Non-consultant Hospital Doctors Research Articles

Impact of telehealth implementation on medical non-consultant hospital doctors training experience

Telehealth is defined as the provision of health care services over a distance. Major health systems, including outpatient clinics and check-ups alike, turned to telehealth and teleconsultation amid the COVID19 pandemic. There are many recognized advantages of telehealth and its increasing implementation, however, not much is known about the specific impact of remote consultation on the quality of non-consultant hospital doctors (NCHD) training experiences in medicine. This study aimed to gain rich descriptive insights into the specific impact of remote consultation on the quality of medical NCHD training experiences and their perceptions, through purposeful sampling. Data was collected via semi-structured virtual interviews of fifteen NCHD participants. The interviews were recorded, transcribed and analysed using thematic analysis. The collective transcripts were analysed using NVIVO data software for common themes. The themes identified suggested that there were both advantages and disadvantages to telehealth and its impact on training across a spectrum of entities including; doctor-patient relationships, peer relationships, service provision, work morale, working hours, clinical skills experience and general feedback as a trainee. NCHD perspectives expressed were mixed across all themes. Further research is recommended to advance understanding of the potential impact of telehealth on current and prospective doctors in training. With a greater understanding of general insights, future changes, including telehealth training programmes, could be implemented to build confidence and familiarity with telehealth utilization and potentiate its conceivable benefits.

Creating a Guidance Template for NCHDs to Evaluate Cognition in Geriatric Medicine Clinics

Abstract Background Non-Consultant hospital doctors (NCHDs), when rotating through geriatric medicine, often take a comprehensive cognitive history for the first time. Graduate clinical exams often overlook this complex assessment, and knowledge of cognitive disorders amongst NCHDs is often limited. We aimed to create a template to guide NCHDs in taking this history, including investigations and management options. Methods We developed a 9-question survey, administered to a sample of representative NCHDs and specialist nurses who have rotated through our department, to gauge their confidence in assessing cognition. We examined their understanding of cognitive assessments and if a template would be useful. With consultants, we subsequently drafted an agreed guidance template for use at clinics. Results We included 35 respondents who rotated through geriatric medicine clinics this year; 8 registrars, 18 SHOs, 5 interns, 1 ANP. 10(31.25%) felt very confident completing a cognitive history, 17(53.13%) felt just somewhat confident and 5(15.65%) did not feel confident. Regarding investigating a new cognitive impairment (CI) n=10 (31.25%) felt very confident, 12(37.5%) felt somewhat confident and 10(31.25%) did not feel confident. Management of CI - 12(37.5%) felt very confident, 11(34.38%) felt somewhat confident and n=9 (28.13%) did not feel confident. MMSE, MOCA, clock drawing test, Addenbrooks and RUDAS were listed as cognitive assessments. Regarding investigations, CT/MRI Brain were mentioned in all but just n=12 mentioned a PET scan. Services listed included Occupational Therapy (20), Social Work (6), Dublin Alzheimer’s Society (6), psychology (6). Almost all 96.87% (31) felt a guide would be helpful and 100% of participants said that they would use it. Conclusion We identified gaps in confidence and knowledge amongst NCHDs regarding assessment of cognition. Consequently, we designed a guidance template to ensure rotating junior staff are more confident and informed during cognitive assessments at clinics in our department.

DNAR: All or Nothing: Impact of Education Sessions Re-Audit in a Model 3 Hospital

Abstract Background Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national HSE guidelines after education sessions, comparing results with the pre-education audit in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both of which were unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. This elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. Therefore, we posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.

Enhancing Discharge Letter Completeness: Consultant Review via Encrypted Medical App

Abstract Background Ensuring comprehensive discharge letters is crucial for safe transitions from acute hospitals to community care. The 2013 National Standard for Patient Discharge Summary Information of the Health Information and Quality Authority (HIQA) 2013 outlines what items of information ought to be included in discharge summaries. On the wards, junior doctors often complete discharge documentation without consultant review. With technological advancements, tools like encrypted chat apps for medical care offer potential solution to improve communication and access to specialized reviews. We aimed to evaluate whether a specific app to access Consultant review could enhance discharge letter completeness. Methods We conducted a retrospective audit of discharge letters for inpatients admitted and discharged under a geriatric team between September 1st and December 23rd, 2023. The letters were divided in two groups: intervention, reviewed by a medical consultant, and control, including letters only signed off by non-consultant hospital doctors. Data access and approval were obtained from the hospital's Clinical Audit Committee; data collection utilized hospital information systems and Excel database, with minimal demographic data collected. SPSS facilitated data analysis. Each discharge letter was assessed for various items outlined in the HIQA guideline. The prevalence of inclusion of each item in each group was compared using non-paired Student t-test. Results We analysed 89 discharge letters, with 34 (38.2%) in the intervention group and 55 (61.7%) in the control group. Although most items showed no statistically significant difference between groups, the inclusion of investigation results significantly differed (91% in the intervention group versus 23% in the control group). Conclusion Our audit observed improved completeness of inclusion of investigation results in the intervention group. Future research should involve a larger sample from various teams to assess whether access to senior letter review via an encrypted app can consistently enhance discharge letter completeness.

2320 DNAR: all or nothing: impact of education sessions Re-audit

Abstract Introduction Do Not Attempt Resuscitation (DNAR) orders are implemented to obviate inappropriate Cardio-Pulmonary Resuscitation (CPR) in patients with low chances of survival post-CPR. However, ambiguity regarding ceilings of care for patients with a DNAR order can arise. This re-audit aimed to review DNAR and ceilings of care documentation according to national Irish Health Service Executive (HSE) guidelines after education sessions in a Model 3 Hospital. Methods A point-prevalence chart review of thirty-one adult medical inpatients with a DNAR order was conducted after two education sessions were held for Non-Consultant Hospital Doctors (NCHDs) and Consultants. Results Of all thirty-one charts, 35% documented DNAR status in the medical notes, with 32% documenting the reasoning for DNAR status, both unchanged from the first audit cycle. There was an increase in documentation of patient discussion (61% versus 45%) and reasons if this was excluded (66% versus 41%). There was no change in documentation of patient relatives’ discussion (48%) but there was an increase in the reasons if this was excluded (25% versus 18%). There was an overall increase in ceilings of care documentation for ICU admission (three-fold increase), intubation (two-fold increase), inotropic support, and comfort measures, but rates of documentation were still less than 15%. Discussion This audit elucidates the efficacy of education sessions in improving DNAR documentation adherence. Recent studies have highlighted uncertainty among NCHDs regarding treatment escalation in acutely unwell patients in the absence of adequately filled DNAR orders and clear documentation of ceilings of care. We posit the introduction of a Ceilings of Care document, akin to the United Kingdom’s Medical Advance Plan. Conclusion Accurate recording of DNAR status and ceilings of care is essential for quality care and treatment escalation. While simple education strategies have proven beneficial in enhancing compliance, additional efforts are needed to enhance ceilings of care documentation.

2168 A survey of non-consultant hospital doctors’ perspectives, knowledge, and practices towards delirium in a large Irish hospital

Abstract Background Delirium is a common condition in hospitals, especially among older people. This refers to a dramatic decline in mental capabilities marked by diminished concentration and consciousness. Aims The purpose of this study is to assess the views, knowledge, and behaviour of non-consultant hospital doctors about managing delirium in a large Irish hospital. Methods Questionnaires were given to 28 healthcare professionals from various departments according to Davis and MacLullicin (2009). It was conducted between July and September 2023 with emphasis on finding out its prevalence rate, diagnostic criteria, and management strategies for delirium. Results The study established that majority of the respondents recognised the importance of delirium but there appears to be a gap in practical management of this clinical syndrome. Although many doctors agreed that delirium was significant, most lacked confidence in diagnosing as well as managing it. The use of standardised assessment tools like the 4AT was limited. Conclusions This study highlights the disparity between what is known and practiced by hospital doctors concerning delirium care. It implies increased training for delirium management with frequent use of assessment tools and ongoing education aimed at enhancing patients’ outcomes during cases of delirium. Keywords: Delirium Management, Hospital Doctors, Medical Training, 4AT, Clinical Practice, Elderly Care.

Assessing current handover practices in surgery: A survey of non-consultant hospital doctors in Ireland

BackgroundHandovers of care are potentially hazardous moments in the patient journey and can lead to harm if conducted poorly. Through a national survey of surgical doctors in Ireland, this paper assesses contemporary surgical handover practices and evaluates barriers and facilitators of effective handover. MethodsAfter ethical approval and pre-testing with a representative sample, a cross-sectional, online survey was distributed to non-consultant hospital doctors (NCHDs) working in the Republic of Ireland. A mixed-methods approach was used, combining data using triangulation design. Main findingsA total of 201 responses were received (18.5%). Most participants were senior house officers or senior registrars (49.7% and 37.3%). Most people (85.1%) reported that information received during handover was missing or incorrect at least some of the time. One-third of respondents reported that a near-miss had occurred as a result of handover within the past three months, and handover-related errors resulted in minor (16.9%), moderate (4.9%), or major (1.5%) harm. Only 11.4% had received any formal training. Reported barriers to handover included negative attitudes, a lack of institutional support, and competing clinical activities. Facilitators included process standardisation, improved access to resources, and staff engagement. ConclusionsSurgical NCHDs working in Irish hospitals reported poor compliance with international best practice for handover and identified potential harms. Process standardisation, appropriate staff training, and the provision of necessary handover-related resources is required at a national level to address this significant patient safety concern.

AB069. SOH24AB_085. Leadership in healthcare: a nationally representative mixed methods analysis of the perceptions and experiences of non-consultant hospital doctors

AB069. SOH24AB_085. Leadership in healthcare: a nationally representative mixed methods analysis of the perceptions and experiences of non-consultant hospital doctors

AB179. SOH24AB_275. Clinical audit on postanaesthetic patient handover to National Health Service protocol in University Hospital Limerick recovery room by anaesthetic non-consultant hospital doctors

AB179. SOH24AB_275. Clinical audit on postanaesthetic patient handover to National Health Service protocol in University Hospital Limerick recovery room by anaesthetic non-consultant hospital doctors

AB067. SOH24AB_031. The creation of an animated library of site-specific surgical procedures for rotating non-consultant hospital doctors: a pilot study

AB067. SOH24AB_031. The creation of an animated library of site-specific surgical procedures for rotating non-consultant hospital doctors: a pilot study

Motivation to Motivate: Pilot of motivational interview training in a tertiary university hospital

IntroductionMotivational interviewing (MI) is an evidence-based communication style that is effective in facilitating behaviour change and patient engagement. Originally developed in the field of addiction, MI can be applied to address a range of health behaviours including smoking cessation, medication adherence and diabetes and weight management. Given its demonstrated efficacy, training clinicians in medical and psychiatry specialties in MI has potential to enhance patient outcomes.Objectives1. Enhance awareness and understanding of the basic concepts and methods of MI among NCHDs (Non-Consultant Hospital Doctors) and hospital staff.1. Assess the perceived effectiveness of the training and help foster a culture of teaching and learning within the hospital.MethodsMI training was organised by the psychiatry department and delivered by a certified external trainer. The training was structured into 2 sessions, each lasting three hours, with a six-week gap between sessions. The training was integrated into the regular academic teaching for psychiatry trainees and a circular email invite was sent to the medical NCHD cohort and psychology department. Pre and post-training questionnaires were collected from participants with five-point Likert scales used to gather responsesResultsThere were 40 attendees across the two sessions. In total, 25 questionnaire responses were collected for the pre training (62.5%) and 30 responses were collected post-training (75%).Prior to training 48% (12/25) indicated they were familiar with MI, 48% felt confident in using MI and 88% (22/25) felt it was applicable to their practice. Post-training, 73% (22/30) felt confident in using MI, 90% (27/40) felt MI was applicable to their practice and 100% indicated they would use MI in their practice. The perception of applicability (p=0.011) and likely utilisation of MI skills (p<0.001) significantly increased over the course of the training as measured by paired t-test (n=23). Ninety-seven percent of responders stated they would recommend the training and 57% (17/30) indicated that they would use MI on a weekly basis in the future.ConclusionsNCHDs and other staff welcomed this training and indicated the training was relevant to their practice. MI demonstrated a positive effect on staff perceptions of applicability and future utilisation of MI skills. Increasing clinician self-perceived efficacy through training events may help contribute to a culture of learning and teaching in hospital settings.Disclosure of InterestNone Declared

Evaluation of a Simulation Based Training Course for Non-Consultant Hospital Doctors (NCHDS) in Psychiatry

IntroductionSimulation-based training (Sim) is an established method of teaching in medical education and can help bridge the gap between medical theory and clinical practice. While sim is well-established in medical and surgical specialties, it is less well developed in psychiatry. Psychiatric emergencies often occur out of hours when there are fewer senior staff available on-site. Sim offers a safe setting for development of essential clinical skills with carefully delivered feedback.Sim can be high-cost involving specialized simulation facilities, especially when utilising high-fidelity equipment. Even lower-fidelity techniques requiring standardized patients (SPs) require funding for actors and this can be a barrier to utilising Sim.ObjectivesWe piloted a Sim course to NCHDs working in psychiatry in a tertiary university hospital with the aim of improving trainee skills and confidence in managing psychiatric emergencies on-call including risk assessment, involuntary admission and acute behavioural disturbance. A low-fidelity approach was taken with minimal use of SPs.MethodsA sim handbook developed by Irish Centre for Applied Patient Safety and Simulation (ICAPSS) was used for reference in developing the simulation modules. Three modules were delivered in a structured manner over three hours; involuntary admission, risk assessment and management of acute behavioural disturbance. Each module involved the simulation exercise (20 minutes) followed by debrief (20 minutes). The facilitated debrief involved open discussion and prompted reflective learning. Anonymous, paper-based questionnaires were used to collect feedback on participants’ experience of the training.ResultsThere were 12 attendees and ten participants completed the feedback. All participants (100%, n=10) agreed or strongly agreed that sim helped them to learn and all agreed that the topics covered were relevant to their clinical role. All participants (100%, n=10), indicated that they enjoyed the workshop. Eighty percent (n=8) agreed or strongly agreed that they would like to do more sim-based workshops. The supportive environment and debrief sessions were reported as the most enjoyable aspects of the workshop.ConclusionsParticipants unanimously agreed that the training was useful to them in their clinical roles and helped them to learn. Sim was effective in teaching high risk complex psychiatric cases to psychiatry NCHDs and consideration should be given to expand this teaching method within postgraduate psychiatry training in Ireland.Disclosure of InterestNone Declared

A survey of non-consultant hospital doctors' perspectives, knowledge, and practices toward delirium in a large Irish hospital.

Delirium is a common condition in hospitals, particularly among older people. This refers to a dramatic decline in mental capabilities, which is marked by diminished concentration and consciousness. The purpose of this study was to assess the views, knowledge, and behavior of non-consultant hospital doctors in managing delirium in a large Irish hospital. Questionnaires were administered to 28 healthcare professionals from various departments according to Davis and MacLullich (Age Ageing 38(5):559-563, 2009). It was conducted between July and September 2023, with an emphasis on determining the prevalence rate, diagnostic criteria, and management strategies for delirium. The study established that the majority of respondents recognized the importance of delirium, but there appears to be a gap in the practical management of this clinical syndrome. Although many doctors agreed that delirium was significant, most lacked confidence in its diagnosis and management. The use of standardized assessment tools, such as the 4AT, was limited. This study highlights the disparity between what is known and practiced by hospital doctors regarding delirium care. This implies increased training for delirium management with frequent use of assessment tools and ongoing education aimed at enhancing patient outcomes in cases of delirium.

The Theatre Recovery and Anaesthetic nurse Capnography Education (TRACE) project.

The Theatre Recovery and Anaesthetic Nurse Capnography Education (TRACE) project is a multidisciplinary quality improvement project. The overall aim is to educate anaesthetic and recovery nurses on the correct use of capnography and educate non-consultant hospital doctors on the guidelines on Preventing Unrecognised Oesophageal Intubation from the Project for Universal Management of Airways group. This project addresses technical aspects of task performance such as correct waveform identification and interpretation, troubleshooting abnormal waveforms and establishing routine checks of capnography both pre-induction and post-intubation. The pre-induction verification of the correct function of capnography is an essential component of this project. In addition, the project focuses on team aspects of task performance with an emphasis on team psychological safety, empowering nurses to speak up using graded assertiveness and flattening hierarchies. As a result of the project, our nurses' knowledge about capnography and waveform identification improved to over 80% correct answers six months after completion of the project. In addition, over 90% of participants reported feeling confident in speaking up to both consultants and non-consultant hospital doctors when a waveform was not present before induction of anaesthesia or after attempted tracheal intubation.

Informed Written Consent for Emergency and Elective General Surgery at a Model 4 Hospital: A Closed-Loop Audit.

Introduction The objective of this investigation was to conduct an audit of the consent form standards signed by patients before elective or emergency general surgery at our institution. The investigation involved a comparison of these standards with those outlined in the "HSE National Consent Policy 2022" established by the Health Service Executive (HSE) and the Royal College of Surgeons in Ireland (RCSI). In the event of discrepancies, we intended to complete the audit loop by educating general surgeons on the essential standards for obtaining written consent in both elective and emergency general surgical procedures. Methods To assess the quality of patient consent, a pre-interventional phase was conducted over one week. Information was gathered exclusively through electronic medical record systems. Subsequent to the data analysis, an in-person educational session was conducted to enlighten non-consultant hospital doctors (NCHDs) in surgery about the significance of informed written consent and the criteria for lawful consent according to local guidelines established by the HSE and the RCSI. Three months following the intervention, a follow-up cycle was carried out to evaluate whether there were any improvements in the standards of consent. Results In the initial phase, prior to intervention, a total of 95 consent forms were collected. The patient's name, date of birth (DOB), and hospital board number (BN) were accurately recorded in all consent forms. However, only 66% (n=63) were accurately documented without the use of abbreviations or acronyms. Following the intervention, 145 consent forms were gathered. All appropriately indicated the patient's name, DOB, and BN. However, 84% (n=122) of consent forms were correctly labeled without the use of abbreviations or acronyms (p=0.0017). Conclusion This closed-loop review illustrates that the quality of consent can be notably enhanced through a straightforward educational intervention led by NCHDsin general surgery. Such interventions can be instructive, leading to improved consent form documentation. This, in turn, enhances patient safety and helps prevent potential medico-legal repercussions for both healthcare providers and institutions.

How well do we truly understand clitoral anatomy? AnIrish maternity hospital's perspective.

The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. A questionnaire was devised, asking ten consultants, ten non-consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area.

267 Survey of knowledge and medications Management of Patients with Parkinson’s Disease among non- consultant hospital doctors

Abstract Background Parkinson’s Disease is a progressive neurodegenerative movement disorder. is the second most common neurodegenerative condition after Alzheimer Disease. The incidence is 1–2:1000 of the general population and 1:100 of the over 80’s, therefore estimating that there are approximately 12,000 people living with Parkinson’s in Ireland. Providing care services and best management for Parkinson’s disease patients needs to be ensured through training staff and continuously auditing the service to meet international standards and patient satisfaction. Methods This study was conducted using an anonymous online survey completed by hospital doctors from all levels and specialties of Non-Consultant Hospital Doctors (NCHD) in a tertiary hospital. The survey contained two sections, the first asked questions on confidence and how commonly NCHD manage patients with Parkinson’s Disease. The second section contained questions to assess general knowledge on medications. Results Of the 40 respondents of non-consultant hospital doctors (NCHD) 50% were SHOs, 30% Interns 20% Registrars. 38% reported to lack confidence in managing patients with Parkinson’s and 50% somewhat confident and only 12% were confident. 77% weren’t familiar with medication side effect and 90% weren’t aware about rescue medications. 82% weren’t familiar with conversion methods. 95% felt that they needed more training. Conclusion Parkinson’s disease patients are commonly admitted to hospitals under medical and surgical teams, and ensuring every patient gets the best management should be our goal. More training is required among hospital doctors, in addition to other continuous easily accessible supportive materials, such as information leaflets, links to be included into hospital’s mobile phone application, Parkinson’s nurse specialist as a point of contact, and regular education.

297 Assessing continence care in a rehabilitation unit: insights from an audit

Abstract Background Urinary incontinence, a prevalent condition and one of the original geriatric giants, remains a taboo topic and is frequently underreported. Urinary incontinence significantly impacts patients and often times their discharge destination. However, urinary incontinence is neither inevitable nor always irreversible. This audit aimed to assess continence and incontinence wear in a rehabilitation facility. Methods The continence care quality in a medical gerontology ward was assessed using the Royal College of Physicians (RCP) National Audit of Continence Care (NACC) standard. A prospective audit was conducted over a five-day period, documenting incontinence wear and urinary continence on a medical gerontology ward. Two interventions were implemented prior to re-auditing. Firstly, continence was incorporated as a teaching topic on the Non-Consultant Hospital Doctor (NCHD) teaching schedule. Secondly, the Multi-Disciplinary Team (MDT) proforma was adjusted to include a patient-specific continence record. A snapshot re-audit was conducted to evaluate any changes resulting from these interventions. Results In the initial audit, 31 patients were included. Among them, 26 (83.9%) wore incontinence wear, with 21 (80.8%) voluntarily opting for it. Urinary incontinence was documented in 13 patients (41.9%). In the re-audit, 40 patients were included. Among them, 27 (67.5%) wore incontinence wear, with 19 (70%) choosing it. Urinary incontinence was documented in 18 patients (45.7%). Conclusion The re-audit revealed a slight decrease in incontinence wear usage (67.5% compared to 83.9% initially). Many patients wearing incontinence wear expressed a preference for it in both audit cycles. The prevalence of urinary incontinence remained similar between audits (41.9% and 45.7% respectively). The persisting prevalence of urinary incontinence calls for effective strategies to address this issue. Additionally, the patients’ preference for incontinence wear emphasises the importance of engaging not only the MDT but also the patients themselves in future interventions. Future projects should focus on gaining a deeper understanding of patients’ perspectives on continence care and evaluating the impact of incontinence on patient outcomes.

26 Audit of osteoporosis treatment in patients undergoing Orthogeriatric rehabilitation

Abstract Background There was a perceived under-prescribing of osteoporosis treatment in this population. The transition from acute hospital to rehabilitation unit presented an opportunity to check medications and institute change. Methods Retrospective audit of patients’ medication charts. All patients on the rehabilitation ward under the care of an Ortho-geriatrician were included. Data was anonymised and recorded in an excel file. Prescription of calcium and vitamin D (single agent or combination) and targeted osteoporosis medications were recorded. Data collection performed by the specialist registrar on a ward round with the consultant. Interventions included education of Non-Consultant Hospital Doctors (NCHDs) to encourage proactive prescribing and documentation of the bone protection plan on the transfer summary. A re-audit was undertaken at a two month interval using the same methodology. Results 12 medication charts were examined as part of the initial audit. 10/12 had a neck of femur fracture and 2/12 had fragility fractures of the tibia/fibula requiring surgery. Zero patients were prescribed calcium alone, two vitamin D alone and 9/12 were on combination calcium and vitamin D. No patients were prescribed targeted osteoporosis treatment. 1/12 patients had a documented plan regarding bone protection. Re-audit examined 10 medication charts. 9/10 had a neck of femur fracture, 1/10 had a fracture of both the distal femur and the proximal humerus. Zero patients were prescribed calcium alone, three vitamin D alone and 6/10 were on combination calcium and vitamin D. 2/10 were prescribed oral bisphosphonate, 5/10 denosumab and 1/10 intravenous bisphosphonate. The remaining two patients did not yet have osteoporosis treatment prescribed. Conclusion Despite all of the initial patients being >14 days post-operative the majority did not have a plan or prescription for bone protection representing a missed opportunity to prevent further fractures. Re-audit post education demonstrated an 80% improvement in prescription of osteoporosis treatment.

328 From delirium detection to correction: enhancing peri-operative care for older patients

Abstract Background Delirium is a common peri-operative complications in older adults. It is associated with poorer outcomes including functional decline, increased length of hospital stays, increased admissions to long term care and higher mortality. Therefore, this project aimed to assess the peri-operative care of older patients admitted under the surgical service in accordance with the standards set by the Collaborative for Peri-operative Optimisation of People (CPOP) and British Geriatrics Society (BGS) Peri-operative Care for People Living with Frailty undergoing Elective and Emergency Surgery Guidelines. Methods The study examined four key aspects of the guidelines: (1) surgical staff training on delirium; (2) proactive screening in for delirium in surgical patients; (3) proactively documenting delirium and implementing delirium guidelines; and (4) documentation of delirium diagnosis in discharge summaries. Results Data were collected from 72 surgical admissions over a fourteen-day period, of which 26 patients were aged >65. Results indicated suboptimal adherence to the guidelines, with only 4/26 older patients (15.4%) being screened for delirium. Three of 4 of these patients screened positive for delirium using the 4AT. No patients had delirium mentioned in their discharge summaries. Additionally, a survey of surgical non-consultant hospital doctors revealed that only 4/16 (25%) had received formal training on delirium. Conclusion In response to these findings, interventions were implemented, including teaching at surgical grand rounds, hospital-wide education for World Delirium Awareness Day, introduction of delirium care bundles, and an updated discharge summary template for surgical patients to include a delirium diagnosis. A reaudit is underway to evaluate the impact of these interventions on guideline adherence and the peri-operative care quality for older patients. These initial findings underscore the need for improved staff education and adherence to CPOP and BGS guidelines. The reaudit will provide valuable insights into the effectiveness of the implemented interventions in enhancing the perioperative care experience for the older patient cohort.