Introduction Preoperative systemic inflammation has been shown to worsen postoperative outcome in emergency surgical patients. C-reactive protein (mg/L)/Albumin (g/L) ratio is a well validated inflammation marker. Studies have shown an inverse relationship between 25-hydroxyvitamin D level and markers of inflammation. Vitamin D deficiency has been previously shown to be associated with inflammation. Aims and Objectives To determine the relationship between 25-hydroxyvitamin D level and CRP/Albumin ratio in older acute hip fracture patients. To explore the impact of gender on this relationship
Introduction: Functional decline and restricted mobility are common issues among nursing home residents with dementia, resulting in frequent use of physiotherapy services. While these residents can typically articulate their therapy needs and preferences, these have not been investigated properly regarding physiotherapy and exercise, which may compromise therapy adherence. This study aims to explore the needs and preferences of nursing home residents with mild to moderate dementia in relation to physiotherapy and exercise interventions. Methods: Semi-structured individual interviews were
In hospital incontinence increases length of stay (1), in orthopaedic patients is associated with increased likelihood of discharge to an institutionalised setting (2) and can have a major negative impact, with many rating bowel and bladder incontinence as a health state the same or worse than death (3). Yet of the Geriatric Giants, it is given relatively little attention. At a busy teaching hospital, we sought to raise awareness and improve management of incontinence across our 167 beds, by using a standardised, multi-disciplinary approach involving identification of patients and use of the
Introduction We proactively reviewed nursing home residents using a multidisciplinary team (MDT) approach within a Primary Care Network (PCN). We aimed to enhance care coordination, reduce inappropriate medication use and ensure all residents had current advanced care plans in place. Method An MDT comprising a geriatrician, prescribing pharmacist, general practitioner, and nurse reviewed residents proactively. This involved reviewing the residents' current health and care needs, falls risk, medication regimens and advance care plans. We then performed medication reviews, reviewed advanced care
Introduction: Advance care planning (ACP) supports individuals to express their values and goals regarding future care, playing a crucial role in patient-centred approach. The Gold Standard Framework (GSF) recommends offering ACP to those with declining health, functional deterioration, or major health transitions. Prior to this project, Harrogate District Foundation Trust (HDFT) had not evaluated ACP quality for >2 years, relying solely on DNACPR forms and patient notes. This QIP assessed the impact of implementing the nationally recommended ReSPECT documentation on ACP quality. Objective: To
Aim: To achieve compliance in > 90% of patients with the NHS Lothian protocol for 'Management of MSK pain in frail elderly’. Background: NHS Lothian Medicine of the Elderly Department expenditure review showed a 3-fold rise in Lidocaine 5% patch costs the last year. Lack of adherence to the protocol and monitoring of patches prescriptions’ effectiveness felt to contribute. Methods: A doctors’ team with pharmacy support reviewed expenditure report from April 2023 to April 2024. A prescribers’ survey was sent to evaluate current practises, and another one to nursing staff who administer patches
The National Institute for Health and Care Excellence (NICE) guidelines for management of head injuries on anticoagulation were updated in 2023, to maximise detection of clinically important falls whilst minimising unnecessary scans. They recommend computed tomography (CT) imaging to be considered within 8 hours if clinically appropriate [NG232]. [1] The Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) current local inpatient falls protocol recommends that all patients who have fallen with suspected head injury, on anticoagulation but in the absence of neurological changes or other
Introduction National guidance suggests that all patients with neck of femur fractures (NOFF) should be mobilised day one post-operatively ( NICE, 2023, QS16). This reduces rates of delirium, pneumonia and length of stay ( Sallehuddin & Ong, Age and Ageing, 2021, 50, 356-357). Hypotension is a leading cause of immobilisation post-operatively. National guidance advises appropriate fluid resuscitation and review of polypharmacy when indicated ( British Orthopaedic Association, 2007). This quality improvement project aimed to reduce post-operative hypotension and improve day one post-operative
Background: There is limited understanding of the confidence of nurses and allied health care professional management of acute medical problems on rehabilitation wards. Health Education England (HEE) has developed a teaching resource named ‘Bitesized Teaching’, originally developed for mental health staff. We aimed to review ward staff access to teaching and implement a quality improvement project to improve access to teaching in a multidisciplinary team setting. Methods: An questionnaire was administered to staff to understand the frequency of teaching they receive. A ‘bitesize teaching’
INTRODUCTION Death certification is a legal requirement. By law, deaths must be registered within 5 days of receipt of the MCCD by the registrar unless there is to be a coroner’s investigation. Prompt and accurate completion is essential because it enables the death to be registered and provides a permanent legal record of the fact and cause of death. It allows the family to make funeral arrangements and to begin the process of settling the deceased person’s estates. Delays in producing death certificates can cause significant distress to grieving families . This QIP looked at a ward’s speed
INTRODUCTION A treatment escalation plan (TEP) should be established for patients at risk of clinical deterioration, particularly when the risks or benefits of specific therapies are uncertain. This plan should be formulated considering inputs from both the patient and their family (SIGN 167). In hospital-at-home setting, TEP was not routinely completed during admission, leading to unclear anticipatory care plans. However, after emphasizing the importance of TEP, we observed significant improvements that positively impacted patient care. METHODS Over the course of a month, we collected data
Introduction Board round is essential in geriatric care for clinical prioritisation, planning discharges and identifying any barriers to discharge. This process can be limited by poor handover, lack of roles and a defined structure. This project aimed to improve board round efficiency in an inpatient acute frailty setting. Methods The project involved a 2 stage PDSA cycle including data collection at baseline and after each successive intervention. Stage 1: Role allocation and Board round proforma Stage 2: Doctor education Data related to several outcomes was collected retrospectively over 4-5
Introduction Advance care planning (ACP) offers patients the opportunity to plan their future care. There is an increasing role for ACP in the community, where there may be more time and chance to build rapport, than in hospital. We aimed to assess ACP engagement within our “Hospital@home” service. Methods Data was collected for patients referred to @home in December 2023. Those appropriate for ACP had a Clinical Frailty Score (CFS) >=6, or a comorbidity with a poor prognosis. Interventions included interactive seminars, and the creation of lanyards and posters. Senior clinicians also prompted
Background: This improvement activity was done within the Geriatrics/ Stroke department and aims to meet the following adopted standards: all DNACPR forms must be signed by a senior clinician and have clear documentation of the review status, if not “indefinite.’ Local problem: Incomplete DNACPR forms with lack of senior clinicians’ signature and unclear review status, which would affect clinical effectiveness of the document. Methods: To gather baseline and post-intervention measurements, snapshot data was collected eighteen days apart to identify patients with a DNACPR in place that includes
AIM As doctors rotate through the busy stroke unit at Fairfield General Hospital (FGH), there is a chance that some important information may be overlooked while undertaking the daily ward rounds or reviewing a patient on the unit. It is essential that documentation is compliant with the Royal College of Physician’s guidelines for ward round documentations, including the ‘SOAP criteria’ (Subjective, Objective, Assessment and Plan). We designed a ‘Stroke Ward Round Proforma’ to improve efficiency and standardisation of documentation on the stroke ward. METHODS The proforma was developed with
Background: This improvement project was done within the Geriatrics/ Stroke department and aims to meet the following adapted standards: all discharged patients must leave with the original DNACPR document, and clear documentation of their DNACPR and review status in the immediate discharge letter to their Primary care provider. Local problem: Firstly, not all discharged patients leave with the original DNACPR document and secondly, their DNACPR status was not communicated to their Primary care provider which highlights a communication gap which exists between secondary and primary care
Background: Accurate documentation of medication suspension is crucial for patient safety, especially during transitions such as out-of-hours discharges. In early 2023, an audit in our hospital’s elderly care ward revealed a significant number of medications were suspended without proper documentation, raising concerns about continuity of care, medication errors, and patient outcomes. This Quality Improvement Project (QIP) aimed to improve the consistency, clarity, and quality of documentation in the ward to enhance patient safety and reduce risks associated with incomplete information
TITLE: Improving the Practice of Measuring Lying and Standing Blood Pressure Among Nursing Staff at a District General Hospital INTRODUCTION: Postural hypotension is a significant cause of morbidity in the frail and older population, contributing to falls and related injuries. Accurate measurement of lying and standing blood pressure (LSBP) is essential for identifying patients at risk. This quality improvement project (QIP) aimed to address gaps in LSBP measurement practices among nursing staff by aligning them with Royal College of Physicians (RCP) guidelines. The project sought to raise
Local Situation: 2023 audit showed 57% of Parkinson’s disease medications were given within acceptable time frame of thirty minutes of prescribed time. The target for this project is a sustained improvement (demonstrated by a run chart showing improvement over two months) with a minimum of 80% of these medications being given in 30 minute time window. Methods: Effective strategies from other centres and Parkinson’s UK resources were adopted to trail as PSDA interventions in our hospital: visual bedside timing reminder aids, educational sessions for nursing and medical teams, posters to raise
Background Constipation causes morbidity, delays discharge, and is treatable. Aims Reduce constipation to minimise risk of sequelae. Objectives 1. All patients to have a stool chart to a given standard 2. Improve doctors review and reaction to charts Methods Weekly ‘snapshot’ of all ward patients on a geriatric ward in a large teaching hospital. Exclusion: gastrointestinal tract stomas. All patients' computer notes were assessed to determine: presence of stool charts, level of quality, and whether action was required or had taken place. Days to laxative (from admission or last bowel opening)