Posters for 2025 G4J (Geriatrics 4 Juniors)

Introduction Early identification and multidisciplinary management of frail patients in acute care is a national priority, as reflected in the NHS Long Term Plan1, NHS Improvement (NHSI)2, and Getting It Right First Time (GIRFT)3. Sunderland Royal Hospital’s acute frailty services run daily from 08:00–20:00 across the Emergency Department (ED) and Emergency Admissions Unit (EAU), assessing patients with a clinical frailty score (CFS) ≥5. Morning duties are primarily dedicated to reviewing overnight admissions on EAU, which can lead to a delay in assessment of new patients arriving in ED. As

Introduction Parkinson’s disease increases fracture risk due to higher fall rates and increased osteoporosis prevalence. This two-cycle bone health audit assessed adherence to the BONE-PARK algorithm at Florence Nightingale Community Hospital’s Parkinson’s clinic and evaluated improvements over 12 months. Methods Fifty patient records were reviewed to assess bone health management, focusing on fracture risk assessments (FRAX/QFracture), serum calcium, vitamin D, and follow-up actions, establishing a baseline before intervention. A re-audit of 39 patients after 12 months assessed progress

Introduction This Quality Improvement Project aimed to increase patient engagement and improve documentation of individual care preferences on geriatric wards. The focus was on enhancing communication—particularly for patients with cognitive impairment—to support personalised, patient-centred care. This was achieved by promoting the use of the "Getting To Know Me" (GTKM) form and "What Matters To Me" (WMTM) icon through dedicated staff support and visual aids. Method Activity Coordinators were assigned specific days to assist patients in completing the GTKM form and WMTM icon. Laminated visual

Background: Antibiotic stewardship is critical to combating resistance. Our Quality Improvement Project (QIP) aimed to evaluate and enhance antibiotic prescribing practices across three DME wards by assessing guideline adherence, therapy duration, end date documentation, and concurrent proton pump inhibitor (PPI) use. Older adults are at higher risk of antibiotic associated complications, especially C. diff infection. Methods: Baseline data were collected from the hospital's electronic prescribing system, evaluating prescriptions for indication appropriateness, duration compliance

Introduction Approximately 70,000 hip fractures occur annually in the UK, costing the NHS over £2 billion each year. These injuries carry significant morbidity and up to 30% one-year mortality. One in five patients will sustain another further fragility fracture within five years - most commonly in the first year. Zoledronic acid, a parenteral bisphosphonate, significantly reduces subsequent fracture risk and mortality. Although timely inpatient use is supported by National Osteoporosis Guideline Group (NOGG) guidance and a 2023 British Geriatrics Society Call To Action, uptake remains low

Introduction: Frail older adults with diabetes are particularly vulnerable to harm from tight glycaemic control. Hypoglycaemia can increase the risk of falls, delirium and prolong hospital stay especially in those with frailty. Regional and National guidelines (NICE NG28, JBDS) recommend individualised HbA1c targets based on frailty status, yet in routine inpatient practice this is often overlooked. The aim of this quality improvement project (QIP) was to improve frailty scoring and individualised HbA1c targets in frail diabetic inpatients Method: This quality improvement project was conducted

Introduction  Orthostatic hypotension is a significant risk factor for falls and is associated with increased morbidity and mortality in older adults. The National Institute for Health and Care Excellence (NICE) recommends recording Lying-Standing Blood Pressure (LSBP) for all patients ≥65 years, with the Royal College of Physicians (RCP) advising readings after 1 and 3 minutes. On a geriatrics ward,  LSBP  assessments were frequently delayed, missed , or performed incorrectly. This Quality Improvement Project (QIP) aimed to improve the timeliness and quality of LSBP assessments to enhance

Introduction The cumulative effect of medications with anticholinergic properties is known as anticholinergic burden (ACB). Adverse effects of anticholinergic drugs include increased risk of cognitive impairment, dementia, falls, and mortality among older people. Despite its serious implications for quality of life of older people, deprescribing to reduce anticholinergic burden is not guided by a single standardised guideline. Hence, practice remains variable. The aim of this service evaluation was to assess how effectively deprescribing is undertaken on Healthcare of Older People (HCOP) wards

Introduction Elderly patients are prone to developing delirium, with this risk being heightened by admission to hospital. In Sunderland hospital all patients are screened on admission by the frailty team, but we suspected cases were being missed later in admission. NICE advocates that delirium is screened and appropriately investigated during a patient's admission. To aid detection, RADAR, a bedside delirium screening tool is completed with each set of observations. RADAR is an effective screening tool, with three to four RADAR screenings per day, RADAR has a 73% sensitivity and a 67%

Introduction It is estimated that the prevalence of cervical spine (c-spine) fractures following low impact falls in those over 65 is around 3.4%. These debilitating injuries carry a 12% 3-month mortality rate and a high morbidity rate. The gold standard investigation for suspected c-spine fractures is a c-spine computed tomography (CT). However, c-spine X-rays (XR) are often requested instead. As a department treating over 1000 falls a year, we suspected CT c-spines were being under-requested. Specifically, this QI project (QIP) aimed to ensure the cervical spine is being assessed with the

Introduction Catheter insertion is an invasive procedure associated with significant morbidity, including urinary tract infections (UTIs), prolonged hospital stays and patient discomfort. UTI is the commonest hospital-acquired infection, accounting for 19% of cases. We conducted a clinical audit to assess patients who had a catheter during their hospital stay, focusing on the indications for catheterization and the incidence of UTIs. Based on the findings of the first audit, we introduced guidelines for out-of-hours catheter insertion and inpatient Trial Without Catheter (TWOC) protocols

Introduction As the UK population ages, the demand for effective geriatric care continues to grow. Discussions amongst resident doctors highlighted that they often feel underprepared in managing older adults with frailty and multiple comorbidities. This quality improvement project aimed to improve confidence in managing complex geriatric topics through an online teaching programme, The Comprehensive Geriatric Lecture Series, targeted towards final-year medical students and foundation doctors. Topics covered included Stroke, Mind, Falls, Medications, Frailty, Orthogeriatrics, and Matters Most

Introduction: Hospital admission exposes older adults to harms, including delirium, acute kidney injury (AKI), and mortality. Hospital at Home (HAH) services allow treatment of acute illnesses, such as infection with IV antibiotics in the home setting. Methods: We retrospectively compared patients managed in the community under HAH with those admitted to an acute frailty ward. Over a twelve-month period, we identified older adults with urinary tract infection requiring IV antibiotics. HAH patients received daily IV ceftriaxone, while inpatients were treated according to hospital guidelines and

Introduction: A fast track discharge is considered when someone has a life-limiting illness, and their condition appears to be rapidly deteriorating. The Fast Track Pathway aims to provide patients with access to NHS continuing Healthcare as quickly as possible with minimum delay. Given the nature of the needs, this time period should not usually exceed 48 hours from receipt of the completed Fast Track Pathway Tool. ICBs should ensure that they have commissioned sufficient capacity in the care system to ensure that delays in the delivery of care packages are minimal. If this discharge is

Introduction: A multidisciplinary team (MDT) clinic was introduced at Sunderland Hospital for patients with Parkinson’s disease (PD) in 2019, leading to a reduction in hospital attendance rates. The MDT clinic enables PD patients to consult with a geriatrician, a specialist pharmacist for PD, and a physiotherapist, allowing for an early assessment of mobility and side effects from PD medications. We wished to evaluate and then improve patient experience at the MDT Parkinson’s clinic. Method/ results: We evaluated patient experience by surveying 28 patients who attended the MDT Parkinson’s

Introduction: Direct-acting oral anticoagulants (DOACs) have seen a recent increase in numbers prescribed, due to effective prevention of strokes and embolic events in non-valvular atrial fibrillation. Despite increasing use, expansive dosing criteria and strict monitoring guidelines, inappropriate doses of DOACs are being prescribed in the community. Recent studies predicted that 15%-20% of elderly patients with AF were receiving inappropriate DOAC doses, with most underdosed. Patients are thus at risk of increased bleeding if overdosed or thrombotic events if underdosed. Method: 85 patients

Title: PRN Naloxone Prescription for Patients on Opioids in Gerontology Wards at Orpington Hospital — Quality Improvement Project Team: EN Udoh; F Khan; N Vakilzadehian Introduction: Nearly half of elderly inpatients receive opioids for pain management. Due to co-morbidities and polypharmacy, these patients are at increased risk of opioid toxicity. Naloxone is the established antidote and should be prescribed alongside opioids to manage potential toxicity. Aim: To evaluate adherence to Trust guidelines for Naloxone prescription in gerontology wards. Method: Two spot audits were conducted

Introduction: Older people admitted to psychiatric hospitals are a highly vulnerable population, often with multiple comorbidities and complex medication regimens. National data estimates premature mortality of 10–20-years for people with severe mental illness, largely driven by physical health disparities. In older age psychiatry, this risk is compounded by frailty, dementia and polypharmacy. Basic physical health assessment is a cornerstone of safe, high-quality care. For older patients in psychiatric hospitals, this extends beyond routine monitoring for cardiovascular risk, metabolic side

Background ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) forms are used nationally to record advanced care planning (ACP) and resuscitation decisions. The Community Care Beds (CCBs) in Leeds offer inpatient rehabilitation to older patients including a comprehensive geriatric assessment, ACP and a resuscitation discussion which is recorded on a ReSPECT form. Objective To increase the number of patients in CCB beds who have a ReSPECT form in place. Methods The medical notes of patients in 4 CCBs in Leeds on a single day were reviewed for the presence of a ReSPECT form

Introduction: DNACPR documentation is an important component of clinical practice and guides decision making in the event of a cardiac arrest. A thorough documentation reflects the rationale behind the decision and states whether patient and family are aware and in agreement. Incomplete documentation fails to justify the DNACPR decision and demonstrate effective communication. Objective: To increase compliance with the completion of DNACPR documentation ensuring that each form achieves a high standard of completion – defined as at least 80% of the form being completed. Methods: A Plan-Do-Study