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Poster presentations / European Geriatric Medicine 6S1 (2015) S32
–
S156
S39
P-027
The use of a proforma to improve the quality of ward round
documentation in care of the elderly medical wards
M.A. McClintock-Tiongco
1
, C.S.J. Yeung
2
, A. Presland
3
, C. Lisk
4
1
Barnet Hospital, The Royal Free NHS Trust, London, United Kingdom;
2
Barnet General Hospital, London, London, United Kingdom;
3
Barnet
General hospital, London;
4
Barnet hospital, Royal free NHS foundation
Trust, London, United Kingdom
Objective:
Ward rounds are complex clinical activities, critical
to the provision of high-quality, coordinated care. Thorough and
appropriate documentation of ward rounds is essential to facilitate
multidisciplinary team communication and enhance patient safety.
This quality improvement project (QIP) investigated whether the
introduction of a ward round proforma improves documentation
quality on two medical wards, predominantly caring for older
patients, at a busy London district general hospital.
Methods:
A proforma was developed with domains for diagnosis,
observations, examination, assessment, and plan. It also prompts
the attending clinician to review current medication, nutrition,
skin integrity, catheters and lines, and escalation care plans. Ward
round documentation was reviewed before and after introduction
of the proforma for evidence of an assessment of these domains.
The proforma was used daily for six weeks. Three ward rounds
were examined per inpatient. Weekends, and the first 24 hours of
admission, were excluded.
Results:
Data were collated (n = 89 pre-proforma, n = 91 post-
proforma introduction). An improvement in documentation was
demonstrated across 34 of the 36 domains reviewed. Of
particular importance are the improvements in documentation
of an assessment/impression (27% vs. 71%), cardiopulmonary
resuscitation status (4% vs. 78%) and antibiotic use (18% vs. 77%).
Conclusion:
This QIP demonstrates that the use of a proforma
improves the quality of ward round documentation. This is
consistent with guidance issued by the Royal College of Physicians
on medical record keeping. Furthermore, by providing structured
review prompts, it ensures vital areas of the bedside assessment
are not neglected, enhancing patient experience, safety and care.
P-028
Early recognition of cognitive impairment in the ED: a pilot
study
R. McNamara
1
, S. Rovida
1
, S. Darcis
1
, J. Ritson
1
, H. Dunlop
1
1
Imperial College Healthcare Trust, London, United Kingdom
Introduction:
Cognitive Impairment (CI) is present in up to 40% of
older adults who use the services of the Emergency Department
(ED). Despite reports that acute delirium confers the same mortality
rates as acute coronary syndromes, is still missed in up to 80% of
cases by emergency physicians.
Methods:
We performed a prospective, point prevalence study of
CI using a combination ot 4AT and AMT10. All patients over the age
of 16 were eligible for inclusion over a 24 period in the department
with the exception of those who were too ill to be interrogated or
for whom a language barrier made it impossible.
Results:
Of the 147 patients who visited our ED during the 24
hour study period who were eligible for inclusion 62(43%) had a
cognitive assessment. The male/female ratio was 65/82 and the
average age was 56.6 years. Out of the 51 patients who were
assessed with the 4AT, 7 (14%) had cognitive impairment (cutoff
≥1). Of the 11 patients who had a AMT10 done 9(81.8%) had CI
(cutoff
<
8). Overall we found that 16/147 (10.8%) patients had signs
of cognitive impairment in the first screening while only 6/147 (4%)
had known previous dementia.
Conclusion:
We found Cognitive Screening to be a ‘high yield’ step
with 10% of all those screened found to have impairment. Our main
purpose in conducting this study was to raise awareness about the
prevalence of CI within our ED and encourage screening prior to
our next audit cycle.
P-029
Geriatrician input at the Medical Assessment Unit
A. Michael
Russells Hall Hospital, Dudley, United Kingdom
Introduction:
People aged 65 years and older comprise a high
proportion of patients in the Medical Assessment Unit (MAU). They
have multiple comorbidities, complex intricate health and social
needs and are expected to stay in hospital longer than younger
people.
Methods:
Geriatrician input at the MAU was trialed in a UK teaching
hospital. The impact of the service was prospectively audited.
Frail elderly patients or those with multiple co-morbidities were
identified in the MAU by the consultant acute physicians during
the post take round or by the MAU team during the whiteboard
round and referred to Care of Elderly (CoE) team. Elderly care
nurse specialist assessed the referred patients using frailty criteria
to identify the most frail patients for the geriatrician rounds. The
geriatrician reviewed the identified patients, provided advice or
transferred the patient to CoE ward as deemed appropriate.
Results:
In the 5 months trial period, 853 elderly patients were
admitted to CoE wards of which 264 (31%) patients were reviewed
by a geriatrician on MAU before later transfer to CoE wards. Other
patients were sent from the MAU or short stay wards.
Mean age of patients seen by the geriatrician was three years
older than the other group (83.9 vs. 80.6 y) however there was no
significant difference in the mean Length of stay between the 2
groups (20.7 vs. 20.5 d).
Conclusion:
Geriatrician input at MAU provides early specialist care
to the frail elderly with potential positive impact on the length of
stay.
P-030
Provision of ambulatory emergency care for the very elderly
population in Barnet, London, October 2013
–
March 2015
R. Coleman
1
, C. Lisk
2
, J. Munroe-Birt
3
1
Royal Free London NHS Foundation Trust, London, United Kingdom;
2
Barnet hospital, Royal free NHS foundation Trust, London, United
Kingdom;
3
Royal Free London NHS Trust, London, United Kingdom
Objectives:
In the United Kingdom (uk), the number one issue
facing the national health service is the unsustainable rise in
emergency hospital admissions. Ambulatory emergency care (aec)
is an evolving approach in which appropriate adult emergency
patients can be diagnosed, treated and discharged from hospital on
the same day. Data regarding the role of aec in the care of the very
old is sparse. This study reviewed the characteristics of the very old
patients referred to a uk hospital’s aec service from october 2013
to date.
Methods:
Retrospective data analysis of patients aged 90 years
and above seen by aec from october 2013 to march 2015 was
conducted.
Results:
96 patients aged 90–104 (mean age 93) were identified.
5 were centenarians. The majority (81%) were female. Sources
of referral were General Practitioners (35%), medical take (30%)
and emergency department (28%). 47% lived alone; 14% lived
in care homes and 18% lived with family/live-in carer at home.
32% of patients were independent, 35% needed some help in
activities of daily living, 14% needed carers and 3% were fully
dependent. Comorbidities ranged from 0–4 with heart disease
and osteoarthritis commonest. Leg swelling/pain (51%) (of these
6% were diagnosed with a dvt) was the most common referral
reason followed by infections (7%), anemia (6%), rash (4%) and
others (22%).