Posters

Advance care plans (ACP) in secondary care: What are the patient outcomes following discharge from hospital with an ACP? Introduction: Treatment escalation plans are discussed in hospital but not always communicated to community care on discharge, leading to avoidable admissions to hospital and hospital deaths which may be not what the patient wants. The project aimed to review what happened to patients discharged from hospital with an ACP over a 12 month period. Method: Older person service (OPS) inpatients were identified for ACP discussions, using Clinical frailty score, presence of life

Background: Frailty and dementia have a bidirectional relationship. However, frailty is rarely reported in clinical trials for dementia and mild cognitive impairment (MCI) which limits assessment of trial applicability. This study aims to use a frailty index (FI) to measure frailty using individual participant data (IPD) from clinical trials for MCI and dementia and to quality the prevalence of frailty and its association with serious adverse events (SAEs) and trial attrition. Methods: We analysed IPD from three dementia (n=1) and MCI (n=2) trials. An FI comprising physical deficits was

Introduction NICE guidelines state that fracture risk assessment should occur in all women aged ≥65 and all men aged ≥75. This includes assessing patients’ FRAX score, measuring serum vitamin D and calcium levels. Early detection and treatment can prevent complications like fragility fractures. We conducted a Quality Improvement Project to improve bone health assessments on Geriatric Wards. Methods A baseline audit assessed: admission reason, falls history, FRAX score, CFS, previous DEXA scans, whether vitamin D and calcium levels were checked during the admission, and if treatment was

Introduction Many people with parkinsonism require care as the disease progresses with much provided unpaid by family and friends. Caring for someone can have a negative impact on physical and psychosocial wellbeing. Caregiver burden can impact ability to continue this role, which can precipitate hospitalisation or institutionalisation of the recipient. Methods In this single-site study, primary, informal caregivers, defined as those providing any care or support, were enrolled alongside the person with parkinsonism or individually. Self-reported questionnaires included the 22-item Zarit

Introduction Advance care planning (ACP) is about what matters to patients, enabling their wishes to be respected, even when they become unable to engage in decision-making. Evidence shows ACP improves end of life care for patients and reduces relatives' bereavement reactions (Detering KM et al. BMJ. 2010; 340:1345). A simulation course for multidisciplinary healthcare professionals, using actors, was developed to improve understanding of ACP, and confidence in having these conversations. In response to the COVID-19 pandemic, the course was adapted to an online format. Method Participants were

Introduction Oral frailty (OF), gradual loss of oral function combined associated with presbyphagia often in conjunction with cognitive and physical decline, has been recommended to be considered as a geriatric giant. DENTAL has been suggested as a possible screening tool for OF. We have looked at the prevalence of OF and its association with dysphagia, frailty and formal care, amongst people admitted acutely to the acute medical/frailty wards in our hospital. Methods OF, dysphagia and frailty were screened for as part of the routine clinical assessment of patients during the usual clinical

Introduction: Patient observations and corresponding National Early Warning Score (NEWS) are valuable components in the identification of patient deterioration. NEWS is particularly important in our older population, whereby presentation of acute illness can be atypical and non-specific. Oxygen saturation and subsequent supplemental oxygen requirement are fundamental components of the NEWS, predicting delirium development, critical care admission and inpatient mortality. Consequently, inaccurate recording has implications for patient safety. Aim: To improve the accuracy of supplemental oxygen

An estimated 500,000 people present to UK hospitals with fragility fractures each year with an annual cost of approximately 4.4 billion pounds. NICE CG146 and NICE QS149 recommend that the risk of fracture be assessed in women over 65 years old and men over 75 years old, and in younger people if certain risk factors are identified. One of these risk factors includes the use of high-dose steroids which is defined by QS149 as the equivalent of 5mg prednisolone per day or greater for 3 months or more. This project aimed to improve the frequency both of fragility fracture risk assessment and bone

Introduction Dehydration is the most common fluid and electrolyte imbalance in older adults; hospitalised older adults with markers of dehydration have mortality rates of 45% (Hodgkinson B et al, 2003). The current method of measuring fluid intake on wards is to record this hourly on fluid balance charts however this is often poorly documented (Jeyapala S et al, 2015). We wished to improve the accuracy of recording the oral fluid intake of older adults by introducing a simplified bedside chart which could identify those at risk of dehydration.
 Methods Using PDSA methodology, a team of doctors

INTRODUCTION Falls have significant morbidity and mortality in Nursing Home (NH) residents. By improving education to NH staff we aim to reduce 999 calls and associated adverse outcomes. . NH residents are more likely to fall than people living in the community and are more at risk of further falls as interventions and risk factor modification is more difficult. METHODS Phase 1 - Ambulance calls, where a vehicle attended the scene, between 01/01/2020-28/02/2022 from NH in Swansea Bay University Health Board (SBUHB) concerning Falls/?Falls (Haemorrhage/lacerations, Unconscious/fainting

Introduction: Vitamin D deficiency remains an important condition affecting our elderly population, with particular relevance to bone health, frailty syndromes and falls risks. We aimed to improve prescribing practices for deficient patients through the implementation of a prescribing tool and order set on our electronic system. Methods: We retrospectively analysed data from patients admitted to two of our wards in July (pre-introduction of the order set) and November 2021 (post-introduction) respectively, paying particular attention to whether their vitamin D levels were measured as an

Introduction “Pathway three delirium” is a short-term placement in a care home specific to North Yorkshire, for patients diagnosed with delirium during hospital admission, who are medically fit but have not recovered cognitively enough for discharge home. The goal is to allow extra time to recover from delirium, to allow return to patients’ own homes. At this placement, patients are followed up by the acute hospital liaison team. Aims To assess final discharge destinations after pathway three delirium placement. To analyse characteristics between discharge groups. Methods We analysed

Introduction The British Geriatrics Society (BGS) Flexible Workforce Statement supports national policy such as the NHS People Plan in promoting less than full time (LTFT) working.1,2 As LTFT trainee representatives on the BGS Trainees' Council we were interested to know how consultant work patterns are advertised. We analysed job adverts for Consultants in Geriatric Medicine over a two-year period to identify how many were LTFT posts. Method A freedom of information (FOI) request was submitted to online recruitment website ‘NHS Jobs’. The request identified jobs in ‘Elderly Care Medicine’ OR

Introduction Inpatient falls are a major cause of avoidable harm in patients on elderly care wards. Delays in identification of fall precipitants and recognition of sustained injuries increases morbidity, mortality and length of stay (Cameron et al, Cochrane Database Syst Rev. 2018 Sep; 2018(9)). Patients sustaining falls are often initially assessed by postgraduate year 1 and 2 doctors independently. We aimed to improve patient outcomes following inpatient falls through standardisation of the assessment and documentation following a fall in hospital. Methods Using PDSA methodology, incident

Introduction Covid has had a devastating effect on the Elderly, resulting in deconditioning, increased falls and loneliness. Tailored exercises can reduce falls in people aged over 65 by 54% and participation in physical activity reduces the risk of hip fractures by 50%, currently costing the NHS £1.7 billion per year in England. This 8 week intervention delivered by trained volunteers in patient’s homes, aims to reduce deconditioning, loneliness and the risk, incidence and fear of falling (FOF) amongst frail patients post-discharge from hospital. Method A gap in service was identified in

Are teams appropriately scanning patients who they know/suspect have sustained a head injury following an inpatient fall? This study examined the appropriateness of neuroimaging requests over 6 months on a geriatric ward at the Freeman Hospital, Newcastle-upon-Tyne. The study also examined whether scans were performed and reports made available within the NICE-stipulated time frames, and also looked at the falls review documentation, and the rationales for neuroimaging (including the role of anticoagulation). DATIX records of all inpatient falls from March-August 2022 were acquired, and the

Introduction Polypharmacy is an increasing concern in medicine which will lead to prescribing errors, serious drug interactions and potentially inappropriate prescribing. Aim To improve recognition of ‘Polypharmacy’, routine medication reviews during patient admissions and better communication and awareness of ‘Polypharmacy’ to General Practitioners (GP). Methods This audit consisted of two cycles both performed over 6 weeks. Inclusion criteria: patients aged 65 and on 6 medications, admitted to Elderly Care ward at Chelsea and Westminster hospital. Interventions after the first cycle

Introduction: The ageing population poses challenges to the health care industry worldwide. The huge demand for residential care home for the elderly (RCHE) services induces pressure on health care workers (HCWs) recruitment and retention. HCWs are personnel who have prominent roles in direct basic care to the older adults, and all kinds of hands-on care. Due to the “unpleasant” work nature, shift work, and physical demands for HCWs, it is essential to unfold how HCWs comprehend their working experiences. Methods: An integrative review was conducted to synthesize various streams of literature

Working in a small district general hospital in Llanelli, West Wales, a weekly hybrid multi-disciplinary team (MDT) meeting is held on the stroke and care of the elderly unit. There are 3 separate geriatric teams covering the ward. Typically, these meetings are attended by physiotherapists, occupational therapists, speech and language therapists, discharge nurses, social workers, nurses and a doctor. The main agenda is to discuss the patients’ current medical issues, rehabilitation needs and likely discharge destination/complexities. Medically, these meetings were attended by a single doctor

Background: Delirium is a common clinical condition associated with increased morbidity and mortality, and prolonged hospital stay. Early detection is vital to improving management of the condition and improving outcomes. Our aims: improve delirium detection using the 4AT screening tool as a validated approach, Improve delirium management across multiple domains using the PINCH ME approach; documented attempt at collateral history within 24 hours of recognition of delirium; obtain serological confusion screen in patients with recognised delirium. (100% each) Methodology: Plan Do Study Act