Posters

Introduction: A Treatment Escalation Plan (TEP) is used to guide the level of appropriate care for patients at risk of deterioration. The aim is to prevent iatrogenic harm by reducing inappropriate investigations and treatments. Benefits of early escalation discussions are well-documented and TEPs are gold standard in the SIGN 167 guideline. Additionally, clarification of care escalation is undeniably beneficial for out-of-hours teams who may unnecessarily investigate and overtreat. The aim of this audit was to 1) identify barriers to TEP decisions on admission to AMU, and 2) increase the

Melatonin biomarkers and delirium in older adults: A systematic review of observational studies Introduction Delirium, a severe clinical syndrome characterised by acute disturbances in attention, awareness and cognition, affects approximately 20–50% of older adults in hospital care. Melatonin, a key regulator of circadian rhythms, has been proposed as a potential biomarker for delirium due to its role in sleep–wake regulation. However, evidence regarding the association between melatonin secretion and delirium remains inconsistent. This systematic review synthesised evidence on the association

Introduction NICE CG103 and SIGN 157 recommend non-pharmacological measures to reduce delirium risk, including visible clocks, day/date orientation, clear signage, and ensuring sensory aids are available and used. This audit assessed compliance with sensory orientation measures on an older adult delirium/dementia ward, then evaluated whether simple ward-based environmental and documentation prompts improved practice. Methods A baseline audit was performed on 14/04/26 on Ward 52, an older adult delirium/dementia ward at Queen Elizabeth University Hospital, Glasgow. Patients aged ≥65 years with

Background: The Clinical Frailty Scale (CFS) is a validated 9-point tool used to assess frailty in older adults, supporting clinical decision-making and care planning. Current guidance recommends CFS assessment at first contact with acute services; however, locally, completion often occurs after review by geriatric teams. This project explored whether a patient/carer-completed CFS questionnaire could facilitate earlier frailty assessment. Aim: To develop a self-completed CFS questionnaire for patients and carers and evaluate its accuracy compared with clinician CFS scores in patients aged over

Introduction: Nepal's older population (aged ≥65 years) represents 6.9% of the national total and is growing rapidly. In remote rural areas such as Lomanthang Rural Municipality (R.M.) in Upper Mustang — an isolated high-altitude community at 3,800 m above sea level — the older prevalence reaches 13.1%, yet health and social support infrastructure remains critically insufficient. No previous study has systematically assessed the care needs of senior citizens in this community. Methods: A cross-sectional descriptive field study was conducted in Lomanthang R.M. between May and September 2025

I ntroduction: Future Care Plans (FCP) enable individuals to express their preferences for future healthcare, promoting person-centred, proactive care and shared decision-making. NHS Greater Glasgow & Clyde recommends that healthcare professionals consider FCP discussions for older people living with one or more long-term conditions who are at increased risk of hospital admission. This quality improvement project aimed to increase FCP completion on Ward 4 and improve documentation of FCPs, Treatment Escalation Plans (TEPs), and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions

Background: Accurate pain assessment is fundamental to effective pain management in older adults. Unrecognised pain is associated with adverse outcomes, including delirium, prolonged hospital stay and reduced quality of life. Although self-report remains the gold standard, some older adults may be unable to reliably report their pain because of cognitive impairment or communication difficulties, making pain more difficult to identify. In these situations, accurate pain assessment depends on healthcare professionals’ knowledge of pain assessment principles and the appropriate use of validated

INTRODUCTION: Older adults living with frailty triaged by the Manchester Triage System (MTS) as low acuity had high admission rates, suggesting under-triage. We tested a Clinical Frailty Scale (CFS)-based modifier to improve MTS accuracy in patients aged ≥65, comparing triage category agreement with clinical outcomes over a three-month period. METHOD: A structured quality improvement approach was used. Baseline data was analysed, triage processes mapped, and a measurement plan developed. The new process was co-designed with Acute Medicine consultants, triage nurses, and consultant

Introduction Signing off investigation results is essential to ensure timely and safe patient care. Missed results contribute to adverse patient outcomes and duplication of work. GGC Healthboard moved to electronic sign off of results in 2021; compliance has been poor. Project Aim: 80% of patients in the older patient's wards will have all results signed off within 48 hours of publication. Method Using PDSA methodology we tested several change ideas over 10 months: Creation of standard operating procedure with clear roles for residents and consultants. Shared via email, SharePoint and posters

Introduction Future care planning (FCP) is indispensable in managing frailty and/or advanced disease, requiring comprehensive discussion of prognosis and treatment options. By articulating what is important to the individual, a personalised future care plan promotes autonomy and dignity. The Recommended Summary Plan for Emergency Care and Treatment (RESPECT) process facilitates FCP and had already been implemented within some areas of our NHS Trust. This quality improvement initiative aimed to promote RESPECT implementation within the hospital at home service to improve FCP for older adults

Introduction Malnutrition in older adults undergoing surgery is associated with increased adverse outcomes, hospitalisation and length of stay.  Preoperative nutrition risk screening is recommended for all patients undergoing intermediate or major surgery. In 2024, a Perioperative care of Older People undergoing Surgery (POPS) service was established in a tertiary centre to deliver comprehensive preoperative assessment and optimisation. In the absence of dietetic funding, a nutrition pathway was implemented to identify patients at risk of malnutrition using the Malnutrition Universal Screening

Background Emergency laparotomy (EmLap) is associated with high post-operative morbidity and mortality, especially in patients living with frailty. Patients who do survive can suffer a significant reduction in levels of independence and quality of life. Decision making and information exchange in this context is therefore critically important. Methods Semi structured interviews with patients and healthcare professionals were undertaken to identify factors recognised as important to the decision making process in the context of EmLap. Non-participatory ethnography at three different acute NHS

Background Emergency laparotomy (EL) is associated with significant patient morbidity and mortality, with potential subsequent reduction in post-operative quality of life and loss of independence. The decision to undergo an EL is therefore important. This project aimed to understand stakeholder perceptions of the decision making process in the context of EL. Methods Semi structured qualitative interviews were undertaken with relevant healthcare professionals, patients who had undergone an EL and family members involved in the decision making process prior to an EL. Interviews took place online

Introduction: We undertook a two-cycle quality improvement project in a district general hospital to improve completion rates for basic post-fall investigations in patients aged 65 years or older admitted to the General Surgery department for conservative management of head injuries or rib fractures sustained due to a fall. This is a vulnerable group of patients with extensive medical comorbidity and often a medical cause for their fall, yet their care takes place outside a geriatric service. Based on British Geriatrics Society and NICE guidance, we implemented pragmatic educational and

Introduction The management of silver trauma ( patients aged ≥ 65 with traumatic injuries or low-energy falls such as a fall from standing < 2 metres causing life- threatening injuries, resulting in ISS > 15) often suffers from delayed recognition, leading to poor pain control, prolonged lengths of stay and functional decline. This QIP aimed to align local emergency department practices with TARN and RCEM guidelines. Our targets were: Initial pain assessment within 15 minutes, Analgesia administration within 30 minutes, Pain reassessment at 30 minutes after analgesia, Silver trauma assessment

Introduction: Timely identification of frailty in the community is essential for implementation of support and strategies to slow progression of frailty, allowing older adults to live safer and more independent lives. Given the diverse MDT within primary, it is important that such members are equipped with the knowledge on how to recognise frailty, and what next steps should be taken to mitigate its course. Delayed recognition of frailty leads to a reduction in access to AHP support and poorer health outcomes. Our aim was to improve MDT-wide awareness and objective documentation of frailty in

Prevalence of Frailty in Heart Failure Patients in 1.1 million sized adult population of Mid & South Essex. Findings support recommending a “Frailty First” approach to managing Heart failure S Zaidi; R Thakkar Background: Heart failure (HF) and frailty have a bidirectional relationship. Although people with HF experience high rates of unplanned hospitalisation, most admissions in those with co-existing frailty are due to non-cardiac causes, including falls, acute kidney injury/electrolyte disturbance and bleeding events, rather than HF itself. These events are frequently related to adverse

Introduction: This quality improvement project aimed to improve falls prevention in elderly patients who presented to the A&E in Mid-Argyll Community Hospital and Integrated Care Centre — a rural hospital in Lochgilphead, Scotland. Falls affect around 30% of adults aged 65 and over and are a leading cause of injury in the elderly. Even patients classified as low risk have a 20–30% chance of a further fall within a year, and international guidelines recommend a proactive, multidisciplinary approach including physiotherapy and occupational therapy input to reduce this risk. A baseline audit of A

Abstract Nicotine has been investigated in prior studies for its analgesic effects and its impact on postoperative nausea and vomiting (PONV), yet results have been inconsistent. Objectives This systematic review and narrative synthesis evaluates the effects of perioperative nicotine administration on postoperative pain control and PONV in patients undergoing general anesthesia. Methods A systematic literature review was conducted, and findings were summarized narratively. Comprehensive searches were performed in PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Google

Introduction Influenza infection poses a significant risk to patients with chronic heart failure (HF), mediating myocardial inflammation, haemodynamic instability, and acute decompensation. NICE guideline NG106 recommends annual influenza vaccination for all adults with HF. Despite this, vaccination uptake in this population remains inconsistently monitored at the primary care network level. This audit assessed compliance with this recommendation across the Watling Street Primary Care Network (PCN) in 2024. Method A retrospective audit of all patients with a coded diagnosis of chronic HF