European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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P-733
Vitamin D deficiency management in a medicine for elderly day
hospital
C. Osuafor 1, C.W. Fan1, M. MacMahon2, C. McGreevy 3, F. McCarthy1.
1Medicine for Elderly Day Hospital, St Mary’s Hospital, 2Clinical
Biochemistry and Endocrinology, Mater Misericordiae University
Hospital, 3Acute and Geriatric Medicine, Mater Misericordiae University
Hospital, Dublin, Ireland
Introduction: There has been no clear consensus on the assessment
and treatment of vitamin D deficiency prior to the publication of the
National Osteoporosis Society (NOS) Vitamin D Guideline. The aim of
our study was to assess our practice in a geriatric day hospital setting
relative to this guideline.
Methods: A 6-month retrospective analysis of all new patients aged
≥ 65 years who attended our day hospital for comprehensive geriatric
assessment was carried out. Assay method used for vitamin D
assessment was liquid chromatography-tandem mass spectrometry.
Results: 76 patients were included in the final analysis. Mean age was
83 years. Mean vitamin D level for females was 61.4 nmol/L while
mean vitamin D level for males was 51.7 nmol/L. 39 (51%) patients had
sufficient levels while 37 (49%) patients had insufficient levels; 14
(19%) being inadequate and 23 (30%) deficient. 18 patients who had
insufficient levels were subsequently prescribed supplements without
loading doses; 13 (72%) received vitamin D3 in combination with
calcium while 5 (28%) received vitamin D3 alone. None had adjusted
serum calcium checked at one month after starting therapy.
Key conclusions: Based on the findings of this study, we recommend
that all new patients in a geriatric assessment unit should have
vitamin D levels checked and action taken based on the result. Only
patients with previously low vitamin D level and started on
replacement should get repeat assessment as well as serum corrected
calcium in order to reduce unnecessary tests. We have also adopted
the NOS guideline.
P-734
An audit on warfarin dosage in a Maltese geriatric hospital
P. Zammit, M. Vassallo, A. Chilmeran, M. Almobaied. Department of
Geriatrics, Malta
The dosing and monitoring requirements of warfarin are unique,
due to the nature of its mechanism of action. Initially the patient is
usually loaded with warfarin, and importantly the effect of any dose
change will only be evident a minimum of two days later. Due to the
delay in the full clinical effect of the drug and the sensitive balance of
variables that can affect its action, the dosing of warfarin is difficult.
The consequences of inappropriate loading or dosing can lead to
the occurrence of preventable adverse events for the patient, and
prolonged length of hospital stay. Thus, guidelines for warfarin dosage
are of importance to follow.
An audit was done to see if guidelines for warfarin dosage are followed
at the main Maltese geriatric hospital. 36 patients in the hospital were
on warfarin when the data for the audit was collected. 25 were female
and 11 were male. Mean age was 79 years with a range of 31. The main
indication for warfarin was atrial fibrillation. 54.3% of patients had
INRs out of range. 72% had errors in the dosage whilst 69.4% had errors
in the interval for dosing. It was shown in this audit that the guidelines
are not being adhered to by the medical staff at the hospital. Several
recommendations were given to improve this in the future.
P-735
Defining and rating key dimensions of interprofessional teamwork
in acute geriatric units
R.D. Piers1, K. Versluys1, J. Devoghel 2, A. Vyt3, N. Van Den Noortgate1.
1Department of Geriatric Medicine, Ghent University Hospital, Ghent,
2Departement of Geriatric Medicine, St Jan Hospital Bruges-Ostend AV,
Brugges, 3Artevelde University College & University of Ghent, Ghent,
Belgium
Introduction: Interprofessional teamwork (ITW) is a cornerstone of
specialist geriatric care. However, research is lacking.
Methods: Perceptions of ITWamong healthcare providers (HCP) of 55
acute geriatric units in Belgium were measured, using a self-assess-
ment questionnaire consisting of 20 items based on Interprofessional
Practice and Education Quality Scales (IPEQS), a 6-item ethical
climate questionnaire and 3 validated items of the Patient Safety
questionnaire.
Results: 890 out of 1538 professionals returned the questionnaire.
More than 80% of HCP scored high on IPEQS items concerning ITW
competences, consultation, experiences and meetings, 70% on items
concerning management and results, less than 50% on items concern-
ing reflection and medical records supporting ITW. Only 50% of HCP
indicated that difficult patient cases are discussed and decided upon in
team. More than 70% often reports incidents of their own, 40% when
colleagues make mistakes. Factor analysis yielded a reduced model of
18 items, explaining 70% of the total variance. Six meaningful factors
were extracted, covering (1) actual ITW and consultation by staff, (2)
team reflection and feedback stimulated by management, (3) medical
records supporting ITW, (4) ethical reflection, (5) conviction, and (6)
incident reporting. The internal consistency of all factors was high
(α≥ 0.80), except for the last factor. The first 3 were rated equally by all
professional roles, reflectionwas rated higher by physicians, conviction
scores lowest by nurses and incident reporting lowest by paramedics.
Conclusions: Interprofessional teamwork in AGUs is satisfactory,
however reflective practice and medical records supporting ITWmerit
more attention.
P-736
Types of interprofessional teamwork in acute geriatric units and its
relation to patient and carers’ outcomes
R.D. Piers1, K. Versluys1, J. Devoghel 2, A. Vyt3, N. Van Den Noortgate1.
1Department of Geriatric Medicine, Ghent University Hospital, Ghent,
2Departement of Geriatric Medicine, St Jan Hospital Bruges-Ostend AV,
Brugges, 3Artevelde University College & University of Ghent, Ghent,
Belgium
Introduction: Interprofessional teamwork (ITW) is a cornerstone of
specialist geriatric care. However, research is lacking.
Methods: Perceptions of ITW, quality of patient care and intentional
jobleave among healthcare providers (HCP) of 55 acute geriatric units
in Belgium were measured, using a self-assessment questionnaire.
K-means clusteranalysis was used to determine types of ITW.
Results: 890 out of 1538 HCPs returned the questionnaire. Four
meaningful clusters were identified. Fourteen teams were categorized
as type 1 with HCPs perceiving that team members effectively
cooperate together, but perceive a lack of support of patient records
and management supporting ITW. Within type 2 (13 teams), HCP have
a strong belief that ITW is worthwhile, however they experience a lack
of support from their management. HCPs working in type 3 (21 teams)
indicate as strong elements management, patient records and incident
reporting, however the perception of effectively working together
is average. Within type 4 (7 teams) HCP gave the highest scores on
management stimulating ITW, however HCP least believe in the
strength of ITWand they gave the lowest scores on reporting incidents.
HCP from type 3 and 4 scored higher on perceived quality of care
compared to type 1 and 2 (mean score respectively 6.14, 5.99, 5.64,
5.57, p < 0.001). Intentional jobleave ranged from 20% in type 2, over
15% in type 1 and 3, to 6% in type 4 (p = 0.023).
Conclusion: We identified 4 meaningful types of ITW which are
related to patient and HCP outcomes; offering opportunities to
develop tailored interventions.
P-737
Efficacy of an integrated model of a protected discharge facility by
using domotic, robotic and telecare systems in hospitalized frail
older people: the MODIPRO project
A. Pilotto1, A. Cella1, M. Puntoni2, C. Patrone2, A. Verri3, N. Casiddu4,
A. Argusti2, C. Martini3, A. Barla 3, S. Pericu 4, C. Prete1, N. Rosso2,
Poster presentations / European Geriatric Medicine 7S1 (2016) S29–S259 S222