67 Nutritional Assessment of Patients Admitted To “Adult Burns Unit” At Southmead Hospital from April To August 2017

Introduction Nutritional support is an integral part of Burns management. Local guidelines for malnutrition screen are available at Southmead Hospital. Aim Audit was aimed at compliance of malnutrition screen for all admissions to “Adult Burns Unit” to the local guidelines. Method A retrospective data of baseline and weekly malnutrition screen was collected and analysed for 106 patients between April and August 2017. These findings were compared to the following local guidelines; Results Of 106 patients, most (n = 72) had <5% TBSA burn. 9 were resus burns (TBSA >15%). 50 patients stayed less than a week while 34 discharged within 24hrs. 20 stayed longer than seven days. Compliance of recording weight on admission was 46.2% while weekly assessment 10%. Height and BMI were measured for 24.5% of admissions. 81% of patients had admission bloods and 19 out 20 staying longer than a week had weekly bloods. All major burns were referred to dietician. Conclusions Assessment of %TBSA, admission and weekly bloods, and dietician referral were areas of good practice. However, compliance with recording weight and height on admission did not meet the Trust target of 85% We recommended a checkbox for weight and height on admission in Trust’s electronic handover system, monitor at weekly burns MDT and re-audit.

The power of reflective practice: evaluating the impact of a psychoeducation and reflective practice group for surgical nursing staff and health care assistants in a trauma centre

AimsTo offer a psychoeducation and reflective practice group for nursing staff (NS) and health care assistants (HCAs) working on a Trauma and Orthopaedics Ward in Southmead Hospital, Bristol. To explore the staff experience of having a reflective space, and how this impacted on their attitudes and knowledge and confidence in psychiatric presentations.BackgroundReflective practice can raise the quality and consistency of nursing care, but it is not part of everyday culture and practice. Southmead Hospital is a trauma centre and the surgical NS and HCAs care for multiple patients following self-harm or suicide attempts. They report at times not having the mental health knowledge and confidence to appropriately manage patients on the ward and are at high risk of occupational stress and burnout. Our mental health liaison team (MHLT) identified this need and offered to provide a space to address these concerns and evaluate the impact of this intervention.MethodAfter liaising with the ward manager, I developed and provided a fortnightly forty-minute psychoeducation and reflective practice group for NS and HCAs on one Trauma and Orthopaedic ward in Southmead Hospital. Topics were rotated and included suicidal ideation, self-harming behaviour, mind and body link, the stress -vulnerability model and verbal aggression.The staff were asked to complete anonymous paired pre-and post-course questionnaires about their attitudes and confidence regarding mental health difficulties. This questionnaire included both quantitative components (e.g. 1–5 Likert scales) and qualitative components (free text boxes) which were analysed and coded accordingly.ResultQuantitative results showed that staff felt it was important to learn about mental health conditions and have a reflective space. Their confidence and knowledge improved in understanding and managing psychiatric presentations. Qualitative results revealed several common themes – (i) Space; staff valued a protected, structured, safe space, (ii) Relationships: staff valued sharing with colleagues and supporting each other, (iii) Sharing and learning; staff valued a space to think about patient's formulations, discuss common experiences, express their own emotions and learn from each other and (iv) Psychoeducation; the staff welcomed ideas of ways to communicate with patients and specific skills to use on the wards.ConclusionTrauma and Orthopaedic NS and HCAs perceived a range of benefits from participating in a psychoeducation and reflective practice group. Further research is required to evaluate whether reflective practice groups help to reduce staff burnout and can change the ward ethos to improve the patient experience.

11 Mortality Rates for Patients Admitted to Complex Care/Care of the Elderly Wards At Southmead Hospital, Bristol

Background Existing data examining mortality rates following inpatient hospital admissions in the United Kingdom is either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess 1, 3, 6 and 12 month mortality rates in patients admitted to complex care/care of the elderly (CC/CotE) wards at Southmead hospital, Bristol Methods Data were collected by the trust's Business Insider department and analysed by the authors. All patients admitted to the four CC/CotE wards from July-December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge, and date of death if applicable. Results 2673 patients were admitted to CC/CotE wards from July-December 2017. 42.72% of patients were male, mean age of patients was 82.46 years. Mean length of stay was 16.68 days, with mean length of stay on CC/CotE ward specifically 9.08 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were:1 month: 11.34% (303 patients)3 month: 21.59% (577 patients)6 month: 30.15% (806 patients)12 month: 38.53% (1030 patients) 12 month mortality increased with age from 75 upwards (34.04% in 75-79 years, 42.94% 85-89 years, 50.27% 95-99 years, 66.67% 100-104 years) but was similar in those aged 65-69 and 70-74 (29.41% and 28.18% respectively). Discussion An improved understanding of mortality rates in patients admitted under CC/CotE may aid clinicians' ability to prognosticate. Appreciating that over a third of CC/CotE patients are potentially in the last year of life provides further impetus to begin advanced care planning discussions during inpatient admissions.

Mortality rates in teaching hospital complex care wards in England: a retrospective audit

ObjectiveExisting data examining mortality rates following inpatient hospital admissions in the UK are either condition specific or examining all inpatient mortality based on single time point audits. This clinical effectiveness project aimed to assess mortality rates in patients admitted to complex care (CC) wards managed by geriatricians at Southmead hospital, Bristol.MethodsData were collected by the trust’s audit department and analysed by the authors. All patients admitted to the four CC wards from July to December 2017 were included. Data collected included age, gender, date of admission, length of stay, date of discharge and date of death if applicable.Results2673 patients were admitted to CC wards from July to December 2017. 42.72% of patients were men, and mean age of patients was 82.46 years. Mean length of stay was 16.68 days. 292 (10.92%) of patients died during the index admission. Overall mortality rates were: (1) 1 month: 11.34% (303 patients); (2) 3 months: 21.59% (577 patients); (3) 6 months: 30.15% (806 patients); (4) 12 months: 38.53% (1030 patients). 12-month mortality increased with age from 75 upwards (34.04% in 75–79 years, 42.94% in 85–89 years, 50.27% in 95–99 years, 66.67% in 100–104 years) but was similar in those aged 65–69 and 70–74 years (29.41% and 28.18%, respectively).ConclusionsAn improved understanding of mortality rates in patients requiring an admission under geriatricians may aid clinicians’ ability to prognosticate. Appreciating that over a third of these patients are potentially in the last year of life provides further impetus to begin advance care planning discussions during inpatient admissions.

Trainee Update September 2014

I hope you have all settled well into your new jobs and a very warm welcome to those that have recently joined the ‘family’ of acute medicine. I would first of all like to thank Ruth Johnson for all her hard work as trainee representative over the last 18 months and wish her all the best as she ventures into consultant territory: her replacement will be announced later in the autumn. July was a busy month, dominated by our Acute Medicine Awareness Week, during which AMUs across the UK undertook events to raise the profile of the speciality and the important work they were doing locally. Barnsley completed a 25 mile virtual marathon, Crosshouse Hospital made £350 in a cake sale, Salford Royal staff walked around every acute medical unit in Greater Manchester, North Staffordshire staff ran a half marathon and there was more cake on sale in Kings College and Leicester Royal. The AMU staff at Southampton raised over £400 with their cake sale and cycle challenge, during which they were joined by the Trust Chief Executive for a ‘virtual’ 120 miles on an exercise bike situated outside the hospital entrance. The highlight, however was the contribution of Dr Nigel Lane, an acute medicine trainee from Southmead Hospital in North Bristol, who put together an outstanding weekly programme of events. This included a visit from the Chief Executive of the trust, visit from local GPs to the unit, daily MDT teaching, daily ‘messages of the day’ located on the trust website and lots of screensavers, banners and information scattered throughout the hospital. I am delighted to announce that Nigel has received the SAM awareness week prize. This involves the opportunity to join the European School of Internal Medicine and attend the winter EFIM school camp in Latvia. Nigel will also be joining us as one of the speakers in the trainee session at SAM Brighton. He will be speaking on “Preparing for your PYA”. There will also be talks in the trainee session on “Keeping your e-portfolio updated”, “Choosing your specialist skill” and “Preparing for your consultant job”. The session will be aimed at both junior and senior trainees. The trainee that has produced the best poster at Brighton will also have a chance to win a place to attend the summer EFIM school camp. The day before the conference starts there will be a SCE revision session. I attended last year and found it extremely helpful! Looking forward to seeing you all in Brighton. In the meantime if you have any problems or suggestions please tweet or email me at the addresses below.