Introduction Type 2 diabetes mellitus (T2D) is associated with poor health outcomes and tight glycaemic targets are questionable in those aged over 70 years. We examined whether people with T2D admitted to emergency department (ED) with a fall, were more likely to have greater frailty, co-morbidity burden, or risk factors for falls and whether use of insulin or gliclazide was associated with poor clinical outcomes. Methods The Older Persons Assessment Service (OPAS) is a local emergency department service which accepts patients on frailty criteria. The OPAS databank was retrospectively analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS). Results 1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (±15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0±2.2 vs 5.9±2.1, p<0.001). Of those people with T2D, 175 (59.5%) and 240 (81.6%) had a HbA1c ≤53 mmol/mol [7.0%] and ≤64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the emergency department. People with T2D treated with insulin and/or gliclazide had a greater mortality (36.6% vs 23.6%, p<0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p<0.001), and greater HbA1c (65.5±17.2 mmol/mol [8.2] vs 48.9±12.1 mmol/mol [6.6%]) compared to those who used other agents. People with T2D were not more likely to live in deprived areas. Conclusion Falls are a significant burden, and hypoglycaemia-inducing medication may contribute to the greater mortality observed in people with T2D. Clinician awareness can support de-prescribing for patients with frailty and HbA1c <64mmol/mol. There should be increased awareness of the impact of hypoglycaemia, especially in those using insulin or gliclizade.
The service saw 437 patients between April and August 2018. 76% of the patients assessed were discharged by utilising available community services, rapid access outpatient follow-up and inpatient re-ablement off the acute site. The service was estimated to avoid 50-80 admissions per month to medicine (Fig 1 ; Table 1), saving 17-23 beds a year, and was commissioned as a permanent service.
IntroductionOn HEPMA there is no way to notify a prescriber if patients are regularly accessing PRN (as-required) analgesia. We aimed to assess how well PRN analgesia use is identified, the WHO analgesic ladder and whether laxatives were prescribed with opioid analgesia.Methods3 data collection cycles were carried out for all medical inpatients between February-April 2022. Medication was reviewed to determine: 1) PRN analgesia prescribed? 2) Is the patient accessing it >3 times in 24hours? 3) Con-current laxatives prescribed. Between each cycle, an intervention was implemented. Intervention 1: Posters were placed on each ward and circulated electronically as a cue to a review and change analgesia “Prescribe. Review. Now!” Intervention 2: A presentation on data, the WHO analgesic ladder and laxative prescribing was created, and circulated.ResultsSee Figure 1 – Comparison of prescribing per cycle. Cycle 1 - 167 inpatients surveyed, 58%female, 42%male, mean age 78(±13.4). Cycle 2 - 159 inpatients,65% female, 35% male, mean age of 77 (±15.7). Cycle 3 - 157 inpatients, 62% female, 38% male, mean age 78 (±15.7). Adequate prescriptions on HEPMA improved by a total of 31% (p<0.005), over 3 cycles and 2 interventions.ConclusionsAfter each intervention there was a significant statistical improvement in prescribing analgesia and laxatives. However, there is still room for further improvement, especially in ensuring adequate laxative cover is prescribed for all patients either >65 years old, or those on opioid-based analgesia. Visual reminders on wards of regularly checking PRN medication showed to be an effective intervention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.