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John Sands Award - 2010
Associate Professor Peter Greenberg, has been awarded the prestigious John Sands Medal for 2010 by the Royal Australasian College of Physicians.
This medal is awarded to Physicians in recognition of their outstanding service who have contributed significantly to the welfare of the College. In 2010 only seven medals were awarded across Australia and New Zealand.
A 'Best of Health Achieving Excellence Award 2007' was won by the General Medical Indicators Project in the category of Quality & Safety
This project has been a collaboration between CEHSEU and the Dept of General Medicine involving Dr Caroline Brand (Director, CEHSEU), A /Professor David Russell, Dr David Smallwood, Dr Simon Lam (all from the Department of Medicine), Alexandra Gorelik & Carol Roberts (both from CEHSEU)
The purpose of this project was to implement a set of process indicators (General Medical Indicator Sets) within the General Medicine Units to improve implementation of evidence into practice in order to support best patient health outcomes and evaluate their effectiveness.
The indicators needed to be relevant to clinicians, reflect opportunities for improving patient care, important for junior resident teaching purposes and incorporated easily into usual care.
Implementation strategies were multifaceted and evidence based and included academic detailing, education and orientation, posters and key tag cards and regular audit and feedback sessions.
The success of the project is evident in it being adopted and implemented by other Victorian hospitals and it has been proposed as the national GMIS by the Royal Australasian College of Physicians (RACP) and Internal Medicine Society for Australia and New Zealand.
Delirium management in older people: a medical record audit
27th September 2007 Grand Round Presentation
Presenter: Jo Tropea (Program Manager, CEHSEU)
Co-authors: Jo Slee (Project Officer, CEHSEU)
Alex Holmes (Psychiatrist, RMH)
Caroline Brand (Director, CEHSEU)
Following on from the unit's recent development of the 'Clinical Practice Guidelines for the Management of Delirium in Older People', an audit was conducted to assess the current practice around the management of delirium symptoms in older general medical and orthopaedic inpatients at RMH. More specifically the main aim of the audit was to assess to what extent the guideline recommendations for the management of severe behavioural and or emotional symptoms of delirium were being met.
A sample was obtained using ICD-10 discharge codes for delirium but excluded same day admissions, delirium tremens and terminal delirium. The data was collected by two reviewers with high inter rater reliability, using a newly developed data collection form. A total of 174 episodes of care were included in the audit; 102 (59%) have severe symptoms of delirium. Patients were aged between 66 - 96 years with two thirds being 80 years or over; and the majority were female (99, 57%) and were living at home (131, 75%).
On assessment of antipsychotic medications among those with severe symptoms of delirium (n=102), the main findings were:
- 67 patients (66%) were newly prescribed antipsychotic medication
- 34 patients were not
- 1 patient had the drug chart missing
- 16 commenced on the recommended low dose of antipsycotic medication
- Haloperidol (n=44) and olanzepine (n=42) were the antipsychotic medication types prescribed the most
- Very few had a medication plan documented at time of first antipschotic prescription (n=6)
- 33 patients had some form of medication review documented during the episode of care, but only 8 patients had regular review
This study provides valuable baseline information about what areas of practice are consistent with the guideline recommendations for the management of older people with severe behavioural and/or emotional symptoms of delirium, and highlights what areas should be the focus for future quality improvement activities.
The Clinical Practice Guidelines for the Management of Delirium in Older People can be accessed at: http://www.health.vic.gov.au/acute-agedcare/
For more information about this presentation please contact Jo Tropea Email: mailto:Joanne.Tropea@mh.org.au