Patterns of blood transfusion practice over an eight-yearperiod (1977-1984) are described. Use of blood and blood products increased annually as did the number of patients crossmatched and transfused. Programs such as the "Blood Group & Antibody Screen" and the "Maximum Surgical Blood Order Schedule" were important in improving transfusion practices. There was improvment in blood use by all subspecialties; the overall C:T (crossmatched:transfused blood) ratio declined from 4.4 to 2.8, Approximately a quarter of both crossmatches performed and transfusions of red cells were associated with cardiac surgery. Incidence of outdated units of blood declined markedly (2.6 per cent in 1984), as did requests for and administration of single unit transfusions. Seven per cent of patients received one unit of blood during hospitalization; since 85 per cent of these were associated with surgery (57 per cent cardiac surgery), it is suggested that single unit transfusions may sometimes be more appropriate than inappropriate. Two per cent of patients had clinically significant alloantibodies. About two per cent of patients had positive direct antiglobulin tests; nine per cent of the sera of these patients contained both auto and alloantibodies. Such data are important for transfusion quality assurance as well as for optimal logistical use of facilities both at hospital Blood Bank and blood collection agency levels.
Introduction
NICE guideline recommends that all patients with Parkinson’s disease should be reviewed every 6–12 months and offered opportunities to discuss Advanced Care Planning (ACP) (1, 2). There is evidence demonstrating that Advanced Care Plans results in shorter length of stay in the last year of life and lower hospital costs (2, 3). A local baseline audit showed that Advanced Care Planning was not performed adequately.
Methods
A local baseline audit on community care home patients with Parkinsonism was completed in February 2018. A community-based Parkinson’s clinic was commenced in June 2018. Patients with parkinsonism who were unable to attend hospital clinics due to underlying frailty, neuropsychiatry and physical issues, were reviewed. At each visit, advice was provided on medicines management and there were discussions around Advance Care Planning.
A re-audit was completed in August 2019. Patient’s Electronic Patient Records were scrutinised to evaluate progress and identify those who had died. Data was analysed using Microsoft Excel.
Results
The initiative contributed directly to end of life care in 7/17 patients. Parkinson’s disease medications were rationalised in 11/17 (64.70%). 14/17 (82.35%) had a community-based Do Not Resuscitate order completed.
Conclusions
The community Parkinson’s clinic service promoted Advance Care Planning in patients with Parkinsonism. This service provides specialist input in frail older people with Parkinsonism who were unable to attend hospital clinic, promoting end of life choices around where they wished to die and avoiding unnecessary hospitalisation in the final stages of their life.
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