scholarly journals 142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
F Roberts ◽  
K Birmingham ◽  
L Darlison ◽  
K Hertzberg ◽  
K Chapman ◽  
...  
Keyword(s):  
Older Adults ◽  
Quality Improvement ◽  
Older Adult ◽  
Functional Outcomes ◽  
Stakeholder Involvement ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Discharge Plan ◽  
Medical Clearance ◽  
Elderly Mobility

Abstract Purpose To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards. Methods The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list. Results The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting. Conclusions The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.

scholarly journals An Interdisciplinary Academic Detailing Approach to Decrease Inappropriate Medication Prescribing by Physician Residents for Older Veterans Treated in the Emergency Department

2017 ◽  
Vol 32 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Jason M. Moss ◽  
William E. Bryan ◽  
Loren M. Wilkerson ◽  
Heather A. King ◽  
George L. Jackson ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Quality Improvement ◽  
Older Adult ◽  
Quality Improvement Project ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Academic Detailing ◽  
Improvement Project ◽  
The Impact

Objective: To evaluate the impact of an academic detailing intervention delivered as part of a quality improvement project by a physician–pharmacist pair on (1) self-reported confidence in prescribing for older adults and (2) rates of potentially inappropriate medications (PIMs) prescribed to older adults by physician residents in a Veteran Affairs emergency department (ED). Methods: This quality improvement project at a single site utilized a questionnaire that assessed knowledge of Beers Criteria, self-perceived barriers to appropriate prescribing in older adults, and self-rated confidence in ability to prescribe in older adults which was administered to physician residents before and after academic detailing delivered during their emergency medicine rotation. PIM rates in the resident cohort who received the academic detailing were compared to residents who did not receive the intervention. Results: Sixty-three residents received the intervention between February 2013 and December 2014. At baseline, approximately 50% of the residents surveyed reported never hearing about nor using the Beers Criteria. A significantly greater proportion of residents agreed or strongly agreed in their abilities to identify drug–disease interactions and to prescribe the appropriate medication for the older adult after receiving the intervention. The resident cohort who received the educational intervention was less likely to prescribe a PIM when compared to the untrained resident cohort with a rate ratio of 0.73 ( P < .0001). Conclusion: Academic detailing led by a physician–pharmacist pair resulted in improved confidence in physician residents’ ability to prescribe safely in an older adult ED population and was associated with a statistically significant decrease in PIM rates.

scholarly journals Implementation of a multicomponent intervention sign to reduce delirium in orthopaedic inpatients (MIND-ORIENT): a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001186
Author(s):  
Christina Reppas-Rindlisbacher ◽  
Shailee Siddhpuria ◽  
Eric Kai-Chung Wong ◽  
Justin Yusen Lee ◽  
Christopher Gabor ◽  
...  
Keyword(s):  
Older Adults ◽  
Quality Improvement ◽  
Clinical Care ◽  
Assessment Method ◽  
Quality Improvement Project ◽  
Evidence Based ◽  
Pharmacological Interventions ◽  
Improvement Project ◽  
Absolute Increase ◽  
Delirium Prevention

Delirium is a serious and common condition that leads to significant adverse health outcomes for hospitalised older adults. It occurs in 30%–55% of patients with hip fractures and is one of the most common postoperative complications in older adults undergoing orthopaedic surgery. Multicomponent, non-pharmacological interventions can reduce delirium incidence by up to 30% but are often challenging to implement as part of routine care. We identified a gap in the delivery of non-pharmacological interventions on an orthopaedic unit. This project aimed to implement a bedside sign on an orthopaedic unit to reduce the occurrence of delirium by prompting staff to use multicomponent evidence-based delirium prevention strategies for at-risk older adults. Quality improvement methods were used to integrate and optimise the use of a bedside ‘delirium prevention’ sign on an orthopaedic unit.The sign was implemented in four target rooms and sign completion rates increased from 47% to 83% (95% CI 71.7% to 94.9%; p<0.001) over a 10-month period. The sign did not have a significant impact on delirium prevalence. The mean Confusion Assessment Method (CAM)+ rate during the baseline period was 8% with an absolute increase in the intervention period to 11.4% (95% CI 7.2% to 15.8%; p=0.31). There were no significant shifts or trends in the run chart for the proportion of patients with CAM+ scores over time. The sign was well received by staff, who reported it was a worthwhile use of time and prompted use of non-pharmacological interventions. This quality improvement project successfully integrated a novel, low-cost, feasible and evidence-based approach into routine clinical care to support staff to deliver non-pharmacological interventions. Given the increased pressures on front-line staff in hospital, tools that reduce cognitive load at the bedside are important to consider when caring for a vulnerable older adult patient population.

scholarly journals 23 Earlier Therapy Intervention in the Emergency Department to Improve Clinical Outcomes for Fallers Aged 65 and Over

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
F Roberts
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Quality Improvement ◽  
Clinical Outcomes ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Positive Effects ◽  
Visual Presence ◽  
Therapy Intervention ◽  
Therapy Team

Abstract Purpose To improve clinical outcomes for fallers aged 65 and over presenting to the emergency department through earlier therapy intervention and multidisciplinary focussed assessments. The intended benefits to the older person and service were for:Older adult fallers to be referred more quickly for a therapy assessment.Older adults to spend less time immobile on an emergency department trolley.Timely multidisciplinary discharge plans being formulated in line with national guidelines.Increased numbers of older adults receiving holistic comprehensive geriatric assessments. Methods The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver simple, proactive interventions developed as a result of local baseline data analysis as well as stakeholder and root cause analysis. These interventions were all aimed at increasing the visual presence of the therapy team within the emergency department. Results The project resulted in an increased referral speed of fallers aged 65 and over for assessment, which led to increased numbers of older adult fallers receiving holistic, multidisciplinary assessments. 120% more adult fallers were seen in January 2019 compared to the previous year, and 58% more fallers were seen in February 2019 compared to 2018. The earlier intervention by the therapy team also led to more older adults up and moving sooner, which had positive effects in terms of maintaining their dignity. Conclusions The quality improvement project found that more older adults aged 65 and over admitted to the emergency department with a fall can receive holistic, multidisciplinary assessments through the introduction of small, simple interventions aimed at increasing the proactivity and overall visual presence of the physiotherapy team. The team are providing care to a larger number of older adults, improving their functional independence, dignity and quality of life and giving them an overall more positive experience. The ED model of care is traditionally nursing and medical led but what this improvement project shows it that it is essentially the collaborative nature of the multidisciplinary team that can lead to better clinical outcomes for older adults attending the emergency department.

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