INTRODUCTION Postural hypotension (PH) is an identifiable and potentially reversible cause of falls in the elderly patients admitted to hospital. The National Audit of Inpatient Falls recommends lying and standing blood pressure (LSBP) measurement for patients aged over 65. Our project aims to review current clinical practice and to develop a standardised approach to correctly investigate and manage PH in patients admitted following a fall to the geriatric department. METHOD: We performed two cycles of retrospective data collection across three geriatric wards, looking at percentage of
Background: Delirium is a fluctuant clinical syndrome caused by an underlying condition not better explained by a pre-existing neurocognitive disorder. Clinical presentation is characterised by alterations in attention, cognition and consciousness. It is categorised into hyperactivity and hypoactivity based on behaviours displayed. 25% of elderly patients are diagnosed with a delirium on admission to hospital. Delirium is associated with a 70% mortality rate 6 months post discharge. R.A.D.A.R is a 3 part questionnaire recommended by NICE to use as a daily screening tool to aid early diagnosis
Title: A quality improvement project on falls prevention in patients admitted under the surgical team. Modifiable and non-modifiable factors contribute to falls in older people. Our aim was to examine prevalence of risk factors for falls in patients >65 admitted under the surgical team and prevent readmittance through signposting to falls clinic. The first cycle of this QIP involved a review of all sets of charts for patients >65 (n=12) admitted under the surgical team with fall-related injuries between Dec 2022- April 2023. Parameters examined included whether an electrocardiogram (ECG), CT
Background: The development of integrated care occurs alongside climate emergency, where transport is a large contributor to carbon emissions (1). Care previously delivered in hospital outpatients, or a central ‘hub’ is now being delivered in integrated care clinics, “spokes”. We aimed to assess the environmental impact of transport to integrated care clinics. Methods: Geriatric Medicine Integrated Care attendances from January 2023 to March 2023 were included. Distance from the patient’s home address to the location of Integrated Care Clinic(spoke), and to the affiliated hospital(hub) were
Background: Environmental changes make hospitals a difficult place to sleep, especially in busy units such as acute medicine (AMU). Poor sleep can lead to a deterioration in stress responses, slower wound healing, delirium, acute worsening of dementia, along with many other complications. Elderly patients are particularly susceptible to these effects. In turn, these effects lead to longer hospital stays and poorer outcomes. Objectives: Evaluate the factors leading to reduced sleep quality on AMU Put into place effective measures to improve sleep quality Determine if the standardised use of
Background Sarcopenia, defined as age-related loss of muscle function and strength, has a reported prevalence of up to 40.4% in the older adult. Despite its association with frailty, disability and mortality, it is underdiagnosed among hospitalized older patients. Exercise interventions have also been shown to improve fall risk scores for sarcopenic patients. Objective A QI initiative was started by a team comprising doctors and physiotherapists. Our aim was to enhance detection of possible sarcopenia and reduce time to delivery of targeted physiotherapy interventions to 1 working day from
Intravenous diuretics remain the mainstay of treatment for patients admitted with decompensated/acute heart failure. NICE recommends close monitoring of the renal function, body weight and urine output during diuretic therapy as part of the initial pharmacological treatment of acute heart failure. The aim is to ensure a safe and satisfactory response to treatment. We looked at the compliance to serial measurement of Body Weight and Fluid Balance in the geriatric population admitted with Decompensated/Acute Heart Failure to Acute Care Units at Kettering General Hospital. Fifty (50) patients, 65
Title: An audit examining the post-fall management of inpatient falls resulting in neck of femur (NOF) fractures. Background: Inpatient hip fractures are a significant cause of morbidity and mortality in older patients. National audits have identified multiple delays in the care of these patients. Aims To analyse the pathway of patients sustaining an inpatient hip fracture at our trust Method: We examined medical records of patients sustaining inpatient hip fractures from 2020-2021 to collect data on; transfer method from floor, time to medical and geriatrician review, documentation of
Introduction: Aspiration pneumonia is a common condition, particularly in older patients, with impaired swallowing being a significant risk factor; however, it can be difficult to recognise and no specific management guidance existed nationally until the British Thoracic Society Clinical Statement was published in March 2023. In this audit, we assessed the management of patients admitted with aspiration pneumonia to Leighton Hospital, Crewe. Methods: We retrospectively collected data from a random sample of patients ≥64 years old admitted to the Acute Medical Unit with aspiration pneumonia
Catheter-associated urinary tract infections (CAUTIs) represent a large proportion of nosocomial infections. Hence, catheters should be inserted only when indicated and plans should be made to remove them as soon as possible. This will reduce the incidence of CAUTIs, lead to a better patient experience and reduce overall NHS burden. The aim of this audit is to identify whether the catheter care bundle is being filled as per NICE guidance. This is a prospective audit involving 50 patients from the geriatrics ward who were catheterised from November to December 2021. We analysed the
Background Patients aged over 65 years old account for a significant proportion of the attendances to emergency departments (EDs). Cognitive impairment (CI), including delirium and dementia, can be a common finding in this population and when undiagnosed, can be a significant contributor to morbidity and mortality. Our aim is to audit, against clinical standards, the assessment of cognitive impairment in those aged over 65 in the Birmingham City Hospital ED. Standard All patients aged over 65 are assessed for CI in ED, using a validated tool. Whenever CI has been identified, there is
Background Nationally, the average rate of discharges drops by over a third over the weekend and prioritising these discharges is recognised by NHS England in improving patient care and facilitating the flow of patients through the hospital.(1) Aims To assess the documentation of criteria for discharge in Care of the Elderly wards for patients who were identified as having an estimated date of discharge within 72 hours and could be discharged over the weekend.Guidance from NHS England recommends clear plans to be documented in all patients notes detailing social, physiological and functional
Introduction The weekend on-call team attends ward emergencies and front door new assessments. The extra routine ward work results in delay in the new assessments and add further exhaustion for the on-call team, impacting on junior doctor’s well-being and patient safety. Objective Aim to improve patient safety by facilitating the continuity of patient care over the weekend Method Group discussions among junior doctors, nurses, pharmacists, and ward managers were done to understand the challenges that impact communication. The average time spent on a ward by on-call team was 60 minutes. Plan-do
Background: This project was carried out in a district general hospital, it included multiple teams working under the supervision of the same clinical lead, between 2019 and 2021. Introduction Asymptomatic bacteriuria is commonplace among patients above 75 years of age (Manisha Juthani-Mehta MD, Volume 23, Issue 3 , August 2007, Pages 585-594). Local guidelines informed by the Scottish Intercollegiate Guidelines Network on UTI management July 2012, therefore advise the importance of sending urine for culture only in cases, where minimum clinical diagnostic criteria are met. Methodology The
Background: Elderly patients report less positive experience of hospital admission than younger patients 1. Targeted interventions have been shown to improve patient ability to perform activities of daily living and reduce frequency of discharges to long-term care facilities. Additionally, non-pharmacological interventions reduce incidence of delirium and prevent falls 2. We aimed to improve the inpatient experience on a care of the elderly ward through use of a recreation room for mealtimes and recreational activities. Methods: We performed a quality improvement project using patient and
Background: Type II Diabetes Mellitus (T2DM) is a common condition managed by geriatricians. Drugs and treatment goals for T2DM are individualized to patient profile and physician preference. Some diabetic medications are also known to affect appetite and subsequently, nutrition. The authors examined whether there is a correlation between glycemic control and malnutrition in older adults. Methods: This cross-sectional study enrolled patients > 70 with T2DM in a teaching hospital in Singapore. Data was collected on age, sex, ethnicity, body-mass index (BMI), function (iADL-impairment), Barthel
Poster Title: CT head requests – Are they clinically indicated? A QIP conducted in Acute Frailty Unit (AFAU) at Princess Royal University Hospital. Aim: 1. To find out how many inpatient CT heads are being completed for patients reviewed at AFAU. 2. To assess the main indications for requesting a CT head. 3. To assess how many CT heads were not clinically indicated, and to explore if there are any particular reasons why non-indicated scans are being done. 4. To identify areas of improvement in relation to CT head requests. 5. To improve the CT head request practice to 90% in a period 3 months
Background: Older individuals living with frailty face a heightened risk of experiencing significant deterioration in their mental and physical well-being following seemingly minor health challenges. Our aim was to assess and enhance the practice of the Clinical Frailty Scale (CFS) during inpatient assessments within a large teaching hospital. Methods: We conducted 2 cycles of retrospective data collection within a single centre setting, screening a total of 600 patients focussing on; age ≥65, level of frailty, location of CFS assessment - Emergency Department (ED), Medical Assessment Unit
Introduction Older people living with frailty are often prescribed many medications exposing them to potential medicine-related harm. Pharmacists are a new addition to the East Kent Community Frailty Team, which otherwise consists of doctors and advanced clinical practitioners at various levels of training. Pharmacists are ideally placed to develop medication review processes and support fellow clinicians with deprescribing efforts in frailty. This audit set out to determine current levels of medication review and associated cost-savings through deprescribing. Method All patients admitted to
Introduction Factors contributing to frailty result in increased hospitalisations, with 5- 10% of patients attending Accident and Emergency department living with frailty, and 30% of those patients admitted to acute medical units (Conroy, 2013). Hospital admissions result in functional decline and deconditioning (Get It Right First Time, 2021). The number of people in the UK over the age of 85 is set to double in the next 20 years and treble in the next 30 (Office of National Statistics, 2013). Their needs are best met in the community with a multi-disciplinary approach. Method Patients