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From Crisis DNACPR to Proactive Planning: Advance Care Planning for Care Home Residents With Frailty

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Andrew Junior Sunday1, Andrew Haden2
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Background Care home residents with advanced frailty often experience repeated acute transfers near the limits of clinical benefit, yet anticipatory planning may be absent until crisis admission. This audit assessed availability of comprehensive Advance Care Plans (ACPs) before transfer and whether acute admission was associated with reactive resuscitation-focused documentation. Methods A retrospective review was undertaken of 146 acute medical admissions from care homes to Prince Philip Hospital between 1 September 2024 and 30 April 2025. Electronic records were analysed for Clinical Frailty
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Improving the efficiency of board round on an acute medical ward in Cardiff

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Ethan Fage
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Background The project was started as board round discussions were regularly taking over one hour, reducing the time available for ward work and causing team dissatisfaction. The team involved included the doctors on the ward, the senior nursing staff and members of the therapy teams. Methods In October 2025, a questionnaire was completed by team members asking how they felt board round could be improved. Improvements were then gradually implemented with verbal feedback throughout. Formal feedback was requested in January 2026, with a further round of interventions and feedback collected again

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Lightning Learning: Improving Knowledge of Parkinson's Disease in Nurses and Healthcare Assistants on a Frailty Unit

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C Cropper1; K Poluru2; H Parry3
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Introduction: People living with Parkinson's disease are frequently admitted to hospital, with many receiving care on frailty units. Timely medication administration for these patients is essential to reduce morbidity, mortality and length of stay. Current national evidence suggests that this is often not achieved. We therefore sought views from frailty unit staff to understand local barriers and develop a solution. A frequent theme was limited understanding of Parkinson's disease medications and the importance of timely administration. Based on these findings, we developed a 15-minute

An analysis of “Advance care planning” and documentation of frailty for discharged patients from an acute geriatric ward

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Dr Hywel Williams1 Dr Beatrice Carpenter1, Dr Isobel Davies2, Dr Shreya Saji3, Dr Nazreen Unnialukkal 3, Yasmina Amzour3
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Introduction:  Advance care plans (ACPs) powerful tools that outline an individual’s health preferences to aid healthcare professionals when considering treatment options for individuals who are at risk of losing capacity to make decisions. This quality improvement project was conducted to analyse the documentation of frailty, and advance care planning among patients discharged to a care facility from a geriatric ward; with one year follow up on patient outcomes. Method:  We conducted a retrospective study using discharge summaries, for patients discharged to a care facility from a geriatric
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Advance Care Planning in Dialysis Patients:  Is resuscitation always appropriate? 

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C Macey1, S Brooks1, I Dale-Jones1
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Introduction:  Advance Care planning and discussions around resuscitation are important, especially when resuscitation is deemed inappropriate. Dialysis patients have a higher number of co-morbidities and poorer physiological reserve than an average  patient. Therefore, it is important that advance care planning  and  resuscitation  status  is considered and documented appropriately  in these patients. Methods: Haemodialysis patients aged >65 years who regularly attend a dialysis unit in Morriston Hospital were included. Using Vital Data, Medical notes and Welsh Clinical Portal, their Charlson
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Embedding Sarcopenia Screening and Assessment in Routine Geriatric Services at a District General Hospital

Authors' names
D DUNK; K CULLEN; T MUNASINGHE; V PARANJYOTHI; E BOWDEN; S SUMAN
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Introduction Frailty is increasingly prevalent in ageing populations and contributes to rising age‑related conditions such as sarcopenia, which is linked to falls, functional decline and greater healthcare use. Early identification is recommended in EWGSOP2 (2019); SARC‑F offers simple screening, while handgrip strength (HGS) provides objective assessment but is harder to implement routinely. This observational study examined the feasibility of embedding Guideline‑aligned frailty and sarcopenia assessment across inpatient and outpatient services. Methods In March 2022, 70 older inpatients were

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Improving the documentation of the weekly multidisciplinary team (MDT) meeting on a care of the elderly ward

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Jennifer Livie, Gilbert Siame
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I recognised the need for improvement of the weekly MDT discussions on a care of the elderly ward. These meetings focused on ensuring each patient had a comprehensive geriatric assessment completed, and had input from a medical, nursing, physiotherapist(PT), occupational therapist(OT), social worker(SW) and pharmacist perspective. Measures for this project included ensuring a standardised proforma was used to document the MDT discussions. This included ensuring that staff present was recorded, clinical frailty score(CFS), functional status and escalation status for each patient was documented

Improving Documentation in Neck of Femur Fracture Admissions: A Quality Improvement Project redesigning a clerking proforma

Authors' names
Mark Heywood1, Amelia Prosser1, Rosa Shiri Feshki1
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Background: Neck of Femur fractures (NoFs) are associated with significant morbidity, mortality and prolonged hospital admission. These make up a significant portion of the Trauma and Orthopaedic admissions at Weston General Hospital. Optimal management requires multidisciplinary assessment and timely optimisation to meet the national targets for management of fractures. A review of the clerking proforma prior to this audit found variability in the documentation quality and completeness. Aim: To assess baseline documentation quality in NoF admissions and evaluate the impact of a redesigned
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RESPECT? Do we have any for our patients?

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Dr C Goode, Dr T Rezaie
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Introduction It is recognised that CPR should be based on an individual risk-benefit assessment, taking into account the likelihood of success, potential harms, and the patient’s wishes. RESPECT forms have been created to document personalised recommendations for emergency care based on discussions around a patient’s preferences, values, and wishes regarding future treatment and end-of-life care . This project aimed to assess and improve adherence to guidance from the Resuscitation Council UK regarding DNAR decision-making, patient + NOK discussions and documentation of these decisions with

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Improving the Diagnosis and Antimicrobial Management of Suspected Urinary Tract Infection in Older Inpatients

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MA Qureshi¹; M Munir¹; M Shojon¹; Nikita
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Background Urinary tract infection (UTI) is frequently diagnosed in hospitalised older people, although non-specific presentations such as delirium, falls and confusion may occur without localising urinary symptoms. This can lead to unnecessary antibiotic exposure, delayed microbiological sampling and missed opportunities for antimicrobial de-escalation. Local problem An initial audit identified inconsistent assessment of urinary symptoms, delayed culture collection, variable adherence to local antimicrobial guidance and incomplete review of microbiology results. The aim was to improve
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Standardising Multifactorial Falls Assessment in a Consultant-Led Outpatient Falls Clinic: A Closed-Loop Audit

Authors' names
MA QURESHI¹; N HASSAN¹; A AZIZ¹; K SINGH¹ K ADHIKARI
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Introduction Falls are a leading cause of injury, hospital admission and loss of independence among older people. At the start of this project, NICE CG161 recommended comprehensive multifactorial falls assessment for older adults at risk of falls. During the second audit cycle, this guidance was superseded by NICE NG249 (2025). Review of the updated recommendations confirmed that the audit criteria and intervention still aligned with the current guideline. We evaluated documentation of multifactorial falls assessment and the impact of introducing a structured Outpatient Falls Risk Assessment
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Brainomix – A Help or a Hindrance in our developing Stroke Services in South Wales?

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Ceara Rice1, Angela Nelmes2, Ben Bridgewater3
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Introduction In 2024 we conducted a service evaluation of our new stroke AI in Wales, Brainomix. We reviewed its sensitivity and specificity at identifying large vessel occlusions (LVO’s) on CT Angiograms (CTA’s) for our stroke patients. The purpose of Brainomix being to assist in rapid detection of LVO’s and support decision making around proceeding to mechanical thrombectomy for appropriate individuals. Multiple studies in recent years have demonstrated improved functional outcomes for patients receiving mechanical thrombectomy. Brainomix was hoped to be pivotal in bringing these

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Protecting Registrar Training: A Quality Improvement Initiative to Improve Access to Protected SPA and Specialty Clinics

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T Anjum1
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Introduction Supporting Professional Activity (SPA) time and specialty clinic attendance are essential components of higher specialty training. Despite being allocated within work schedules, protected educational time was frequently interrupted by clinical service demands, limiting curriculum progression and trainee development. We aimed to improve reliable access to protected SPA and specialty clinics for Group 1 specialty registrars through low-cost system interventions. MethodA prospective quality improvement project was undertaken in a district general hospital using two Plan–Do–Study–Act

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Evaluating the Safety of Opioid Prescribing in Older Inpatients: A Quality Improvement Project.

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S Ganegoda1; T Kola1; C L T Don1
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Introduction. Opioids are commonly prescribed to older adults but are associated with important adverse effects, including constipation, delirium, sedation, falls, respiratory depression and toxicity, particularly in patients with renal impairment. This quality improvement project assessed the safety and appropriateness of opioid prescribing among older inpatients. Methods. A prospective review was undertaken over four weeks across Newington and McDonald wards at Conquest Hospital, East Sussex Healthcare NHS Trust. Thirty inpatients aged ≥65 years who were prescribed an opioid were included
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Can We Predict Prognosis After Hip Fracture? A Review of GSF Accuracy in Orthogeriatric Patients

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J Morris1; H Alam1; E Lines1, C Rippingale1
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Background: The Gold Standards Framework (GSF) is a nationally recognised tool used to identify patients approaching the end-of-life and facilitate advances care planning (ACP). Accurate GSF assignment can improve ACP, support preferred place of care and death, and reduce unnecessary admissions. Mortality following hip fracture is currently 6% within one month and varies from 12.1%-35.8 % globally at one year, making accurate prognostication particularly important in orthogeriatric populations. We therefore evaluated the accuracy of GSF assignment in patients aged over 60 years admitted with

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Beyond Frailty: The Prognostic Value of comorbidity in Non-invasive Ventilation Outcomes

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Marjorie Jaffet; Valerie Aghoghovbia; James Jegard; Myuran Kaneshamoorthy; Charlotte Whitear; Nursyahira Zulkefli; Telli Ezzati; Nimra Iftikhar; Talent Hwandih
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Introduction: Several studies explored the role of frailty in predicting outcomes in critically ill patients. Frailty has been identified as an independent risk factor for all cause morbidity poor outcomes, including mortality, longer hospital stays and complications Rockwood et al. (2005). Muscedere et al. (2017) found that frailty is associated with worse outcomes in patients receiving mechanical ventilation, however there is limited focus on NIV. While NIV is widely used for managing acute respiratory failure, its effectiveness across varying levels of frailty and comorbidity remains

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Back Pain, Bladder Dysfunction and Lower Limb weakness in Older Adults: Improving Recognition of Cauda Equina Syndrome

Authors' names
R Hurley1; A Jogee2; U Naraine3; I Khuzaima2; M OConnor1.
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Introduction Cauda Equina Syndrome (CES) is a time-critical neurosurgical emergency in which delayed diagnosis may cause irreversible neurological disability. Diagnosis in older adults is challenging because back pain, bladder dysfunction and reduced mobility commonly coexist with age-related comorbidities. This quality improvement initiative evaluated the clinical characteristics of MRI-confirmed CES in older adults and the effect of introducing routine post-void residual (PVR) measurement. Methods A retrospective clinical audit reviewed adults undergoing lumbosacral MRI for suspected CES at
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Functional Recovery Following Revision Total Hip Arthroplasty in Older Adults: A Retrospective Cohort Study

Authors' names
Samuel Jian Rong Lim1, Hamza Toru2, Adeel Akhtar3
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Introduction Revision total hip arthroplasty (rTHA) is increasingly performed in an ageing population, but functional recovery and the need for subsequent revision remain important concerns. This study aimed to evaluate the functional outcomes, re-revision rates and mortality following rTHA in a geriatric population. Methods We retrospectively reviewed 145 revision total hip arthroplasty procedures performed in 138 patients between 2021 and 2025. Patient demographics, indications for revision, re-revision, mortality and postoperative mobility were reviewed. Results A total of 145 revision
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Evaluating Management of Suspected Transient Ischaemic Attacks (TIA) in the Emergency Department

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SA Hay 1; X Huang 2; M Whitehead 2; S Ghosh 2; E Ogg 3; E Mulhern 3
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Introduction Suspected Transient Ischaemic Attack (TIA) is a common and important reason for Emergency Department (ED) presentation in older adults. Local guidance recommends that patients should undergo CT head imaging, be prescribed aspirin and referred to the TIA clinic. However, a suspected TIA can create diagnostic uncertainty, making clinical decision-making challenging. We evaluated adherence to the local referral pathway to guide service improvement opportunities and identify variation in management according to final diagnosis. Method We conducted a retrospective audit of TIA

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Parkinson's Pills - Do our patients "Get it on Time"?

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ZDoak1, ZMuir1
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Introduction: Medication timing is critical for patients with Parkinson's Disease (PD). The 'Get It on Time" campaign strives to have PD patients receive their medications within 30 minutes of prescribed time. Methods: Using PDSA methodology, a list of current inpatients with PD was populated and their medicines reconciliation (med rec) repeated to check accuracy of admission prescriptions. HEMA records were analysed to ascertain how many doses in the last 3-5 days of admission were given >30 minutes late. We also collected qualitative data from patients via an in-person survey, asking how

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