Vaccination status of the adult sickle cell anaemia population: The South Wales experience

The Sickle Cell Society have issued standards for additional immunisations that adults with sickle cell disease (SCD) require. These include annual influenza, 5-yearly pneumococcal conjugate vaccine (PPV23) and Hepatitis B vaccination. Patients who have not received their primary vaccination as part of the national schedule in the UK should also receive further additional vaccines. We reviewed whether adults with SCD in South Wales currently receive these. 49 adult patients were identified as having SCD under the care of the Hereditary Anaemia Service based in the University Hospital of Wales, Cardiff. GP records were not available for 5 patients leaving a final cohort of 44 patients to analyse. Average age was 33 years (range 17-67). Median age was 27 with the cohort predominantly lying in the 17-29 year category (52%). Results showed good compliance with the annual influenza vaccine in those over 40 (>80%). However, compliance for the 17-29 category and 30-39 categories were 37.5% and 42.8%, respectively. The improved compliance in those >40 was not seen with the 5-yearly pneumococcal vaccine. Compliance was worse in all age groups compared to the annual flu vaccine with only 23% compliance overall. However, when looking at those who had received a single dose of PPV23, the numbers improved to nearly 60%. Compliance with the SARS-CoV2 vaccination was highest at 61.3%. However, rates were lower in the 17-29 and 30-39 age groups in keeping with previous trends. Only 34.1% of patients had full hepatitis B cover. Again, trends in compliance mirrored previous with poorer rates in those under 40. Assessing compliance for the remainder of the standards was more challenging given that we could not confirm retrospectively how many of our cohort had received their primary vaccinations in other parts of the UK, thought to be around half. However, most of the cohort had not received any additional vaccines suggesting high non-compliance regardless. This review looked at data from 2020 and likely reflects the impact of the SARS-CoV2, whether positive or negative. The reduced compliance in 5-yearly pneumococcal compared to flu suggest better health-professional education is needed;if patients are attending for their annual flu vaccine, there is ample opportunity to administer other vaccines. The vaccination rate for our patient group is comparable to national rates by ethnicity although lower than the national average for age. Vaccination rates for the SCD population of South Wales are not adequate. Better education and engagement is needed.

IMPACT OF INTERGENERATIONAL SERVICE LEARNING ON PSYCHOLOGICAL DISTRESS FOR HOMEBOUND OLDER ADULTS DURING COVID

More than 2 million of older adults are homebound and 5 million need help leaving their homes. They often experience social isolation, food insecurity, and lack of connection to community resources, which for many has intensified since the pandemic. To date, home-based services for those aging in place are lacking. Using newly available data, this study examined the benefits of an intergenerational home-based service learning program in reducing psychological distress for a community-based sample of 190 homebound older adults during the COVID-19 pandemic. Multivariate regression analyses were conducted to examine the association of living in one's own home, disability status, presence of child and spousal caregivers, and length of services from the program with psychological distress. Findings indicated that length of service with the intergenerational in-home support program was associated with lower psychological distress (β = -0.16, p < 0.05). Having a child as a caregiver was associated with lower psychological distress (β = -0.15, p < 0.05). Poor health status was associated with higher levels of psychological distress (β = 0.16, p < 0.05). Living in one's own home, having a spouse as a caregiver, disability status, and having a long-term medical condition were not associated with psychological distress in the analysis. Results from this study suggest that intergenerational in-home support services can help reduce psychological distress for homebound older adults. Policies and practice can support a pipeline of geriatric health professionals through innovative service learning models to benefit older adults, caregivers, and students.

Audit outcomes of the Referral Pathway for Haematology Patients to the Intensive Care Facility at the University Hospital of Wales During the COVID Pandemic

Patients with haematological conditions can become critically ill due to their underlying disease or secondary to treatment complications. The BSH published guidelines on the management and admission to intensive care unit (ICU) of critically ill adult patients with haematological malignancies in 2015 (Wise et al, BJHaem) Here we present the first published data on compliance with this guideline at the University Hospital of Wales, Cardiff. We performed a retrospective study of 30 haematology patients referred to ICU between September 2020 and July 2021. Patients were identified from an intensive care database and individual patient data were collected using patients medical records. The BSH audit template was used to evaluate the patient pathway. Additional data such as performance status, advanced care planning were assessed and are shown in the table below. All were monitored by NEWS score throughout admission. Referral to ICU was made by haematology registrars in 42%, medical registrars in 26% and haematology consultants in 32%. Sixteen (53%) patients had ICU reviews as part of planned discussions which occurred at a median of 23 (2-243) h of becoming unwell, whereas 14 (47%) patients were reviewed by ICU at the time of a crash call. Importantly, the majority (66%) of crash calls occurred outside normal working hours highlighting the importance of adequate out of hours (OOH) medical cover. With regards to communication, 68% of patients admitted to ICU had documentation with either patient or relative at the time of ICU admission. Of the patients referred, 19 (63%) were accepted for admission to the ICU. The average length of hospital stay prior to ICU admission was 17 days and the average length of stay in ICU was 5 (1-58) days. The majority of patients (68%) had sepsis and 14 (74%) required invasive ventilation. Eight cases were neutropenic and had a higher death rate of 75% compared with 55.6% of non-neutropenic patients. Overall, mortality rate during ICU stay was 68%. By contrast, in eight patients who were initially deferred but later accepted, the mortality rate was 75%. These patients were accepted for transfer to ICU typically 2-3 days after the initial deferral. Haematology inputs were documented in 89% of patients during the ICU stay. In summary, clear documentation of escalation plans and resuscitation status is essential to enabling prompt treatment decisions in a deteriorating patient. Our audit highlights the need for improvement in this area and we take lessons from medical admissions during the COVID pandemic where all patients have a clear escalation plan. The data also highlighted the majority of crash calls occurred OOH. A recent introduction of a remodified critical care outreach service, PART (patient at risk team) will be crucial for service development and coordination of care between ICU and haematology. In a COVID era regular ICU and haematology communication may be challenging thus virtual mortality and morbidity meetings can be helpful. Communication with patients and families is encouraged at all phases of care with more emphasis around the ICU admission. A re-audit is planned in 1 year to evaluate practice which will evaluate the additional benefit of the PART team in co-ordination of care. (Table Presented).