to determine the prevalence and predictors of bedrail use in an acute hospital. overnight survey ... more to determine the prevalence and predictors of bedrail use in an acute hospital. overnight survey in a University teaching hospital. Three-hundred and twenty-seven beds and patients in 14 wards. data were collected on bedrail use and on the bed system, ward and patient characteristics. Medical, nursing and physical therapy notes were examined and the night and day nurses and, if necessary, the doctors and therapists caring for the patient interviewed to determine patients' diagnoses, functional and cognitive status. there were 133 (40.7%) beds with one or more raised rails. Independent predictors of bedrail use were use of electric profiling beds, confusion, reduced alertness and any difficulty with transferring from bed. The most common reported indication for bedrail use was 'to prevent rolling out of bed' (59%); 'to prevent getting out of bed' was recorded in 11% of cases. Use of bedrails was judged inappropriate in 27/133 (20.3%) patients and in 14/43 (32.6%) ...
Background Osteoporosis accounts for more disability-adjusted life years than many non-communicab... more Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Resu...
Background Orthogeriatric services have been shown to improve quality of care for older patients ... more Background Orthogeriatric services have been shown to improve quality of care for older patients post hip fracture and have an impact on length of stay (LOS), both acutely and in the rehab setting(1) but other key performance indicators (KPIs) have not been examined in detail. Methods Data was prospectively collected on all hip fracture patients seen by the Orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb 2018. We examined KPIs including LOS on the orthopaedic ward, rehab admissions, rehab LOS, new nursing home (NH) admissions. We compared the proportions discharged directly home instead of to convalescence, and conducted a preliminary cost benefit analysis. Results Similar numbers of patients were seen in each time period (n=146 v n=139). Mean reduction in LOS on the orthopedic ward was 3.5 days (15.5 days vs 19 days). The proportion of patients admitted to rehabilitation increased from 8.8% t...
Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best pra... more Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best practice tariffs incentivising compliance with the Irish Hip Fracture Standards (IHFS) have been introduced in Ireland(1). We compared levels of compliance to IHFS before and after introduction of a dedicated orthogeriatric service in a tertiary referral hospital. We also hypothesized that improved continuity of care by regular orthogeriatric review would result in less general medical consults to medical teams. We looked at the number of inpatient consults sent for each time period and compared the number of general medical consults sought by orthopaedic teams for similar time periods. Methods Data was prospectively collected on all hip fracture patients seen by the orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb2018. Results Similar numbers of patients were seen in each time period (n=146 v n=139) w...
night-time sedation prescribed during a hospital stay can result in long-term use of such medicat... more night-time sedation prescribed during a hospital stay can result in long-term use of such medications in older people. We examined the effectiveness of a multifaceted intervention to reduce night time sedation in an inpatient rehabilitation unit. an initial retrospective survey of night-time sedative use was followed by prospective re-evaluation after a number of changes were made including education of staff and of patients regarding the potential hazards of sedative medications, measures to promote sleep hygiene and facilitate a 'quiet time' after 10 pm and development of a withdrawal protocol for patients on long-term night sedation. The primary outcome measures were the proportions of patients started on night sedation in the unit and the proportion of those using night sedation where a dose reduction was attempted before and after the intervention. night sedation was prescribed for 22/68 (32.4%) subjects in the pre- and 23/169 (13.6%) subjects in the post-intervention s...
to determine the prevalence and predictors of bedrail use in an acute hospital. overnight survey ... more to determine the prevalence and predictors of bedrail use in an acute hospital. overnight survey in a University teaching hospital. Three-hundred and twenty-seven beds and patients in 14 wards. data were collected on bedrail use and on the bed system, ward and patient characteristics. Medical, nursing and physical therapy notes were examined and the night and day nurses and, if necessary, the doctors and therapists caring for the patient interviewed to determine patients' diagnoses, functional and cognitive status. there were 133 (40.7%) beds with one or more raised rails. Independent predictors of bedrail use were use of electric profiling beds, confusion, reduced alertness and any difficulty with transferring from bed. The most common reported indication for bedrail use was 'to prevent rolling out of bed' (59%); 'to prevent getting out of bed' was recorded in 11% of cases. Use of bedrails was judged inappropriate in 27/133 (20.3%) patients and in 14/43 (32.6%) ...
Background Osteoporosis accounts for more disability-adjusted life years than many non-communicab... more Background Osteoporosis accounts for more disability-adjusted life years than many non-communicable diseases. Identification and treatment is important to reduce morbidity and mortality associated with further fracture.(1) National Osteoporosis Guideline Group recommends all patients with a fragility fracture should undergo a bone health assessment and commence pharmacological therapy if indicated.(2) Methods Electronic discharge summaries of all patients with a diagnosis of fracture discharged from an off-site rehabilitation unit from 1st January 2018 to 31st December 2018 were reviewed. Patient details, location and mechanism of fracture, bone health assessment and discharge prescription were assessed. Following data collection, an education session directed at NCHDs was performed and a discharge checklist prompting bone health review and consideration of pharmacological therapy was introduced. A re-audit was performed at 4 months to assess change following this intervention. Resu...
Background Orthogeriatric services have been shown to improve quality of care for older patients ... more Background Orthogeriatric services have been shown to improve quality of care for older patients post hip fracture and have an impact on length of stay (LOS), both acutely and in the rehab setting(1) but other key performance indicators (KPIs) have not been examined in detail. Methods Data was prospectively collected on all hip fracture patients seen by the Orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb 2018. We examined KPIs including LOS on the orthopaedic ward, rehab admissions, rehab LOS, new nursing home (NH) admissions. We compared the proportions discharged directly home instead of to convalescence, and conducted a preliminary cost benefit analysis. Results Similar numbers of patients were seen in each time period (n=146 v n=139). Mean reduction in LOS on the orthopedic ward was 3.5 days (15.5 days vs 19 days). The proportion of patients admitted to rehabilitation increased from 8.8% t...
Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best pra... more Background Older patients post hip fracture benefit from specialist orthogeriatric care. Best practice tariffs incentivising compliance with the Irish Hip Fracture Standards (IHFS) have been introduced in Ireland(1). We compared levels of compliance to IHFS before and after introduction of a dedicated orthogeriatric service in a tertiary referral hospital. We also hypothesized that improved continuity of care by regular orthogeriatric review would result in less general medical consults to medical teams. We looked at the number of inpatient consults sent for each time period and compared the number of general medical consults sought by orthopaedic teams for similar time periods. Methods Data was prospectively collected on all hip fracture patients seen by the orthogeriatric service from Aug 2018-Feb 2019 and was retrospectively compared with patients admitted with hip fractures from Aug 2017-Feb2018. Results Similar numbers of patients were seen in each time period (n=146 v n=139) w...
night-time sedation prescribed during a hospital stay can result in long-term use of such medicat... more night-time sedation prescribed during a hospital stay can result in long-term use of such medications in older people. We examined the effectiveness of a multifaceted intervention to reduce night time sedation in an inpatient rehabilitation unit. an initial retrospective survey of night-time sedative use was followed by prospective re-evaluation after a number of changes were made including education of staff and of patients regarding the potential hazards of sedative medications, measures to promote sleep hygiene and facilitate a 'quiet time' after 10 pm and development of a withdrawal protocol for patients on long-term night sedation. The primary outcome measures were the proportions of patients started on night sedation in the unit and the proportion of those using night sedation where a dose reduction was attempted before and after the intervention. night sedation was prescribed for 22/68 (32.4%) subjects in the pre- and 23/169 (13.6%) subjects in the post-intervention s...
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Papers by Shaun O'Keeffe