Effects of the Liaison Nurse Management on the Infectious Stroke Complications: A Randomized Controlled Trial

Background Two of the most serious complications after stroke are pneumonia, and urinary tract infection. Liaison nurse, from hospital admission to discharge and then at home helps patients with complicated caring issues stroke. This study investigates the effect of liaison nurse management on the incidence of pneumonia and urinary tract infection in patients with stroke after discharge from the hospital. Methods This randomized controlled trial was conducted on 80 patients in a hospital in Iran. The intervention group was assessed and developed a caring program by the liaison nurse and the control group received routine care. Two weeks and two months after discharge, the patients were evaluated for the incidence of pneumonia and urinary tract infection. Collected data were analyzed using the Chi-square test. P < 0.05 was considered statistically significant. Results The two groups were homogenous in terms of mean age; gender frequently distribution, and having urinary catheter. The incidence of pneumonia in intervention and control groups (11.6% vs. 19.2%, P = 0.35) had no statistically significant differences, but there was a significant difference in the incidence of urinary tract infection (0% vs. 24.6%, P < 0.001). Conclusions With liaison nurse performance, there was a significant difference in the incidence of urinary tract infection, in two months after discharge from hospital, but the incidence of pneumonia had no statistically significant differences in two groups. Nurse's evaluation each patient individually according to needs, developing and monitoring the home-based care program, beyond overall education to these patients, could reduce some of complications of a stroke. Trial registration: This study is retrospectively registered by Iranian Registry of Clinical Trials with decree code: IRCT20170605034330N3 on April 4, 2018.

P55 Immunosuppression in the first six weeks following paediatric cardiac transplant

AimThe aim of this audit was to establish whether immunosuppression was being prescribed correctly and whether target levels were being reached during the first six weeks post-transplant.1 2MethodThe standards were discussed and agreed, due to an absence of standardised local or national written protocols, with the lead paediatric cardiothoracic transplant consultant and a specialist transplant liaison nurse. The paediatric transplant database provided a list of patients between October 2016 and July 2018, from which paediatric cardiac transplant patients were included in this audit. All data were collected retrospectively, for the first six weeks post-transplant, from patient’s electronic records.ResultsTwenty-three patients were included in the audit; fifteen males and eight females and the mean age was 6 years old. The standards for the timing and dosing of the first ciclosporin dose were met for 87% and 78% of patients respectively. Six patients (26%) had a ciclosporin level within the target range by day 4 post-transplant, for the remaining seventeen patients the average was day 9 post-transplant. The mean levels remained within this range or slightly above after day 9. Azathioprine or mycophenolate was started within 7 days of transplant in 6 patients (23%). Four patients (17%) had documented episodes of rejection; in one patient all other standards were met and in the other three only one additional standard was not met. Nineteen patients (83%) did not have a documented episode of rejection.ConclusionsPost-transplant management is individualised based on multiple factors such as clinical conditions e.g. renal/liver impairment and whether other agents such as ATG or steroids are being used.1 The lack of documentation around the treatment decisions made it difficult to explain deviations from standards in this audit. Ciclosporin standards were not met completely but were most likely unfeasible due to a narrow target range and the time between first dose and level monitoring. There did not appear to be a clear association between standards not being met and episodes of rejection. It would be beneficial to repeat this as a larger, prospective audit using revised standards.ReferencesCostanzo MR, Costanzo MR, Dipchand A, et al. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010;29:914–56.Sandimmun Concentrate for Solution for Infusion 50 mg/ml - Summary of Product Characteristics (SmPC) - (eMC) [Internet]. [cited 2018 Sep 2]. Available from: https://www.medicines.org.uk/emc/product/1036

39 Care Home Liaison Role- Bridging the Gap Between Acute Hospitals and Care Homes

Introduction There are over 400,000 people over 65 in UK care homes, three times the number than that in acute hospitals. They are amongst the frailest in our community, with average life expectancy of 15months once in the home. Their needs are often complex and challenging, which when unmet, often result in unwanted and unnecessary hospital admissions. Imperial College Healthcare Trust (ICHT), along with funding from Health Education England (HEE), have introduced a care home liaison nurse. The aim is to bridge the boundaries, making a significant difference to cross organisation communication and support. Methods The care home liaison nurse manages a frailty liaison service with the largest local nursing care home. This home has 140 residents with complex needs. The care home liaison nurse provides a point of contact for advice, guidance and support for individual patient pathways, she provides face to face assessment and treatment or verbal advice. In addition, the nurse supports discharge from the acute setting. This direct contact allows rapid access to specialist advice, and aims to build confidence both within the care home team and within the acute team, that the patients’ needs can be met in their own surroundings. Results The preliminary data demonstrates a positive impact this role is having both to the acute trust and most importantly patient’s experience. Comparing ICHT data from April-May 2018 to April-May 2019 it showing that the number of avoidable admissions has decreased from 54.3% to 37.5%, length of stay when patients are admitted has decreased from 11.7 days to 6.5 days, and the number of patients with an advanced care plan has risen 14.9%. Feedback from nursing staff at the care centre as well as that from patients and families has been overwhelmingly positive. Conclusions The role is still in the pilot phase. Given the already positive impact it is hoped that it will continue and expand into other care homes and extra sheltered accommodations.