future Care Plan (FCP) discussed and documented on Clinical Portal Methods: Using the PDSA cycle, baseline data was collected from 92 patients admitted to Ward 2A between October and March to determine if change was needed

Introduction- Treatment Escalation Plans (TEPs) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms are vital in hospital care, providing clarity on patient management while considering patient wishes. Though DNACPR decisions ultimately lie with doctors, discussions with patients or relatives foster understanding. Factors such as comorbidities and the Clinical Frailty Scale (CFS) influence these decisions. Proper form completion guides patient care and helps prevent adverse outcomes, but incomplete forms often lead to challenges for medical teams. Objective- This quality

Background: - Falls and associated injuries are a significant area of concern for older adults. Approximately 30% of those aged over 65 and 50% of those aged over 80 experience at least one fall each year. - NICE guidelines state, “Older people who present for medical attention because of a fall, should be offered a multifactorial falls risk assessment”, which includes review of visual impairment. Aims: - To identify if visual impairment was documented on the orthopaedic clerking document for patients admitted following fall. - To raise awareness of visual impairment as being a significant

Category one – clinical effectiveness Category two- Innovation Background The Older Person’s Same Day Emergency Clinic (OSDEC) at Portsmouth Hospitals University NHS Trust is an acute admission unit for older people. Introduction The aim of this quality improvement project was to design and deliver a teaching programme to improve understanding of key OPM topics and the complexity of older patients on OSDEC. This would facilitate rapid holistic assessment and effective communication within the multidisciplinary team (MDT) and with other services, improving patient flow through OSDEC, which

Introduction: It is very often observed in clinical practice that older patients with frailty stay in the A&E for long periods under the Therapy Assisted Discharge Service (TADS) team without an appropriate referral to the medical/Frailty team. There are many potential risks identified such as missed opportunity for early geriatrician/frailty input, incomplete clinical assessment, missed opportunity for CGA, critical medications omitted, missed VTE assessment, and delay in receiving care. Methodology: A retrospective study of 50 patients was conducted through EPR notes at East Kent Hospitals

Introduction: Heart failure (HF) is a pandemic syndrome characterized by raised morbidity and mortality. With the aging population, an acute heart failure event requiring hospitalization is associated with a poor prognosis and demands a longer hospital stay. However, the length of hospital stay and complication will increase if clinical and biochemical parameters are not observed, monitored, and corrected apart from mainstream medications (IV diuretics, ARNIs, BB, MRAs, and SGLT2i). Objectives: Reduction of acute complications (such as AKI, electrolyte imbalance, etc.) related to heart failure

Introduction People with Parkinson's disease are more likely to have osteoporosis and falls. They also have a higher risk of fractures, and their outcomes are poorer than in the general population. Despite this, only half of the patients seen in Parkinson's clinic have a bone health assessment. The aim of this project was to improve bone health assessments in the Parkinson's clinic at Mansfield Community Hospital. Method One plan - do-study-act cycle was completed with the implementation of a Parkinson's fracture risk assessment tool in the clinic. 19 clinic notes were evaluated over an 8-week

Title: Antibiotic Stewardship Audit in Gerontology wards in Princess Royal University Hospital Introduction: Misuse of antibiotics leads to the emergence of antimicrobial resistance, which is an important public health and patient safety issue. Infections caused by resistant organisms are associated with poorer clinical outcomes and undesired side effects. Aim: Assessing compliance with the antimicrobial stewardship package introduced by the UK Department of Health in 2011 and with the trust guidelines. Method: * Spot checks done across all gerontology wards between January and March 2024 to

Title: Evaluation of Frailty Assessment, Management Practices, and Patient Outcomes in GIM Patients Under 85 Years: A Two-Cycle Audit in GIM Wards at Queen Alexandra Hospital, Portsmouth Hospital University NHS trust. Introduction: Frailty significantly affects outcomes like length of stay and readmissions in elderly patients. At Queen Alexandra Hospital, inpatients under 85 are under the care of General Internal Medicine (GIM) wards and they lack regular access to frailty services. This baseline audit evaluated frailty assessment, management practices and patient outcomes, implementing staff