SUMMARY The results of a small scale retrospective study are presented. The study was initiated to determine the incidence of diabetes in long‐stay patients in two psychiatric hospitals in Northern Ireland and to attempt to define whether there was a relationship between the two disease states, schizophrenia and diabetes mellitus. There was a higher percentage of diabetics in the two institutions than was expected. It was concluded that drug therapy of the mental illness may have had a contributory effect on the subsequent development of diabetes mellitus.

There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person’s views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person’s priorities and the clinician’s priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.

SUMMARY Drug information queries were analysed over a representative period of 10 weeks in a 1,300 bed psychiatric hospital. A total of 90 queries were answered; 30 of these related to psychiatric drugs but 60 were concerned with general medical conditions. Half the number of questions came from doctors who, in presenting a diagnosis, were asking for information on the most appropriate therapy available. Queries from nurses formed the bulk of the remainder. The results of the survey disprove the misconception that pharmacy practice in a psychiatric hospital is highly specialized.

Assistive technology devices for computer access can facilitate social reintegration and promote independence for people who have had a stroke. This work describes the exploration of the usefulness and acceptability of a new computer access device called the Nouse™ (Nose-as-mouse). The device uses standard webcam and video recognition algorithms to map the movement of the user's nose to a computer cursor, thereby allowing hands-free computer operation. Ten participants receiving in- or outpatient stroke rehabilitation completed a series of standardized and everyday computer tasks using the Nouse™ and then completed a device usability questionnaire. Task completion rates were high (90%) for computer activities only in the absence of time constraints. Most of the participants were satisfied with ease of use (70%) and liked using the Nouse™ (60%), indicating they could resume most of their usual computer activities apart from word-processing using the device. The findings suggest that hands-free computer access devices like the Nouse™ may be an option for people who experience upper motor impairment caused by stroke and are highly motivated to resume personal computing. More research is necessary to further evaluate the effectiveness of this technology, especially in relation to other computer access assistive technology devices.

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

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Introduction Falls are associated with negative health outcomes such as injury and mortality, as well as increased healthcare usage and costs. Risk factors for falls are multifactorial and include polypharmacy and the use of certain medications (1). Aim To develop and validate a medication-related fall (MRF) screening and scoring tool. Methods The MRF tool was developed from medication classes associated with falling in the Polypharmacy Guidance Realistic Prescribing 2018 (2), and additional medications identified and categorised by specialist and consultant pharmacists and physicians across a region of the United Kingdom. Medication classes were categorised as high-risk (three points), moderate-risk (two points) or low-risk (one point) in their ‘potential to cause falls’. The overall medication-related fall risk for the patient was determined by summing the scores for all medications. The MRF was validated using Delphi consensus methodology, whereby three iterative rounds of online surveys were conducted using SurveyMonkey®. Delphi panel experts were defined as individuals with recognised expertise in geriatric medicine and pharmacotherapy in older people. Twenty-two experts determined their agreement with the falls risk associated with each medication on a 5-point Likert scale with accompanying written feedback. Only medications with at least 75% of respondents agreeing or strongly agreeing were retained in the next round. Following the first validation round, any proposed criteria that did not meet retention requirements were removed. The second and third rounds of the survey were created based on the panel comments from the previous round. Results Consensus was reached for 19 medications/medication classes to be included in the final version of the MRF tool (table) and to reject eight medications/medication classes. Consensus was not reached regarding eight medications and they were not included in the final version of the tool. Conclusion The MRF tool is simple and feasible to use in healthcare settings to evaluate and optimise medications as a standalone screening instrument or as part of a multidisciplinary intervention to reduce fall risk and negative fall-related outcomes. The score from the MRF tool has potential for use as a clinical parameter to evaluate prescribing appropriateness. References (1) Public Health England (2020) Falls: applying All Our Health. Available at https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health Guidance Falls: applying All Our Health. (Accessed: 4th April 2020) (2) Scottish Government Polypharmacy Model of Care Group (2018). Polypharmacy Guidance, Realistic Prescribing. 3rd Edition.

Background University Hospital Hairmyres is a small District General Hospital in Lanarkshire Scotland. We have an active Care of the Elderly Department with a well-established Acute Care of the Elderly (ACE) team of Advanced Nurse Practitioners, supported by Consultants. This team delivers Comprehensive Geriatric Assessment (CGA) to frail older people in acute medical receiving as well as offering liaison to medical, surgical and orthopaedic wards. Local problem and intervention: Our patients were not always being managed by the correct professionals in a timely manner, leading to delays especially in the Emergency Department (ED). We set up a Frailty at the Front Door (FAFD) service to address this, commencing July 2018. Supported by additional consultant sessions, we re-focused the ACE team on assessing and managing frail patients in the ED. The aim was to get the right patient to the right place at the right time and to manage acutely ill people at home where this was safe. Where admission was required we aimed to admit directly to a specialty bed, bypassing acute receiving wards. Methods We routinely collect important data including number of frail patients, %patients receiving CGA within 24 hours, number of discharges. To assess the impact of our change we analysed the data by plotting on run charts and statistical process control charts. In addition we assessed the effect on referrals from medical specialties and the number of direct-to-specialty admissions. Results After the 22 July 2018 we noticed a significant increase in patients screened for frailty, and a significant increase in discharges. We were able to reliably sustain over 95% of frail patients getting CGA within 24 hrs. There was an increased use of hospital at home. There was a reduction in referrals from medical wards (median = 10/week before, 5/week after intervention). Between August 2018 and May 2019 we were able to admit 163 patients directly to specialty beds. There was no change in re-admission rate. Conclusions We successfully changed our service to have consultant delivered Frailty at the Front Door, assessing more frail patients. Most importantly, we have an improved patient pathway, both managing more people at home but also reducing ward moves by achieving direct to specialty admissions. CGA can be safely delivered in the ED.