Purpose The purpose of this paper is to improve surgical antimicrobial prophylaxis (SAP) prescribing in orthopaedic surgery using the model for improvement framework. Design/methodology/approach Orthopaedic patients receiving joint replacements, hip fracture repairs or open-reduction internal-fixation procedures were included. Antimicrobial(s); dose, time of administration and duration of SAP were evaluated for appropriateness based on the local SAP guidelines. After baseline data collection, a driver diagram was constructed with interventions devised for plan-do-study-act cycles. Data were fed back weekly using a point prevalence design (PPD). Interventions included SAP guideline changes, reminders and tools to support key messages. Findings SAP in 168 orthopaedic surgeries from 15 June 2016 to 31 January 2017 was studied. Prescribing appropriateness improved from 20 to 78 per cent. Junior doctor changeover necessitated additional education and reminders. Practical implications Due to constant staff changeover; continuous data collection, communication, education and reminders are essential to ensure continuous compliance with clinical guidance. Patients with hip fractures are difficult to weigh, requiring weight estimation for weight-based antimicrobial dosing. Unintended consequences of interventions included the necessity to change pre-operative workflow to accommodate reconstitution time of additional antimicrobials and inadvertent continuation of new antimicrobials post-operatively. Originality/value Rather than perform the traditional retrospective focused audit, we established a prospective, continuous, interventional quality improvement (QI) project focusing on internal processes within the control of the project team with rapid cyclical changes and interventions. The weekly PPD was pragmatic and enabled the QI project to be sustained with no additional resources.

Introduction: Multimodal exercise training can ameliorate the physiological decline associated with ageing. This study aimed to investigate whether 12 weeks of a home-based online multimodal training and health education intervention could improve functional ability and perceptions of physical and mental health in middle-aged and older adults. Methods: Sixty-one male (N = 18, 59.1 ± 7.0 years) and female (N = 43, 60.9 ± 6.8 years) participants with various clinical conditions completed two 60-minute training sessions per week for 12 weeks delivered online via Zoom. All sessions included aerobic, resistance, balance, and flexibility exercises. One weekly session incorporated 15 minutes of health and fitness education. The pre/post testing sessions were conducted in a local community centre in line with COVID-19 public health guidelines. Paired samples t-tests and the Wilcoxon signed rank tests were utilised to compare scores pre and post intervention. Results: There were significant improvements in participants 6-minute walk (p < 0.0001), sitto-stand (p < 0.0001), timed-up-and-go (p < 0.0001), sit-and-reach (p < 0.0001), squat jump (p < 0.0001), core endurance (p < 0.0001), grip strength (right hand p = 0.03, left hand p = 0.04) and balance (right leg p < 0.0001, left leg p = 0.004) tests post intervention. Perceptions of physical (p < 0.0001) and mental (p < 0.0001) health also improved significantly. Discussion: Twelve weeks of online multimodal training and health education can significantly improve cardiovascular fitness, strength, power, balance, flexibility, and perceptions of physical health, mental health, and quality of life in middle-aged and older adults. While there are some limitations to online interventions, the benefits are numerous and equal to those reported for onsite interventions and should be considered for wider rollout in this population.

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Introduction:The deleterious effects of ageing and inactivity are compounded by the menopause which typically occurs in females aged 50+. The menopause is associated with unfavourable changes in body composition including decreased skeletal muscle mass, bone density and increased adipose tissue. This study aimed to determine the effects of a 6-week community-based intervention on nutrition knowledge and physical, metabolic, and cardiovascular health of women aged 50+ years.Methods: Nineteen participants (57 ± 6 years, 32.4 ± 7.2 kg/m 2 ) completed the intervention consisting of 2 hours of aerobic training (home-based / participant led), 2 hours of concurrent training (instructor led) and one 60-minute health workshop per week. General nutrition knowledge was assessed using an adapted validated questionnaire. Body weight, body mass index (BMI), body composition and waist circumference were measured pre and post intervention. Lower body strength endurance and cardiovascular endurance were assessed using sit-to-stand and 6-minute walk tests respectively. Point-of-care testing determined fasting glucose and lipid profile.Results: There were significant reductions in body weight (-2.2 ± 2.0 kg, p < 0.01), BMI (-0.9 ± 0.8 kg/m 2 , p < 0.05), percent body fat (-1.1 ± 0.5%, p < 0.05), waist circumference (-2.4 ± 0.5 cm, p < 0.05) and fasting glucose (-0.6 ± 0.8 mmol/L) post intervention. General nutrition knowledge score (5.8 ± 0.05, p < 0.05), 6-minute walk test (Mdn = 82.5, IQR = 49.5, p < 0.05) and sit-to-stand performance increased (11.5 ± 4.5 repetitions, p < 0.05) significantly.Discussion: This intervention successfully improved body weight, BMI, body fat percent, waist circumference, fasting glucose, general nutrition knowledge, cardiovascular fitness, and lower body strength of participants. Metabolic health improved with a trend towards improved cardiovascular health.

Current trends in the NHS promote patient rights including the right to accept or refuse surgery. Valid consent when the patient appears to have fluctuating competence can place theatre nurses in a difficult position. This article explores the legal framework in which the Department of Health consent forms work and looks at the NMC's Code of Professional Conduct for standards of practice.