Posters

Introduction- Treatment Escalation Plans (TEPs) and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms are vital in hospital care, providing clarity on patient management while considering patient wishes. Though DNACPR decisions ultimately lie with doctors, discussions with patients or relatives foster understanding. Factors such as comorbidities and the Clinical Frailty Scale (CFS) influence these decisions. Proper form completion guides patient care and helps prevent adverse outcomes, but incomplete forms often lead to challenges for medical teams. Objective- This quality

Background: - Falls and associated injuries are a significant area of concern for older adults. Approximately 30% of those aged over 65 and 50% of those aged over 80 experience at least one fall each year. - NICE guidelines state, “Older people who present for medical attention because of a fall, should be offered a multifactorial falls risk assessment”, which includes review of visual impairment. Aims: - To identify if visual impairment was documented on the orthopaedic clerking document for patients admitted following fall. - To raise awareness of visual impairment as being a significant

Category one – clinical effectiveness Category two- Innovation Background The Older Person’s Same Day Emergency Clinic (OSDEC) at Portsmouth Hospitals University NHS Trust is an acute admission unit for older people. Introduction The aim of this quality improvement project was to design and deliver a teaching programme to improve understanding of key OPM topics and the complexity of older patients on OSDEC. This would facilitate rapid holistic assessment and effective communication within the multidisciplinary team (MDT) and with other services, improving patient flow through OSDEC, which

Introduction: It is very often observed in clinical practice that older patients with frailty stay in the A&E for long periods under the Therapy Assisted Discharge Service (TADS) team without an appropriate referral to the medical/Frailty team. There are many potential risks identified such as missed opportunity for early geriatrician/frailty input, incomplete clinical assessment, missed opportunity for CGA, critical medications omitted, missed VTE assessment, and delay in receiving care. Methodology: A retrospective study of 50 patients was conducted through EPR notes at East Kent Hospitals

Introduction: Heart failure (HF) is a pandemic syndrome characterized by raised morbidity and mortality. With the aging population, an acute heart failure event requiring hospitalization is associated with a poor prognosis and demands a longer hospital stay. However, the length of hospital stay and complication will increase if clinical and biochemical parameters are not observed, monitored, and corrected apart from mainstream medications (IV diuretics, ARNIs, BB, MRAs, and SGLT2i). Objectives: Reduction of acute complications (such as AKI, electrolyte imbalance, etc.) related to heart failure

Introduction People with Parkinson's disease are more likely to have osteoporosis and falls. They also have a higher risk of fractures, and their outcomes are poorer than in the general population. Despite this, only half of the patients seen in Parkinson's clinic have a bone health assessment. The aim of this project was to improve bone health assessments in the Parkinson's clinic at Mansfield Community Hospital. Method One plan - do-study-act cycle was completed with the implementation of a Parkinson's fracture risk assessment tool in the clinic. 19 clinic notes were evaluated over an 8-week

Title: Antibiotic Stewardship Audit in Gerontology wards in Princess Royal University Hospital Introduction: Misuse of antibiotics leads to the emergence of antimicrobial resistance, which is an important public health and patient safety issue. Infections caused by resistant organisms are associated with poorer clinical outcomes and undesired side effects. Aim: Assessing compliance with the antimicrobial stewardship package introduced by the UK Department of Health in 2011 and with the trust guidelines. Method: * Spot checks done across all gerontology wards between January and March 2024 to

Title: Evaluation of Frailty Assessment, Management Practices, and Patient Outcomes in GIM Patients Under 85 Years: A Two-Cycle Audit in GIM Wards at Queen Alexandra Hospital, Portsmouth Hospital University NHS trust. Introduction: Frailty significantly affects outcomes like length of stay and readmissions in elderly patients. At Queen Alexandra Hospital, inpatients under 85 are under the care of General Internal Medicine (GIM) wards and they lack regular access to frailty services. This baseline audit evaluated frailty assessment, management practices and patient outcomes, implementing staff

Introduction Residents of care homes for older people experience multi-factorial problems when being given oral medication. A systematic integrated mixed-methods review of the literature revealed that practices of modifying tablets, crushing and mixing with food, in attempts to administer medication, remain widespread internationally. There is a high prevalence of swallowing problems. Care home routines are time pressured, and there are incidences of disempowering practices and language associated with processes of medication administration. The literature presented very little from the

Background: Anaemia, defined as insufficient haemoglobin to meet the body’s demands, is common in older adults. It is especially common in frail older adults, affecting over 50% of nursing home residents. In the elderly, anaemia is linked to increased falls, impaired cognition, reduced muscle strength, and poor quality of life. New iron deficiency anaemia (IDA) in those over 60 is a red-flag symptom that warrants urgent investigation for GI malignancy. Methods: This quality-improvement project used the Plan, Do, Study, Act (PDSA) framework in three audit cycles, including care of the elderly

Background Frailty in over 65s is common, but is not often assessed on medical admission at Barnsley Hospital. Identifying frail patients is clinically important, as it can highlight those who may benefit from a Comprehensive Geriatric Assessment –an intervention which has been shown to reduce mortality and improve independence. Introduction At Barnsley Hospital, only 13.49% of patients aged over 65 admitted to the Acute Medical Unit (AMU) were found to have a documented Rockwood Clinical Frailty Score (CFS). This project aimed to increase this to a target of 30%. Methods A survey conducted

Introduction: Opiates are suitable analgesics in acute pain. However, there is no evidence to support their use in chronic pain and NICE discourages its prescription. Opiates are commonly prescribed amongst the elderly, and long-term use is associated with immunosuppression, hyperalgesia, fractures, falls and dependence. Once opiates are prescribed for acute-on-chronic pain, we should discourage long-term use by ensuring they are reviewed and weaned in the community and that patients are counselled on their risks. We aimed to promote effective opiate weaning practices upon patient discharge

Introduction: Orthostatic Hypotension is a significant cause of falls leading to injury and morbidity in elderly population. In an online survey by Royal College of Physicians (RCP) 271 out of 316 clinicians routinely performed these measurements and there were significant variations in how lying and standing BP is performed. This could have adverse effects on detection rates and accuracy of the procedure resulting in misdiagnosis. As a result, RCP has released guidance on L/S BP2 measurements in view of standardising practice and improving accuracy. The purpose of this QIP is to improve how L

Introduction The Older Persons Assessment and Liaison team at North Manchester General Hospital (NMGH) reviews geriatric patients using a Comprehensive Geriatric Assessment (CGA), as directed by the British Geriatric Society. The Anticholinergic Burden (ACB) score is an integral part of the CGA however it is often overlooked. ACB is the cumulative effect of taking one or more drugs used to block Acetylcholine. A greater ACB score increases the risk of developing adverse drug reactions such as; falls and urinary retention. As such, it is integral that we work to reduce patient ACB scores during

Delirium is a neuropsychiatric syndrome characterised by an acute fluctuation in attention and cognition and affects approximately one quarter of older patients admitted to hospital (1) (2). Delirium results in increased length of stay, increased risk of long-term cognitive impairment, increased mortality, and results in significant patient and carer distress (3) (4) (5). Electronic patient records for adults admitted to the Frailty Acute Medical Unit (fAMU) at Huddersfield Royal Infirmary from 2022 to 2024 were reviewed to assess whether delirium was identified, and whether this was discussed

Introduction: Discharge summaries (DS) for older patients can be more complex due to an increasing life-expectancy and multiple co-morbidities. However, this is not always reflected in the quality of DS produced. It is generally agreed that good quality DS should reduce readmission and improve patient care after discharge. Aims: Identify areas of weakness in Discharge summary V4 a on an elderly care ward at Salford Royal Hospital (SRFT) using a pre-established assessment and scoring tool. Secondary aims were to use interventions an educational session, poster (S.M.I.L.E) and acronym expansions

Introduction Hospital-acquired deconditioning (HAD) leads to functional decline, extended hospital stays, increased fall risk, and higher readmission rates, resulting in a significant cost burden on the NHS. Preventing HAD through early and regular physical rehabilitation is crucial for improving patient outcomes and reducing healthcare costs. This Quality improvement project , conducted in a ward, aimed to evaluate and enhance the implementation and effectiveness of physical rehabilitation programs to prevent HAD. Method The project began with administering questionnaires to both staff and

Introduction: Advance care planning is a process that allows individuals to make decisions about their future healthcare, including end-of-life care, by discussing and documenting their preferences, values, and goals with healthcare providers and loved ones.These are especially critical for patients with serious, life-limiting conditions or for frail older adults who may face unexpected health crises.It is a commonly recognised barrier to care planning however that senior doctors often do not have the time to complete it for all patient’s who require them and that junior doctors lack

Introduction Geriatric medicine is inherently complex and requires multidisciplinary integration. Simulation-based training is recognised as a method to enhance learning and improve patient outcomes. This project aimed to develop a multi-professional simulation programme within care of the elderly to mimic the multi-professional practice of geriatrics. Methods Ten half-day simulation sessions were run across two sites over two years. The scenarios cover frailty, orthogeriatrics, acute delirium, Parkinson’s disease, thrombolysis and palliative care. There were 57 participants, including 24

Direct Oral Anticoagulants (DOACs) have revolutionized the management of stroke prevention in non-valvular atrial fibrillation (AF), particularly in patients >65 years old who are at higher risk of thromboembolic events and bleeding complications. DOACs offer efficacy comparable to warfarin with a better safety profile and fewer dietary interactions making them suitable for elderly patients. However, challenges remain in patients with renal impairment, polypharmacy, poor nutrition or elevated bleeding risk. An audit at Derriford Hospital, Plymouth, evaluated DOAC prescriptions for stroke and