Posters for 2023 Joint BGS and Northern Ireland Frailty Network Meeting

Introduction The patients most often admitted with a hip fracture are older adults, many of whom are frail. The Scottish Hip Fracture Standards recommend that all patients have fluid assessment and are mobilised by the end of day 1 post operatively. We set out to look to see which patients are most at risk of acute kidney injury (AKI) and orthostatic hypotension (OH) post operatively and whether this was linked to the prescription of iv fluids (IVF). Method All online notes of patients admitted with a hip fracture in the months of July and November 2022 were reviewed. Notes were reviewed for

Background Understanding human factors involved in patient care is a focus of the Geriatric Medicine Training curriculum including the leadership of and communication within an interprofessional team. Geriatric Medicine Specialty Trainees (ST4+) need advanced communication skills and confidence in managing complex situations. Simulation-enhanced Interprofessional Education (Sim-IPE) can be used to provide insight into other disciplines roles. We hypothesised that the implementation of a Sim-IPE programme dedicated to communication skills could improve confidence. Method We organised a one-day

Background Time critical intervention delays contribute to increased waiting times, length of stay, worsening morbidity, and mortality for the already frail patient. Evidence suggests some clinicians decide to admit whenever test results are not yet available; mistakenly believing this decreases patient risk. Within one day, this project reduced waiting times for decision makers by upgrading the blood sample processing priority so results are available sooner. Method Our Quality Improvement (QI) team leader spent one shift observing practices in the Emergency Department, noting ED blood

Introduction Rib fractures are very common worldwide, particularly in the elderly due to the increased risk of fragility fractures. They are associated with significant morbidity and mortality, largely due to respiratory complications secondary to pain. For each additional fracture in the elderly, mortality increases by 19% and the risk of pneumonia by 27% . It is therefore crucial that recognition and effective analgesia is done promptly. This quality improvement project aimed to assess demographics and management of patients presenting to the Emergency Department (ED) at Weston General

Background: Pembrolizumab is an immune checkpoint inhibitor licensed for use in patients with melanoma. Melanoma is more common with increasing age, requiring oncologists to quantify suitability for immunotherapy. Currently, patient’s fitness for treatment is determined using the Eastern Cooperative Oncology Group (ECOG) performance status (PS) scale. Recently, the G8 frailty screening tool has been developed to enhance prognostic value in the geriatric oncology population. Methods: Records of all patients treated with pembrolizumab for melanoma in the Northern Ireland Cancer Centre from

Background Clinicians are increasingly aware of the association of frailty syndrome and adverse outcomes. The British Geriatric Society recommends that clinical frailty scores (CFS) are assessed for all patients on admission to surgery, to optimise peri-operative care. Method For in-patients over one month (June 2023), the concordance with guidelines was recorded and any ‘missing’ scores retrospectively completed (Rockwood CFS). Clinical metrics included length of stay. Results 110 patients were admitted under vascular surgery. The median age was 67 (IQ 61-79). 73 (66%) were aged >65-years and

Introduction: Anti-psychotics and benzodiazepines are commonly prescribed for older people. They are usually indicated in the short term for delirium and agitation. There are known risks associated with these drugs in the older population including functional decline, increased falls risk and overall mortality. Moreover, chemical sedation is a form of restraint and deprives patients of their liberty. Sedative prescribing should be protocol driven and preceded by non-pharmacological intervention. However, these prescriptions are often initiated prematurely and evade review, continuing in the

Introduction Advance care planning is a cornerstone of holistic care in patients with dementia. I conducted a quality improvement project (QIP) in Musgrave Park Hospital on the Orthogeriatrics Ward. The QIP focused on advance care planning in patients with moderate to advanced dementia. Method The target cohort was post-operative fracture patients with a formal diagnosis of dementia. Patients with moderate to advanced dementia were identified using the clinical frailty scale. Once a patient was identified, I ascertained whether the patient had capacity. If the patient was not deemed to have

Introduction: Virtual frailty wards, where patients are treated at home who otherwise would be in an acute hospital, are a model of care being promoted within the NHS in the UK, with the aim to ‘provide an alternative to admission and/or early discharge’. The evidence base for this model of care is limited and the ideal set up has not been defined. The aim is to describe the implementation and delivery of a virtual frailty ward serving a rural community. Methods: Creating a 7 day a week frailty virtual ward integrated across primary and secondary care. A multidisciplinary team (MDT) focus was

Background: Patients not yet receiving medication provide insight to drug-naïve early physiology of Parkinson's Disease (PD). Decisions to start medication and assessment of response to its initiation can be challenging for physicians and patients alike. Aim: To identify objective, sensor-derived features of upper limb bradykinesia, postural stability, and gait that can inform decision-making in a movement disorder clinic. Methods: We used a single finger sensor to identify upper limb features and an array of six body-worn sensors to measure postural stability and gait. Patients were tested

Unlike nursing homes, which have a qualified nurse on duty 24 hours, residential homes offer a social care model and are managed by a senior care assistant. This may increase the risk of admission to the emergency department (ED). The 45 bedded residential care home and associated GP medical practice in this pilot reported poorly communicated, inappropriate, and duplicate referrals to the practice, with nearly half of admissions to the emergency department occurring without professional assessment of any kind. The pilot aimed to enable care home staff to improve identification of residents at

Introduction: Intracerebral haemorrhage (ICH) accounts for 10-20% of strokes worldwide. Mortality is high at 40% and survivors might suffer from severe disabilities that massively impact quality of life and independence. Diagnosis and treatment are straight forward. A non-contrast CT head scan is diagnostic. Treatment is focused on prompt anticoagulation reversal and blood pressure control, with consideration of surgery in appropriate cases and admission to an acute stroke unit or an intensive care unit. Methods: Two PDSA cycles of 28 and 29 patients were completed in the acute stroke Unit

Introduction Causeway Hospital’s frailty service consists of an Acute Elder Medicine/Stroke unit of 30 inpatient beds and a Frailty Direct Assessment Unit (DAU) for GP referrals and EmergenIntroductioncy Department (ED) patients suitable for same-day turnaround with comprehensive geriatric assessment (CGA) from our multidisciplinary team. We have devised a new Frailty Model to enhance our service, maximise integration between primary and secondary care services and facilitate more effective short-stay care and early supported discharge. Method To initiate this model, we plan to: 1. Strengthen

Introduction AFU aims to provide Comprehensive Geriatric Assessment to frail, older service users. A key component is Medication Review. Patients living with frailty are more susceptible to medication side-effects and are often on Falls Risk Increasing Drugs (FRIDs 1) and medications with Anticholinergic Burden (ACB 2) effects, which can cause falls/confusion/delirium/hallucinations. Aiming to reduce inappropriate polypharmacy, ACB and FRIDs scores, and optimise bone health is therefore essential. Data highlighted only 17% of patients received Medication Review by a Pharmacist, which needed

Introduction; Patients living with frailty admitted under Emergency Surgery are vulnerable to complications, longer lengths of stay and readmission. Perioperative Care of the Older Person in Surgery (POPS) services are well evidenced and recommended by many national reports. Whilst they are well established in the other home nations, our POPS pilot in Craigavon Area Hospital is the first in N.Ireland. Method; Our POPS Pilot in the Emergency Surgical Unit aimed to identify all patients over 65 living with frailty and deliver high quality comprehensive geriatric assessment (CGA). This consists

Introduction: Faecal-immunochemical test is employed as a screening tool for colorectal cancer. Our observational study examined the FIT in primary care as a risk stratification tool in frail patients. Method: The records of 217 frail patients over a 24-month period were analysed. Patients with haematological indices of anaemia were offered FIT to detect GI haemorrhage as part of assessment for selection for lower GI investigations. Patients were risk stratified based on FIT results based on the presence or absence of red flags. Patients who were FIT positive were referred for urgent lower GI

Introduction: There is a high level of clinical need among residents but little is known about the role of physicians or nurse practitioners (NP) in the nursing home (NH) setting. Our objective was to test for associations between physician and nurse practitioner (NP) presence on care units and outcomes among nursing home (NH) residents. A retrospective cross sectional analysis of secondary data collected in the Translating Research in Elder Care (TREC) study during 2019-20. The sample consisted of 10,888 residents across 320 care units in 92 facilities. Methods: We used TREC Survey data

Rationale: The Frailty Intervention Team (FIT) is a multidisciplinary team that provides a service to community based frail adults. This particular service is novel in the sense that it is a hospital based out-patient service as opposed to a frailty at the front door or a community based service, and has access to rapid diagnostic and intervention services. As this is a novel service a qualitative study was undertaken to assess patient satisfaction and guide the direction and development of future quality improvements initiatives. Objective: To evaluate the satisfaction of service users with

Between 2016 and 2021, HSC Trust reported 1,383 choking-related adverse incidents, highlighting a pressing concern for patient safety. This Quality Improvement (QI) Initiative was developed within a Nursing Home specializing in caring for residents with learning disabilities who faced an elevated risk of eating and drinking difficulties. The primary objective was to enhance safety during meal times by integrating a structured safety pause, aligned with the "7 Rights" framework. The initiative leveraged various QI tools, including process mapping, PDSA (Plan-Do-Study-Act) cycles, structured

Introduction: The use of the ROX index in COVID-19 patients allows evaluating those with a high risk of ventilatory failure, however, it has not been openly validated in patients who use a mask with a Hudson-type reservoir. Materials and Methods: retrospective study of 306 adults infected with SARSCOV2 by antigenic or molecular test. The main objective was to evaluate the role of the ROX index as a predictor of respiratory failure and mortality. In the inferential statistical analysis, the odds ratios OR with their confidence intervals greater than 95% will be used as association measures