T his article has been written from a pharmacist's perspective, but the principles are applicable to any healthcare professional undertaking a medication consultation. Prior to COVID-19, consultations for older people living with frailty were routinely delivered 'face to face' in a home setting or outpatient clinic. Health and social care professionals moved between locations, guided by local pathways of care. This became the accepted practice for delivery of care, where the benefit of seeing the person face to face far outweighed the risks. The global COVID-19 pandemic has provided us with a unique opportunity to stop and evaluate our methods when delivering care in all settings. There has been a seismic shift, where the immediate risk of acute harm from face-to-face visits for the older or vulnerable patient can greatly outweigh the benefits. This has necessitated creative thinking and the need to re-engineer customary practices, but it has also given us a golden opportunity to evaluate the rationale for our previous practice. We believe that there has been an ingrained bias towards face-to-face consultations as the preferred mode of delivery, causing us to unconsciously dismiss alternative ways to deliver meaningful consultations. Patients and clinicians alike have undergone a revolution in their beliefs when undertaking consultations. Remote consultation-by phone and, increasingly, using video-are the 'new normal' and are providing effective care for the majority of people able to use these services. 1 However, there is a paucity of information about the use of remote consultation for medication review. This is not a 'one size fits all'. People with physical, mental and cognitive challenges, such as older people living with frailty
Postcode of the patients home address; the data showed a spread across the deciles with a mean in the centre of 5th decile with 1st, 2nd and 10th deciles having greatest numbers. Primary diagnosis was malignant in 70% of patients and non-malignant in 30% Religion 62% of patients were documented as having a religion, these were Christianity (57%), Hinduism (1%), Jewish (1%), Sikhism (2%) and others (1%). Ethnicity 68% were White British, 6% were from a BAME background. 26% did not have an ethnicity recorded. Conclusions St Oswald's is providing increased access to nonmalignant conditions including; neurological, respiratory and cardiac conditions. The patient population served appears diverse in relation to socioeconomic status. Some ethnic groups and religions remain underrepresented, this has provided areas to consider for our equality, diversity and inclusion steering group.
Introduction NICE guidance recommends that doctors need to identify patients who are approaching their final year of life, through the utilisation of tools such as the Clinical Frailty Score (CFS). The ‘Getting it right first time’ (GIRFT) document recommended that all local health systems identify older people in the last phase of life and offer them Advanced Care Planning (ACP). Wigan has a large population of frail patients who would benefit from ACP discussions. Aim Initiate a strategy for identifying patients with severe frailty and establish a process for implementing ACP. Method Retrospective discharge data was used to identify patients aged >65 years, with a CFS of >7, over an 8-week period. The cohort was examined to see if they had been recognised as a patient who would benefit from ACP, or if an aspect of ACP had been completed during their admission. In total, 19 patients were identified, of which 6 were included and 13 were excluded. Results Initial data showed that we were poor at identifying and completing ACPs for patients with severe frailty. No advanced care planning decisions (0%) were taken during this period. Education (PDSA cycle 1) on ACPs for the ward doctors led to an improvement regarding ACP discussions. However, we were still poor at identifying severe frailty. Education (PSDA cycle 2) for nursing staff was undertaken, which highlighted inaccuracies with calculating CFS. Further PDSA cycles are to follow, including a geriatric frailty score assessment, introduction of Electronic Palliative Care Coordination Systems (EPACCS) and frailty posters and cards. Conclusion Severe frailty is an end-of-life state and should trigger a healthcare professional to identify and sensitively discuss end of life needs and preferences. ACP should be disseminated to other healthcare professionals to allow them to act in accordance with the patient’s wishes or best interests.
Introduction The Fracture Liaison Service (FLS) is a multidisciplinary service for individuals over 50 presenting with fragility fractures. It is designed to assess future fracture risk, and appropriately diagnose and manage patients with osteoporosis.1 At Wrightington, Wigan and Leigh Teaching Hospitals (WWL), concerns were raised that access to this service was poor, meaning some patients presenting with fragility fractures were not receiving appropriate management to reduce risk of recurrent fracture. This project was designed to increase referrals to the service. Methods A cohort was identified of patients over 50 presenting to WWL with a fractured proximal humerus or distal radius/ulna over a three-month period from January to March 2021. These presentations were reviewed to identify the proportion of these patients who had been appropriately referred to the FLS. Following the initial audit, the FLS referral pathway was reviewed, and discussions were held with multidisciplinary teams (MDTs) in radiology and orthopaedic surgery to highlight the importance of appropriate bone health risk assessment. The number of patients referred each week by radiology were assessed before and after these discussions to assess whether access to the FLS had improved. Results In the initial audit 4.2% of patients with humeral fractures (n=24) and 0% of patients with radial/ulnar fractures (n=29) were appropriately referred to the FLS. Mean weekly referrals from radiology to the FLS significantly increased following the MDT discussions (mean 6.14, SD 4.40 vs mean 22, SD 6.38; t=6.71 p<0.001). Conclusions Pre-existing referral pathways to the FLS were found to be resulting in many patients not receiving appropriate care for their bone health. A simple review of referral pathways, and discussion with MDTs in other departments was found to be a simple way of improving access to the FLS and therefore hopefully reducing risk of fracture recurrence. Reference 1. https://theros.org.uk/media/1eubz33w/ros-clinical-standards-for-fracture-liaison-services-august-2019.pdf [Accessed 18.05.2022].
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