Successful Incorporation of a Plant-Based Menu Into a Large Academic Hospital

Unhealthy food choices and poor diet have a significant impact on development and progression of cardiovascular disease. Further, plant-based diets have been shown to mitigate cardiovascular risk factors and improve the health status of patients with cardiovascular disease. Currently, hospitals spend substantial healthcare dollars on food expenditures for inpatient services and recent pushes by the American Heart Association (AHA) and American College of Cardiology (ACC) encourage predominantly or full plant-based diets. The University of Florida has been one of the first institutions to incorporate a fully plant-based menu offering to their inpatient population. Herein, we discuss the program instituted at UF, the challenges faced while making this institutional change, and our solutions to these obstacles. The success of our plant-based initiative can serve as a foundation for other healthcare institutions to incorporate plant-based menu programs.

Patterns and predictors of smartphone ownership in a cardiology inpatient population

Introduction Mobile health (mHealth) interventions have grown in popularity, particularly for chronic disease management. Uptake of these interventions depends on patient smartphone ownership. Purpose To examine the smartphone ownership rate among cardiac inpatients and identify the associated demographic factors. Methods Between February 2019 and March 2020, 565 patients were screened for potential enrolment in the TeleClinical Care (TCC) pilot study at two hospitals in Australia. All patients had an admission diagnosis of acute coronary syndrome or heart failure. Mobile phone ownership was documented at the time of screening. Retrospectively, each patient's electronic medical record was examined for: age, sex, primary diagnosis, suburb of residence, private health insurance subscription, smoking status and occupation. Continuous variables were analysed using a multinomial logistic regression model. Categorical variables were analysed using a generalised linear model. Results Mobile phone ownership was documented for 523 patients (92.6%). 60.6% of all patients owned smartphones, and 14.9% owned basic mobile phones. 24.5% of patients did not own any mobile phone. The average age of participants was 70.8 years. Smartphone ownership rates were high among patients in the 18–49 (96%), 50–59 (89%) and 60–69 (85%) year groups. The differences between these groups were not statistically significant. In the age group 70–79 years, however, smartphone ownership fell to 56.5% (p<0.001, figure 1). The relative risk (RR) of not owning a smartphone increased by 12% for each additional year of age. Overall, smartphone ownership was less more common in women than men [79/179 (44.1%) vs. 238/344 (69.2%), RR 0.78, 95% CI 0.67–0.91, P=0.003, age-adjusted) driven by a difference in patients aged 70 or above [36/131 (27.5%) vs. 82/168 (48.9%), RR 0.66, 95% 0.49–0.90, p<0.001]. After adjustment for age and sex, patients with a primary diagnosis of ACS were more likely to own a smartphone compared to those with HF [227/316 (71.8%) vs. 90/207 (43.5%), RR 1.22, 95% CI 1.04–1.43, P=0.015]. Patients with private health insurance were more likely to own a smartphone than those who were uninsured [68.9% (162/235) v 54.0% (154/285), RR 1.28, 95% CI 1.13–1.43, P<0.001, figure 2). Smartphone ownership was significantly higher in those who were currently working, compared to those who were retired (117/119, 98.3% vs. 56/87, 64.3%, RR 0.76, 95% CI 0.64 – 0.89, P=0.001), even after adjustment for age. Patients living in the region with lowest average household income had the lowest rate of smartphone ownership (52.4%). There was no significant difference in smartphone ownership based on type of occupation. Conclusion Smartphone ownership was common in this inpatient population. Patients who are older, female and of lower socioeconomic background are less likely to own smartphones, and future mHealth programs should be cognizant of this. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Prince of Wales Hospital, Department of Cardiology Figure 1. Smartphone ownership by age Figure 2. Insurance status

Development of an algorithm for assessing fall risk in a Japanese inpatient population

Falling is a representative incident in hospitalization and can cause serious complications. In this study, we constructed an algorithm that nurses can use to easily recognize essential fall risk factors and appropriately perform an assessment. A total of 56,911 inpatients (non-fall, 56,673; fall; 238) hospitalized between October 2017 and September 2018 were used for the training dataset. Correlation coefficients, multivariable logistic regression analysis, and decision tree analysis were performed using 36 fall risk factors identified from inpatients. An algorithm was generated combining nine essential fall risk factors (delirium, fall history, use of a walking aid, stagger, impaired judgment/comprehension, muscle weakness of the lower limbs, night urination, use of sleeping drug, and presence of infusion route/tube). Moreover, fall risk level was conveniently classified into four groups (extra-high, high, moderate, and low) according to the priority of fall risk. Finally, we confirmed the reliability of the algorithm using a validation dataset that comprised 57,929 inpatients (non-fall, 57,695; fall, 234) hospitalized between October 2018 and September 2019. Using the newly created algorithm, clinical staff including nurses may be able to appropriately evaluate fall risk level and provide preventive interventions for individual inpatients.

Feasibility of the Menu Task Assessment in an Inpatient Population With Heart Failure

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The Menu Task Assessment is a brief, reliable, and valid functional cognitive assessment designed for use by OTs in both the acute- and the postacute-care environment. This poster describes the feasibility of its use in an inpatient heart failure population, as well as the prevalence of cognitive dysfunction and association between Menu Task Assessment score and discharge disposition. Primary Author and Speaker: Malachy James Clancy Additional Authors and Speakers: Megan Drollinger

Hyperammonemia in patients receiving valproic acid in the hospital setting: A retrospective review

Introduction Valproic acid (VPA) is widely used for the treatment of epilepsy, migraine, and a variety of psychiatric conditions. The reported incidences of hyperammonemia induced by VPA use is variable. The purpose of this study is to evaluate the incidence of VPA-induced hyperammonemia in the general adult inpatient population. Methods Adult patients who received at least 1 dose of VPA and derivatives between June 1, 2017 to December 31, 2017 were included. Patients were excluded if they did not have VPA administered during their inpatient stay or if they had elevated ammonia levels (>33 μmol/L) prior to initiation of VPA. Patients with a confirmed diagnosis of liver cirrhosis were also excluded. The primary endpoint was the incidence of hyperammonemia. Secondary outcomes included symptoms of hyperammonemia, diagnosis of VPA-induced hyperammonemia, and treatment of VPA-induced hyperammonemia. Results A total of 162 patients were included in this study. A total of 33 (20.4%) patients were identified as having the primary outcome of hyperammonemia; 26 (16.0%) patients had symptoms of hyperammonemia, and 13 (8.0%) patients were diagnosed with VPA-induced hyperammonemia. Treatment modalities included administration of lactulose, levocarnitine, discontinuing VPA, or decreasing the VPA dose. Discussion The administration of VPA in the general adult inpatient population resulted in a 20.4% incidence of hyperammonemia, with a lower rate of diagnosed VPA-induced hyperammonemia. Clinicians should be encouraged to obtain ammonia levels in patients receiving VPA if symptoms of altered mental status or encephalopathy develop.

Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation

Context: A proportion of UK hospital inpatients have palliative care needs but do not access specialist services. Objectives: To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population. Methods: Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans. Results: End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support. Conclusion: There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.

525 EVERYONE NEEDS TO POOP: REDUCING CONSTIPATION IN THE ELDERLY INPATIENT POPULATION

Introduction Due to a variety of factors when elderly patients are admitted to hospital they can become constipated. This can impact the entire admission increasing morbidity and mortality for what is a treatable problem. The aim therefore was to assess how prevalent constipation was across the inpatient population; analyse if there were any common themes and implement interventions that might help solve these. Method Data was collected over 15 days across the department (up to 87 patients) using nursing handover sheets to review the date bowels had last been opened. Patients were classified as constipated if they had not opened their bowels for more than 3 days. On two days common themes in the constipated patients were reviewed and analysed. On average 27% of patients were constipated. The majority of these had been deemed ‘Medically Ready for Discharge’. They all had either no or only a reduced range of aperients prescribed. Stakeholders including patients, nursing staff, prescribers and Consultants were surveyed. First cycle intervention was to highlight those constipated at morning Multi-disciplinary Team (MDT) meetings to prompt medical review. Second cycle intervention: an e-prescribing bundle was designed to allow for simple prescription and for nurses to give aperients on an as required basis. A laxative prescribing guide sheet was also written to aid prescribers. Results Aim is to reduce constipation to less than 20% thereby reducing morbidity and mortality in inpatients. Highlighting patients at MDT had little effect partly as it was person dependent. Effect of prescribing bundle yet to be determined but received positively by stakeholders. Prescribing guide received positively by Consultants and junior prescribers. Conclusions Person dependent intervention was ineffective at reducing constipation highlighted by staff sickness due to Covid-19. A prescribing bundle is more system based. If used at admission hopefully will be effective and sustainable.