147 ‘CHAMPIONING CONTINENCE’—ESTABLISHMENT OF A MULTIDISCIPLINARY CONTINENCE PROMOTION WORKING GROUP IN AN ACUTE TEACHING HOSPITAL

Background

In line with the National Frailty Programme1, patients over the age of 75 admitted to hospital should have a comprehensive geriatric assessment including the assessment of current continence status and any history of incontinence. Up to 39% of adults are reported to develop new onset urinary incontinence during admission to hospital2,3, however studies show that is it a problem not always identified by staff members,4. In response to these observations within an acute teaching hospital, a continence working party was formed involving members of nursing, physiotherapy and occupational therapy colleagues to explore the current practice and culture relating to continence management.

Methods

The group established key objectives which were broken into four strands;

1. Audit of documentation of baseline continence on admission (therapy and nursing).

2. Obtaining access to additional types of continence wear.

3. Staff education.

4. Pre and post education survey.

Results

1. Audit of documentation demonstrated poor standards of documentation of baseline continence. This led to an amendment to questioning prompts on therapy initial assessment forms and a plan to further evaluate the nursing documentation.

2. A wider array of continence wear has been made available on the wards providing greater options for patients.

3. Staff education session was compiled by a specialist physiotherapist and is widely available for staff to access on the hospitals online training portal.

4. Pre-education surveys have been completed with a view to re-administering following education roll-out.

Conclusion

The aim of this multidisciplinary working group is to equip staff with the correct resources, knowledge, and confidence to ensure best practice promotion of continence on the targeted wards. This project is the first strand of a wider culture changed that is needed around continence promotion for older adults in the acute setting.

146 INTRODUCTION OF A STANDARDISED SCREENING TOOL FOR REFERRAL TO OCCUPATIONAL THERAPY AND PHYSIOTHERAPY ON SPECIALIST GERIATRIC WARDS

Background

The Occupational Therapists (OTs) and Physiotherapists (PTs) on the Specialist Geriatric Wards provide assessment, rehabilitation, and discharge planning for frail older adults. All patients are screened on admission by OT or PT to determine the need for therapy input. This rapid response eliminates delay in accessing therapy input and allows for proactive commencement of intervention and discharge planning without the delay of awaiting a referral.

It was identified that the existing process for screening patients lacked structure and clarity, leading to inefficient use of time and resources with the risk of duplication.

The aim of this local Quality Improvement (QI) initiative was to standardise the process for screening using a triage sticker containing set criteria for referral to OT/PT.

Methods

Following team consultation and review of frailty screening tools, a triage sticker was adapted and modified from the ‘Think Frailty’ tool1. QI methodology and PDSA cycles identified 6 blanket triggers for OT/PT assessment on the ward.

F—Functional impairment.

R—Resident in a care home.

A—Acute/chronic confusion.

I—Immobility/Instability.

L—Living at home with support.

S—Specialist seating or skin integrity issues.

Retrospective review of traditional triage vs the new sicker was performed to evaluate accuracy.

Results

Retrospective analysis found 83% accuracy between the new triage sticker and the traditional triage method. Of the patients who did not meet the criteria for referral, to date none have been subsequently referred during their admission, demonstrating its comprehensiveness as a tool.

Conclusion

Pro-active and early intervention from OT and PT is beneficial for ensuring optimum patient care and efficient discharge planning for frail older adults admitted to hospital. This local QI project demonstrated that standardising the screening process for referral to OT/PT could improve clarity and enable more efficient use of time and resources.

Ototoxicity from cis-platinum in patients with stages III and IV previously untreated squamous cell cancer of the head and neck

Forty-four patients were evaluated for ototoxicity following treatment with the chemotherapeutic agent cis-platinum. Statistically significant hearing changes at 2,000 Hz (p less than 0.001); 4,000 Hz (p less than 0.05); and 8,000 Hz (p less than 0.001) were observed. Chi-square analysis demonstrated that at 8,000 Hz patients who had lower than average thresholds prior to chemotherapy were more likely to experience greater threshold shift than those patients whose pre-chemotherapy thresholds were higher than average. In this patient sample, there was no significant correlation shown between serum creatinine levels and ototoxicity.