scholarly journals EP.TU.380Compliance with delirium guidelines in older surgical patients and susceptibility to improvement

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ko Ko Zayar Toe ◽  
Marc Pressler ◽  
Nick Lees ◽  
Emma Vardy ◽  
Angeline Price
Keyword(s):  
Surgical Patients ◽  
Secondary Outcome ◽  
Patient Records ◽  
Care Needs ◽  
Delirium Assessment ◽  
Management Guidelines ◽  
Operative Care ◽  
Pdsa Cycle ◽  
Standard Tool ◽  
Improve Compliance

Abstract Aim Delirium in older hospitalised adults is both common and serious, particularly following surgery. It is associated with increased mortality, prolonged admission and greater care needs. All patients ≥ 65 years should have a delirium assessment within 24 hours of admission, and again post-operatively. Where delirium is identified, a thorough assessment of reversible causes should be undertaken using validated tools. Despite clear guidelines, delirium remains under-recognised and inconsistently managed. A study was undertaken to determine compliance with delirium assessment and management guidelines for older surgical patients in one acute hospital, and their susceptibility to improvement. Methods A QI project was undertaken using the PDSA cycle. 50 patient records were reviewed retrospectively. Multidisciplinary educational sessions were delivered. A further 50 patient records were audited after 1 month. Primary outcome: delirium assessment (4AT) within 24 hours of admission. Secondary outcome: TIME bundle completed where delirium identified. Results Conclusion Delirium assessment and identification is improved through the use of a standard tool (4AT) and targeted educational sessions. As a common post-operative complication, delirium assessment is an important aspect of routine post-operative care. Further work is needed to improve compliance with use of the TIME bundle when delirium is present.

scholarly journals Care needs of people with dementia in the peri-operative environment: A systematic review

Dementia ◽  
2018 ◽  
Vol 19 (6) ◽  
pp. 1889-1906 ◽  
Author(s):  
Alicia Diaz-Gil ◽  
Joanne Brooke ◽  
Olga Kozlowska ◽  
Sarah Pendlebury ◽  
Debra Jackson
Keyword(s):  
Healthcare Professionals ◽  
Hospital Setting ◽  
Surgical Care ◽  
Cognitive Status ◽  
Surgical Patients ◽  
Care Needs ◽  
Operative Outcomes ◽  
People With Dementia ◽  
Operative Care ◽  
Tract Infections

The care of people with dementia within the hospital setting is challenging for healthcare professionals. Hospital design and services are not optimized for people with dementia, owing to the lack of preparation of healthcare professionals and the busy environment of the acute hospital. The peri-operative environment may present particular difficulties but little is known about the experience and care of people with dementia in this setting. The aim of this review was to examine the care of surgical patients who have dementia and their family members in peri-operative environments and describe strategies adopted by healthcare professionals. A systematic search of the following databases was completed: BNI, CINAHL, PubMED and PsychINFO in accordance with PRISMA guidelines. Data were extracted and analysed within a thematic analysis framework as described by Braun and Clarke . Ten papers based on eight studies were included, five (n = 355,010 participants) containing quantitative data and five reporting qualitative data (n = 395 participants). People with dementia who go undergo surgery experienced higher adverse post-operative outcomes such as respiratory problems or urinary tract infections. The key elements in surgical care for people with dementia included: health assessment throughout the surgical trajectory (pre-, intra- and post-operative) and the resources used by healthcare professionals in the peri-operative care. Healthcare professionals reported difficulties in the completion of health assessments due to the cognitive status of people with dementia and a lack of skills in dementia management. The use of restraints was still a common practice and a source of conflict. Dementia-specific training and guidelines focused on the care of surgical patients who have dementia in peri-operative environments are required to improve care and post-operative outcomes. More research is required to develop effective interventions to improve care and decrease the risk of complications for people with dementia in the peri-operative care environment.

scholarly journals MULTIDIMENSIONAL FRAILTY SCORE IS SUPERIOR TO PREDICT COMPLICATIONS AFTER SURGERY THAN CONVENTIONAL RISK FACTORS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S686-S686
Author(s):  
Jung-Yeon Choi ◽  
Kwang-il Kim ◽  
Hee-won Jung ◽  
Cheol-Ho Kim ◽  
Sung-Bum Kang ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Grip Strength ◽  
Gait Speed ◽  
Surgical Patients ◽  
Secondary Outcome ◽  
P Value ◽  
Asa Classification ◽  
Increased Risk ◽  
Prognostic Utility ◽  
Frailty Score

Abstract Frail older adults are at increased risk for postoperative morbidity compared with their robust counterparts. We compared predictive utility of multidimensional frailty score (MFS) with physical performance parameters or conventional risk stratification indicators to identify postoperative complication in older surgical patients. From January 2016 to June 2017, 648 older surgical patients (age≥ 65) were included for analysis. The MFS was calculated through comprehensive geriatric assessment (CGA). Grip strength and gait speed were measured preoperatively. The primary outcome was postoperative complication (eg, pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned ICU admission). Secondary outcome was 6-months all-cause mortality. Sixty-six (10.2%) patients experienced postoperative complications and 6-months mortality was 3.9% (n=25). Grip strength, gait speed, MFS and ASA classification could predict postoperative complication but only MFS (Hazard Ratio = 1.564, 95% CI, 1.283-1.905, p < 0.001) could predict 6-months mortality after full adjustment. MFS (C index = 0.747) had superior prognostic utility than age (0.638, p value = 0.008), grip strength (0.566, p value < 0.001) and ASA classification (0.649, p value = 0.004). MFS only had additive predictive value on both age (C-index of 0.638 (age) vs 0.754 (age +MFS), p = 0.001) and ASA classification (C index of 0.649 (ASA) to 0.762 (ASA + MFS), p < 0.001) for postoperative complication, but gait speed or grip strength had no statistical additive prognostic value on both age and ASA classification.

Mortality risk factors in surgical patients in a tertiary hospital: a study of patient records in the period 2004–2006

2009 ◽  
Vol 85 (4) ◽  
pp. 229-237 ◽  
Author(s):  
Jesús Gil-Bona ◽  
Antoni Sabaté ◽  
Albert Pi ◽  
Romà Adroer ◽  
Eduardo Jaurrieta
Keyword(s):  
Risk Factors ◽  
Mortality Risk ◽  
Tertiary Hospital ◽  
Surgical Patients ◽  
Patient Records

scholarly journals 1212 A Novel Approach to Alleviating Surgical Anxiety: QI Study in a Primary Care Government Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
H Peri
Keyword(s):  
Patient Satisfaction ◽  
Support Groups ◽  
Elective Surgery ◽  
Treatment Modalities ◽  
Satisfaction Rate ◽  
Adequate Knowledge ◽  
Operative Care ◽  
Novel Approach ◽  
Pdsa Cycle ◽  
Patient Satisfaction Rate

Abstract Aim Surgical Anxiety is a challenging problem in the peri-operative care of a patient often leading to poor surgical outcomes and repeated visits by the patient to the hospital. Despite being well documented, in practice, it still remains the most neglected and haphazardly adopted part of patient care. This study aimed to make the overall experience of surgery, safer and pleasant to the patient by instituting a novel, multimodal and easy to follow protocol. Method A self-made questionnaire formed the source for data collection from 43 patients listed for elective surgery in a government setup, throughout the duration of their admission and review period. Patient satisfaction rate was assessed by re-audits, post implementation of changes via a Plan-Do-Study-Act (PDSA) cycle. The ease of protocol administration and sustainability were assessed from staff via an audit and it was further simplified to ensure adoption was easy and patient satisfaction rate remained high as well. Results Initial audit showed only 49% (n = 21) of patient satisfaction rate at the time of admission. Significant variations of > 90% (n = 39) patient satisfaction rate was noted post implementation of changes after the first PDSA cycle. A second PDSA cycle was instituted to simplify the protocol and post audit >90% acceptance rate from staff were noted. Conclusions Shared Decision Making, Peer Support Groups, Adequate knowledge of the treating surgeon, the disease, treatment modalities and complications instituted via a proper protocol helped to alleviate surgical anxiety and prepare a positive patient for surgery.

scholarly journals Quality Initiative to Improve Compliance With Perioperative Anticoagulation

2019 ◽  
Vol 15 (9) ◽  
pp. e835-e842 ◽  
Author(s):  
Elizabeth B. Pelkofski ◽  
William D. Baker ◽  
John C. Rowlingson ◽  
Leigh A. Cantrell ◽  
Linda R. Duska
Keyword(s):  
Gynecologic Oncology ◽  
Skin Incision ◽  
Secondary Outcome ◽  
Multidisciplinary Working ◽  
Perioperative Anticoagulation ◽  
Improve Compliance ◽  
Bundle Compliance ◽  
Type Data ◽  
Prophylactic Anticoagulation ◽  
Surgical Pathway

PURPOSE: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in gynecologic oncology surgical patients. Many centers use neuraxial analgesia (NA), which affects the timing of prophylactic anticoagulation. In 2012, we determined that the rate of VTE in patients undergoing laparotomy with NA was higher than in those who received alternative pain control. In addition, compliance with preoperative anticoagulation guidelines was only 40%. We undertook a quality initiative (QI) project to increase compliance to 80% in NA cases and maintain 90% in non-NA cases. METHODS: A multidisciplinary working group designed and deployed a QI intervention bundle. Compliance was defined as the receipt of a prophylactic dose of anticoagulant within 1 hour after NA or before skin incision regardless of anesthesia type. Data were abstracted from the medical record after the study period. Cases from the year before QI were used for comparison. Primary outcome was compliance and secondary outcome was the rate of VTE. RESULTS: One hundred women were treated under the QI project and 182 historical cases (HCs) were used for comparison. Overall compliance improved (96% QI v 73% HC; P < .001). This difference was marked in cases with NA (95% QI v 40% HC; P < .001) and remained stable in non-NA cases (97% QI v 91% HC; P = .29). The overall rate of VTE, independent of anesthesia type, remained unchanged (2.1% HC v 0% QI; P = .3). CONCLUSION: Relatively simple and inexpensive initiatives to improve routine processes within the surgical pathway are feasible and attract staff participation. Such efforts are likely to translate into greater levels of patient safety.

scholarly journals Novel nutritional substrates in surgery

2013 ◽  
Vol 72 (3) ◽  
pp. 277-287 ◽  
Author(s):  
Nikki Buijs ◽  
Elisabeth A. Wörner ◽  
Saskia J. H. Brinkmann ◽  
Joanna Luttikhold ◽  
Barbara S. van der Meij ◽  
...  
Keyword(s):  
Surgical Stress ◽  
Surgical Patients ◽  
Western World ◽  
Surgical Patient ◽  
Acid Base Balance ◽  
Beneficial Effects ◽  
Operative Care ◽  
Immunological Mechanisms ◽  
Operative Recovery ◽  
Care Surgery

Pharmaco-nutrients have beneficial effects on protective and immunological mechanisms in patients undergoing surgery, which are important for recovery after injury and in combating infectious agents. The aim of this review article was to outline the potential of the administration of nutritional substrates to surgical patients and the underlying mechanisms that make them particularly important in peri-operative care. Surgery causes a stress response, which has catabolic effects on the body's substrate stores. The amino acid glutamine is a stimulating agent for immune cells. It activates protective mechanisms through its role as a precursor for antioxidants and it improves the barrier function of the gut. Arginine also enhances the function of the immune system, since it is the substrate for T-lymphocytes. Furthermore, n-3 PUFA stabilise surgery-induced hyper-inflammation. Taurine is another substrate that may counteract the negative effects of surgical injury on acid–base balance and osmotic balance. These pharmaco-nutrients rapidly become deficient under the influence of surgical stress. Supplementation of these nutrients in surgical patients may restore their protective and immune-enhancing actions and improve clinical outcome. Moreover, pre-operative fasting is still common practice in the Western world, although fasting has a negative effect on the patient's condition and the recovery after surgery. This may be counteracted by a simple intervention such as administering a carbohydrate-rich supplement just before surgery. In conclusion, there are various nutritional substrates that may be of great value in improving the condition of the surgical patient, which may be beneficial for post-operative recovery.

scholarly journals Multicentre prospective cohort study of unmet supportive care needs among patients with breast cancer throughout their cancer treatment trajectory in Penang: a PenBCNeeds Study protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044746
Author(s):  
Noorsuzana Mohd Shariff ◽  
Nizuwan Azman ◽  
Rohayu Hami ◽  
Noor Mastura Mohd Mujar ◽  
Mohammad Farris Iman Leong Bin Abdullah
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Supportive Care ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ethics Committee ◽  
Supportive Care Needs ◽  
Secondary Outcome ◽  
Care Needs ◽  
Over Time

IntroductionProper assessment of unmet supportive care needs of patients with breast cancer and its influencing factors at different treatment intervals will improve the rehabilitation of patients with breast cancer. Therefore, this study aims to determine the prevalence of unmet supportive care needs, changes of needs over time and associated factors during the treatment period.Methods and analysisThis multicentre, prospective cohort study will be conducted in three governmental hospitals and one tertiary cancer institute in Penang, Malaysia. Adult women diagnosed with primary or recurrent tumour, node, metastases stage I–IV breast cancer based on pathological biopsy will be eligible for this study. At least 281 samples are required for this study. Participants will undergo follow-up at three time intervals: T1 at breast cancer diagnosis; T2 at 3 months after diagnosis and T3 at 6 months after diagnosis. Patients will complete a set of questionnaires at each time. The primary outcome of this study includes the changes in supportive care needs over three time points, followed by the secondary outcome examining patients’ characteristics, coping behaviours and positive psychological components as they affect changes in unmet supportive care needs over time.Ethics and disseminationThe study has received ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-19-268-45809 IIR) and the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/17100443). The results of the prospective study will be submitted for publication in a peer-reviewed journal.

Effects of an Innovative Psychotherapy Program for Surgical Patients

2015 ◽  
Vol 123 (1) ◽  
pp. 148-159 ◽  
Author(s):  
Léonie F. Kerper ◽  
Claudia D. Spies ◽  
Anna-Lena Salz ◽  
Edith Weiß-Gerlach ◽  
Felix Balzer ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Mental Disorders ◽  
Mental Healthcare ◽  
Severity Index ◽  
Stepped Care ◽  
Surgical Patients ◽  
Secondary Outcome ◽  
Global Severity Index ◽  
General Psychological Distress ◽  
Comorbid Mental Disorders

Abstract Background: The stepped care program Bridging Intervention in Anesthesiology (BRIA) aims at motivating and supporting surgical patients with comorbid mental disorders to engage in psychosocial mental healthcare options. This study examined the efficacy of BRIA. Methods: This randomized, parallel-group, open-label, controlled trial was conducted in the preoperative anesthesiological assessment clinics and surgical wards of a large university hospital in Germany. A total of 220 surgical patients with comorbid mental disorders were randomized by using the computer-generated lists to one of two intervention groups: BRIA psychotherapy sessions up to 3 months postoperatively (BRIA) versus no psychotherapy/computerized brief written advice (BWA) only. Primary outcome was participation in psychosocial mental healthcare options at month 6. Secondary outcome was change of self-reported general psychological distress (Global Severity Index of the Brief Symptom Inventory) between baseline and month 6. Results: At 6-month follow-up, the rate of patients who engaged in psychosocial mental healthcare options was 30% (33 of 110) in BRIA compared with 11.8% (13 of 110) in BWA (P = 0.001). Number needed to treat and relative risk reduction were 6 (95% CI, 4 to 13) and 0.21 (0.09 to 0.31), respectively. In BRIA, Global Severity Index decreased between baseline and month 6 (P &lt; 0.001), whereas it did not change significantly in BWA (P = 0.197). Conclusions: Among surgical patients with comorbid mental disorders, BRIA results in an increased engagement in subsequent therapy options and a decrease of general psychological distress. These data suggest that it is reasonable to integrate innovative psychotherapy programs into the context of interdisciplinary surgical care.

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