Analysis on the Training Strategies of University Library Service Talents under the Concept of "Three-all Education" in the New Era

Embracing the challenge and mission of the new era, colleges and universities, as an important battle filed for cultivation of talents, should be guided by the educational concept of "Three-all Education", to train and transport outstanding talents for the country. Based on the concept of "Three-all Education" and centering on the innovative ability of college library service personnel training, this paper utilizes big data technology and means to realize the idea of "all-process education, all-staff education and all-round education", and explores the cultivation strategies for college library service personnel, which not only meets the urgent needs of college reform and development. It is also of great practical significance to cultivate young talents in the new era.

EP.FRI.997 Recognising frailty: the scale of the problem

Aim To assess compliance with frailty scoring in acute surgical admissions. Method Data including age, admitting speciality, whether the frailty score was completed and the recorded score if completed, were collected for all admissions to an acute surgical unit over a 7 day period in November 2019. Results The average age of the 139 patients was 56.25 years (range 16-89). Frailty scoring was completed in 53 patients (38.1%); 8 patients (15%) met the criteria for frailty. Sixty-four patients (46%) were aged over 65 years, 26 (40.6%) had the score completed and 7 (27%) met the frailty criteria. Of 36 patients (26%) aged 75 or over, 16 (44.4%) were scored and 6 (37.5%) met the frailty criteria. Scoring was most frequently completed in patients admitted under the Vascular Surgery team (52.9% compliance) with a mean score 3.8. Conclusion Worsening frailty is associated with increased morbidity and mortality in acute surgical admissions. The 7-point Clinical Frailty Scale has been added our acute surgical admission document and should be completed for every patient. Our compliance with scoring is a long way from our recommended 100%, with compliance with assessing frailty across age groups similar, despite the increased rates of frailty seen in older age groups. Poor compliance with frailty assessment may hamper future progress with the management of the frail, older surgical patient. We are planning documentation changes, staff education sessions and to appoint frailty ‘champions’ with a repeat audit of compliance to assess the effects of these changes.

Early mobilization as a new pathway to improve functional mobility of cardiac patients in High dependency Unit

Funding Acknowledgements Non funded project Background Early mobilization as a multidisciplinary team approach in cardiac High Dependency Unit-B (HDU B) helps to reduce loss of muscle strength, decrease hospital length of stay, improve functional capacity, cognitive levels, enhances the quality of care, and helps to decrease the hospitals costs. Purpose Early mobilization means reducing the time of bed rest from admission to first activity. Based on this definition the project aimed to mobilize more than 95% of cardiac patients within 24 hours of admission by September 2019 in HDU B unit. Methods HDU B Initiated Early mobilization program as a part of Value improvement project (VIP). Experts from multidisciplinary team (MDT) worked together to improve the functional mobility of patients. A cross section survey was conducted to identify barriers for early mobility in the unit followed by analyzing barriers through Pareto chart. An early mobility flow chart (Level1-Passive, Level 2-Active assisted, Level 3-Active) framed in order to standardize the practice of mobilizing patients in HDU B. New changes were tested by using methodology of Plan Do Study Act. Staff education, training given regarding the implementation of early mobility protocol. Patients with mobility level 1 and 2 were identified by nurses, requested for Physiotherapy referral by Physicians. Nursing staff education on mobility assessment given an easy access of data about mobility level of patients in handoff communication, which guided the staff to decide on the need of PT consultation for each patient. In coordination with MDT team referral were also given even during weekend for the patients with mobility level 2. To engage patient and family in the early mobility program a new concept of END PYJAMA PARALYSIS was introduced. Patients with mobility level 3 were identified and encouraged to wear their own dress and move outside their room under supervision.This concept aims to build confidence in patients making them feel that they are ready to go home. Results With support and co-operation of the MDT, this project became a highly successful project in VIP. Initially 50% of the patients has been mobilized when the program was introduced in the ward during March 2019 which increased gradually to 90% at the end of the month. After introducing the flow chart, there was increase in 93.3% by April 2019. In addition to Physio referral it went to 100% at the end April 2019. End pyjama paralysis and weekend physio referral sustained the 100% compliance to Early mobility till the end of July 2019. Active interventions of the team helped to early mobilize by 100% till the end of September 2019 and currently it is in sustainable phase. Conclusion Early mobilization in HDU-B brought significant change in the culture of mobilization. Commitment, cooperation of MDT, a structural system and End pyjamas paralysis program are key factors of the success for the program that promoted patient safety and prevented adverse events.

Interventions to Enhance Medication Safety in Residential Aged Care Settings: An Umbrella Review

Aim: To conduct the first systematic synthesis of existing evidence reviews on interventions to enhance medication safety in RACS, to establish and compare their effectiveness. Method: This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases (MEDLINE, EMBASE, CINAHL, and The Cochrane library database of Systematic Reviews) were explored for eligible reviews. Those meeting the inclusion criteria were critically appraised using the JBI Critical Appraisal Instrument for Systematic reviews and Research Syntheses by two authors. Results: Fourteen reviews covering 166 unique, primary studies were included. Interventions were grouped according to type: medication review (n= 12); staff education (n= 8); multidisciplinary team meetings (n= 6); computerised clinical decision support systems (n= 5); and transferring medicines information between health care settings (n= 1). Most reviews showed mixed evidence to support interventions’ effectiveness, due to the significant heterogeneity between original research studies in respect to sites, samples sizes and intervention periods. However, in all intervention categories, pharmacists’ collaboration with other health care professionals was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. The evidence suggests that combining two or more interventions is the most promising approach, despite this presenting implementation barriers in the resource-limited environments of many RACS, and methodological challenges in identifying the precise contribution of individual interventions, when implemented concurrently. Conclusion: Health stakeholders should explore a combination of at least two interventions, such as medication review and staff education, to improve medication safety in RACS.

Bowel monitoring in psychiatry of old age: a quality improvement project

AimsThis project aims to ensure all patients in the dementia ward 1 in Kingsway Care Centre, Dundee have daily bowel monitoring and achieve a normal bowel habit. The hypothesis is that patients are inadequately screened and substantial undiagnosed constipation exists.BackgroundConstipation has a prevalence of 16-50% among individuals over 65 years old in the community. Psychiatric illnesses are known risk factors with older psychiatric patients 3-6 times more likely to be constipated. Untreated constipation may progress to serious complications such as bowel obstruction and bowel perforation. Delirium, often mislabelled as worsening psychiatric symptoms, also may occur leading to additional psychotropic medications being prescribed, further worsening the constipation.MethodAll patients in Ward 1, Kingsway Care Centre Dundee over 4 months were included, amounting to 25 patients. Data were gathered from stool charts weekly. Quality improvement framework was followed with two plan-do-study-act (PDSA) cycles completed. Normal bowel function was assessed against ROME IV constipation criteria and less than 75% of Bristol stool type 6 or 7 due to the risk of overflow diarrhoea and laxative overuse. In the first PDSA cycle, stool charts were modified to account for patients independently mobilising to the bathroom and daily documentation even if bowel movements were uncertain. The second PDSA cycle introduced a sticker on charts folder to “ask the patient” along with a staff education leaflet on the complications of constipation. Data were anonymised and analysed with run charts using Microsoft Excel.ResultAt baselines, 50% of patients had a stool chart. This increased to 90% in cycle 1, 100% in cycle 2. 28% of patients had any stools documented at baselines. This increased to 31% in cycle 1, 59% in cycle 2. At baselines, 0% of patients had a normal bowel habit. This maintained at 0% in cycle 1 but increased to 13% in cycle 2. No serious complications were found in patients assisted with toileting. However, 34% of independently mobile patients developed serious complications.ConclusionPoor documentation existed in all patients, particularly those independently mobile. Independently mobile patients were particularly at risk of serious complications of constipation compared to assisted patients. Introduction of new stool charts in the first PDSA cycle resulted in increased documentation but limited benefit for identification of constipation. The second PDSA cycle, targeting staff education and compliance, showed an increase in identification of constipation indicating limited staff knowledge as a key barrier to improvement in patients’ bowel habit.

Monitoring side-effects of antipsychotics using the glasgow antipsychotic side-effect scale

AimsAntipsychotic drugs frequently produce side-effects which represent common reasons for noncompliance. National guidelines, published by the National Institute of Care and Health Excellence, the Royal College of Psychiatrists, and the Maudsley Prescribing Guidelines in Psychiatry, stipulate that patients prescribed antipsychotic drugs should be reviewed for side-effects on a weekly basis. This completed audit cycle, conducted on a mixed acute general adult psychiatric ward, examined whether patients were being assessed for side-effects of antipsychotic drugs using a standardised, self-reporting scale – the Glasgow Antipsychotic Side-effect Scale (GASS) – as per national guidelines. As identification of side-effects is important in tailoring treatment to improve compliance, auditing monitoring practice was important in realising these outcomes.MethodRetrospectively, 26 inpatients were identified over a two-month period who were prescribed antipsychotic drugs. Their notes were reviewed for documented weekly GASS scores for the duration of antipsychotic treatment. Initial data demonstrated 0% compliance with guidelines, as no patients completed a weekly GASS. The intervention to improve compliance was a training session for ward staff on implementing the GASS. Data were subsequently collected prospectively over three weeks for 15 patients.ResultSeven patients completed the GASS weekly over three weeks, representing 47% compliance. Two patients (13%) completed two forms, three (20%) completed one form, and three (20%) completed no forms. There was a positive correlation between being offered the GASS and completing it – only one patient declined to complete it and was not offered it during the third week. Of the remaining 14 patients, if the GASS was offered there was 100% rate of completion. Staff did not offer the GASS to every patient each week, which accounted for most cases of non-completion. Some patients with pre-existing symptoms of physical illnesses included these on the GASS, which complicated interpretation. Future interventions could include further staff education, and involving a ward pharmacist to review results during medication reviews to optimise treatment compliance, as no medication changes resulted directly from patients completing the GASS.ConclusionCompliance with completing the GASS weekly improved following staff education, identifying the main factor affecting compliance as staff not offering the GASS to patients. Patients generally engaged well with side-effect monitoring, as most completed the GASS when offered. Further staff education may produce even greater compliance with guidelines, and involving pharmacy staff to review GASS scores and inform medication choices may lead to use of the GASS resulting in more tolerable and effective treatment plans.