bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Suicide and Homicide on Clinicians & Those Left Behind: A Survey of Current Experiences and Improvement of Practice
Authors: Elisha-Aboh Christiana , Laud Rose , Nightingale Sharon
Published: July 2023

Aims

Experiencing the death of a patient by suicide can be incredibly difficult, often associated with feelings of guilt and isolation, as doctors can hold themselves responsible. Most psychiatrists will be involved in a suicide/homicide on at least one occasion. This can lead to a variety of emotions and impact on clinical practice. The process of investigation can add to the overall stress of the incident and exacerbate the fear of legal retribution. Lack of support and understanding by an organisation may result in fewer discharges and increased defensive practice. Aimed at reviewing how supported involved clinicians feel following a serious untoward incident (SUI), including a suicide/homicide and consider improvement methods.

Methods

A webinar was organised with a guest speaker from Royal College of Psychiatrists, Dr Rachel Gibbons. Medical students and doctors across all grades were invited with 99 people in attendance. Anonymous feedback was received through survey monkey and analysed.

Results

55 respondents found the seminar either extremely or very helpful. 40 respondents wanted to attend a similar future webinar. Of the 57 respondents, 36.8% (n=21) had been involved in an SUI during their medical career. 16 respondents (48.8%) had been involved in a suicide or homicide. Roughly a third of doctors felt supported by colleagues during an SUI and 21% felt they were not supported. In comparison, only 17% felt they were well supported by the Trust and 25% felt they were not well supported by the Trust. The bulk of respondents indicated that family/friends and colleagues were the most helpful support mechanisms. Others found defence unions, Trust support and counselling helpful. Respondents found out about the SUI in the following ways: from another team member or colleague (52%), manager/supervisor (22%), Trust investigation team (22%) and reading patient notes (13%). A third were dissatisfied with the way the found out. Finding out from managers/supervisors is preferable. A limitation to interpreting the results is that there were more responses to questions than those involved in a suicide/homicide.

Conclusion

This webinar was well received and indicated that clinicians preferred to find out about an SUI in a controlled and supportive environment. It appears that the most helpful support came from family, friends and colleagues which suggests that the Trust could be doing more. Our recommendations included to raise awareness on the trusts new People Well-being lead and other resources available locally and nationally, while ensuring adequate senior pastoral support and encourage buddying systems.
Improvement of Ward Referral Quality to the Mental Health Liaison Service (MHLS), Antrim Area Hospital, Northern Ireland
Authors: Flynn Adam , Fleming Zarah , Huda Uzma
Published: July 2023

Aims

To achieve 90% of ward referrals to MHLS having adequate information provided on online referral system. To improve ward staff knowledge and confidence through education in order to empower them with ability to make appropriate and timely referrals.

Methods

Quality Improvement Project established at start of 2022 after discussion with MHLS with regards to referrals. MHLS acts at interface with acute medical wards and there were operational issues identified that could be improved. Driver diagram used to map these, to establish where intervention could be most effective. Lack of detailed referral often requires phone-call to the ward to seek further information, delaying patients’ assessment.

Criteria to be included on referral defined as: reason for referral, reason for admission, investigations performed, past psychiatric history, medications prescribed, and substance use history.

Two Plan Do Study Act (PDSA) cycles were established, the first in February 2022 that involved targeted lunchtime teaching of F1 doctors who are new to making referrals and may lack confidence.

Second PDSA cycle was established from December 2022 to January 2023 and focused on nursing staff as it was predominantly this cohort referring. A poster campaign on good practice and preferred information to be included in referrals was established on acute wards and discussed at nursing safety briefs. Data were then reanalysed.

We subsequently acquired data regarding wards which made the highest number of referrals and were able to specifically target the top ten as a third intervention. Further data collected end of January 2023.

Results

Reason for referral inclusion improved (95.07% to 96.43%). Reason for admission to hospital similarly (92.56% to 100%). Past Psychiatric History inclusion improved (14.88% to 27.91%). There was an improvement in inclusion of prescribed medication (16.53% to 42.86%). Relevant investigations being included improved (9.92% to 17.86%) and substance abuse history improved (16.53% to 42.86%).

Overall number of referrals from same time period the previous year reduced from 349 to 307 post-interventions.

Conclusion

Whilst some clear improvements have been noted, there are still significant barriers towards the relevant referral content being included.

However, from speaking to ward staff there is evidence that thinking has improved in terms of appropriateness of referral, supported by reduction in referral numbers. This is possibly an impact of visual poster prompts, teaching and face to face discussion with staff.

Further work to help sustain improvement could include questionnaires distributed to wards, input at medical changeovers and prompting document circulated via email to all Trust staff.
Improvement of Junior Doctor Handover in Holywell Hospital, Northern Ireland
Authors: Flynn Adam , Morrison Richard , O'Neill Ryan , Fulton Jill
Published: July 2023

Aims

To achieve 100% of digital handover records being completed by doctors at end of shifts in Holywell Hospital, Northern Ireland.

Methods

Transition to completion of digital handover record began in 2019. This was initially audited during 2020-2021 with slowly worsening results. After this, audit data were no longer recorded.

Since becoming trainee representative in February 2022, I investigated, along with my colleagues, reasons as to why this was not being completed nor being achieved. Reasons established included unaware of necessity, chronic culture of not being completed, a lack of access to shared drive and outside locums covering shifts as well as a higher percentage of doctors who were on shorter 4 month rotations. Literature review around junior doctor handovers in other sites was also completed and analysed.

A Plan Do Study Act (PDSA) cycle was subsequently established taking these factors into account from August 2022 to January 2023 with a focus on information sharing, training at specific junior doctor changeover points, liaising with administration to ensure adequate access to handover and regular audit and feedback amongst junior doctors.

Results

From a new baseline of 5.36% of digital handovers being completed in February 2022 there has initially been a gradual increase noted at April 2022 to (35.00%) remaining relatively static into August 2022 (25.81%). Some of this related to doctors not having requisite access to shared folder.

However, percentage completed increased substantially after August 2022 with better administrative support and from September 2022 (70.00%) to December 2022 (88.71%) and into January 2023 (91.94%) handovers were completed.

Conclusion

Through a combination of better information sharing amongst junior doctors, signposting to digital handover, improvement of early access to requisite folder and specific teaching regarding handover at induction at all changeovers, stressing importance of completion from clinical governance perspective, there has been a genuine sea-change amongst junior medical staff that has included taking better ownership of the process and shared responsibility for it being completed.

This record-keeping improvement has been stark and maintained for a prolonged period, particularly from September 2022 and is now averaging over 90% being completed. There remains some issues regarding access if shift being covered by an outside locum doctor and this would be next targeted area with the goal of achieving 100% record of digital handover occurring.
Development of a Multi-Disciplinary Team Memory Clinic Checklist: A Quality Improvement Project
Authors: Ginty Shona , Loo Jiann Lin , Tereza Salvador Olivio , Bhattacharyya Sarmishtha
Published: July 2023

Aims

Although “to err is human”, human error in medical practice can be costly for both patients and the healthcare organisation. Different preventive methods have been developed and one of the approaches is the use of checklist. The conceptualisation of this quality improvement project (QIP) came about after a near-miss prescribing error occurred in the memory clinic. Therefore, the Memory Clinic Multi-disciplinary Team (MDT) Checklist has been created to make the documentation process of diagnosis, investigation, and treatment more systematic and structured, which will in turn reduce the risk of errors associated with it. The checklist is separated into the subtype of Initial Assessment and Follow Up. This article is aimed to share the outcome of the QIP.

Methods

The QIP was carried using the Plan-Do-Study-Act (PDSA) model. Version 1 of the checklist was made based on the guidance from the National Institute of Clinical Excellence (NICE) guideline NG97, which was tried in the Memory Clinic MDT discussion of Older Person Mental Health Community Team of Wrexham Maelor Hospital (OPCMHT WMH), Betsi Cadwaladr University Health Board (BCUHB). Microsoft Forms survey was performed to capture the feedback from the junior doctors using the checklist. The following five properties were ranked using a five-point Likert scale (with one as the lowest and five as the highest): ease of use, time efficiency, environmentally friendly, capturing important information and space availability. The checklist was then updated based on the qualitative feedback and PDSA cycle was repeated until the feedback was rated more than 4/5 on average for all domains.

Results

Two PDSA cycles were needed to reach the version that was rated as more than 4/5 on average for all domains and the final version of the checklist was accepted as the completed version, i.e. the Version 3. There was a significant improvement in the ease of use, time efficiency, environmentally friendly and space availability. All versions of the Memory Clinic MDT checklists were good for capturing important information but not performing well for the other domains.

Conclusion

The Memory Clinic MDT Checklist are now fully in use in OPCMHT WMH BCUHB. Long term evaluation is still required to maximise the efficiency of the checklist. There is further plan of expanding the use of checklist in different memory clinic of BCUHB.
Getting Better: How Well Are We Assessing and Managing Anxiety Disorders in Community Camhs?
Authors: Greenstone Harriet , Prentice Juliet , Matone Luciana
Published: July 2023

Aims

Anxiety disorders are a common presenting problem for young people under the care of Melksham Community CAMHS. Guidelines from NICE outline recommendations for best practice in assessment and treatment of these disorders. A local gap analysis in 2017 identified areas for improvement in assessment of anxiety disorders. Measures were implemented following this, including training for staff. A repeat audit was conducted in 2021 and results compared.

Methods

NICE guidelines were used to set audit standards, which were used for data collection in both 2017 and 2021. A proforma was developed. A pilot sample of five patients was used to test the proforma. A cut off of 80% compliance was used. Caseload screening by clinicians was used to identify all eligible patients, then a random sample of these was selected by the project leads. Case note review was then conducted. Patients with a diagnosis of autism were excluded from the sample. ROMS, SDQ, GAD-7 or general clinical observation was used as a measure of treatment response. In total in the 2021 sample, 22 patient records were audited.

Results

Treatment and follow up for anxiety disorders was good or excellent in 2017 and remained so in 2021. Areas for improvement lay in the assessment of anxiety disorder. In the 2017 audit, there was poor documentation of: mental health history (this had improved from unacceptable to good by 2021), past treatments (improved from unacceptable to requires improvement by 2021), family history (improved from unacceptable to good by 2021), domestic violence/CSA (improved from unacceptable to requires improvement by 2021). Response to treatment was inconsistently documented in the 2017 audit. In 2021 there remained some inconsistencies in documentation. Improvements in recording response to treatment would assist with clearly evidencing compliance with the NICE standards.

Conclusion

Overall, treatment and follow up for anxiety disorders was good or excellent (and remained so in 2021). Areas for improvement lay in the assessment of anxiety disorder. Recommendations to promote ongoing improvement include: 1) Circulation of re-audit results to the team 2) Brief recap of guidelines on assessment of social anxiety disorder to the team 3) Written/ email reminder to consider and document the other areas that received less than 80% compliance 4) Continue use of ROMS. Effective assessment and management of anxiety disorder is an important area of clinical practice for all clinicians in the team; we would recommend this is re assessed in 2023 to ensure standards continue to improve.
Quality Improvement Project to Improve Management of Disclosed Sexual Assault in the General Adult Inpatient Population
Authors: Halton Katie , Maguire Cormac , Bruce Ailsa
Published: July 2023

Aims

This quality improvement project aimed to improve mental health professionals' understanding and confidence in management and support of patients in the general adult inpatient setting who have disclosed sexual assault. It also aimed to improve patients' experience of support following their disclosure of sexual assault.

Methods

Baseline knowledge and understanding was evaluated using an anonymous questionnaire sent to staff.

Stakeholders were identified from medical, nursing, police, FME and third sector agencies and patient advocacy – their expertise was utilised to develop standardised guidance.

The intervention included an education session delivered at site-wide teaching, and the creation of a procedure with associated resources for staff reference.

Teaching sessions and guidance were based on this expertise to fill knowledge gaps identified in the baseline knowledge questionnaire.

The questionnaire was subsequently redistributed and collected to analyse for an improvement in knowledge and confidence.

Results

Initial questionnaires presented qualitative and quantitative data suggesting lack of confidence and understanding of the processes involved in reporting and management of disclosed sexual assault.

Post-intervention dataset analysis shows an improvement in staff understanding, confidence and access to appropriate resources in management of sexual assault in the general adult inpatient population.

Conclusion

Prior to the project there was no protocol for the management of disclosed sexual assault in the local general adult inpatient population.

This left uncertainty amongst staff regarding the appropriate steps to take. This resulted in an increased risk of crucial time windows not being considered associated with a potential loss of evidence.

The Quality Improvement project improved staff confidence regarding management of disclosed sexual assaults thus optimising patient outcomes and experience when reporting assault.
Meeting the Needs of Asylum Seekers & Refugees: The Norfolk Experience
Authors: Hameed Yasir , Fox Hannah , Clegg Izobel , Roupa Eirini Charami , Haq Maham , Rayala Meghana , Ahmed Ahmed
Published: July 2023

Aims

As the number of forced migrants continues to raise every year due to conflicts, wars, climate change, and other factors, mental health services need to find innovative and new solutions to meet the needs of these vulnerable groups. We present here our experience of establishing the first mental health clinic for asylum seekers and refugees in Norwich, Norfolk (United Kingdom).

Methods

The clinic was established as part of the Advancing Mental Health Equalities QI Collaborative, which the Royal College of Psychiatrists launched to reduce barriers to accessing mental health services for disadvantaged populations. QI methodology was used to promote equality, increase access and improve outcomes over the next three years.

The monthly clinic has no funding and is run by a consultant psychiatrist (Yasir Hameed) and GP (Hannah Fox). Two research assistant psychologists offered the administration support. Another assistant psychologist and two core trainees joined the small team to offer reviews and follow-ups for the patients.

The monthly clinics are based away from the mental health settings (as some patients might be reluctant to attend these clinics) and are held in a friendly well-being hub run by the MIND organisation close to the city centre, which is easily accessible.

The clinic receives referrals from primary care, social services, charity organisations (such as the British Red Cross), Well-being service (Psychological Therapies), and inpatient and Community Mental Health Teams.

The clinic aimed to offer a person-centred, trauma-informed approach and improve the communication between services (through regular meetings with various services on a monthly basis), and enable access to appropriate treatment.

In addition, the team of the clinic run drop-in session in local hotels where asylum seekers are housed to talk about mental health and access mental health services.

Finally, the clinic offered training opportunities in transcultural psychiatry and working with interpreters.

Results

Between March 2022 to January 2023, 40 referrals were received, mainly from primary care.

Nearly 20% had a diagnosis of PTSD.

We followed nearly half of these patients in the clinic in subsequent visits and worked closely with the psychological therapy to refer patients for appropriate therapies.

Conclusion

The clinic improved the access of forced migrants to comprehensive, trauma-focused mental health assessments and improved communication and collaboration amongst services. It provided training opportunities. The drop-in sessions were a great opportunity to meet asylum seekers in their accommodation. Lessons learned and full data analysis will be shared in the poster.
A Quality Improvement Project Reviewing the Quality of Information Included in Discharge Summaries Sent to General Practitioners (GPs) From a Home Treatment Team (HTT) in an Inner London Borough
Authors: Harding Fiona , Garvey Rebecca , Constable Giles
Published: July 2023

Aims

To improve the quality of the information included in discharge summaries to GPs from HTT. To gather the views of local GPs as to what constitutes a good discharge summary. To streamline the process for creating the discharge summaries by developing a proforma, incorporating the views of local GPs.

Methods

1.

A cross sectional analysis of discharge summaries sent by HTT was performed.

2.

Each summary was assessed if they included certain information and the reader also made comments.

3.

A questionnaire was sent to local GPs asking for feedback on discharge summaries they had received.

4.

The information from the cross sectional analysis and questionnaire were used to create a discharge summary proforma.

5.

The findings and proforma were presented to the HTT. The team brainstormed further ideas which were incorporated in to the proforma.

6.

The proforma was sent to the team to begin using.

7.

The cross sectional analysis was repeated 6 weeks later.

Results

Initial cross sectional analysis:

46 patients (2 excluded).

25% of patients were discharged to the GP.

Over 80% contained all the information required.

Common issues included copy and pasting large amounts of irrelevant information, missing information, use of a lot of abbreviations with no explanation, unclear discharge medication, unclear discharge plans and not specifying who would prescribe.

GP questionnaire:

8 respondents. All GPs felt that they would want a brief summary of treatment, discharge medication (with any changes highlighted) and a plan with actions for the GP. They also felt that details of follow up with contact details for the community team would be useful. Brevity was mentioned as being of key importance, as was explaining abbreviations.

Second cross sectional analysis:

31 patients (6 excluded).

8% of patients were discharged to the GP.

12% of summaries had fully utilised the proforma and a further 16% had partially utilised it. With regards to the summaries not using the proforma the results were variable. The summaries which either fully or partially used the proforma covered all information screened for and were noted to be informative and easy to read.

Conclusion

A discharge summary proforma created using direct GP feedback is a useful tool to cover all the relevant information however the uptake of use of the proforma was poor. The reasons for the poor uptake would benefit from further assessment with a view to improving it further.
The Creation of a MEED Score Calculator to Aid MEED Score Completion in Patients With Eating Disorders
Authors: Hayward Simon
Published: July 2023

Aims

The Medical Emergencies in Eating Disorders (MEED) guidelines include a scoring system, the MEED Score, which is an all-age risk assessment of the physical safety and risk to life of patients with eating disorders. Accurate MEED Scores are therefore fundamental for patient safety. However, MEED Scores can be timely and confusing for unfamiliar professionals. The MEED Score Calculator is a spreadsheet consisting of a colour-coded table with each MEED Score category. Red, Amber and Green are selected based on the described parameter and totals are automatically calculated. Additional “Background and Instructions” and “Medical Management” pages explain how to use the calculator and how to manage medical issues arising from MEED Scores. The aims of the MEED Score Calculator project are to: 1) Increase confidence amongst healthcare professionals completing MEED Scores 2) Increase efficiency of completing MEED Scores

Methods

•

A preliminary survey questioning MEED Score confidence and efficiency was sent to healthcare professionals who complete MEED scores

•

The MEED Score Calculator was created using Microsoft Excel

•

Upon completion of the survey, the MEED Score Calculator was distributed via email

•

Three months later, the secondary survey was sent to users, focusing on calculator use and the impact on MEED Scoring efficiency and confidence

Results

•

20 participants completed the preliminary survey

•

10 participants completed the secondary survey

•

60% of respondents now use the MEED Score Calculator when completing MEED Scores

•

0% prefer not using the calculator (40% haven't completed a MEED Score since having Calculator access)

•

60% of respondents report increased confidence completing MEED Scores

•

89% of respondents report reduced time spent completing MEED Scores

•

*Result collection ongoing

Conclusion

The MEED Score Calculator increases confidence and efficiency of MEED scoring amongst healthcare professionals, achieving both aims.

Furthermore, due to positive feedback from eating disorder professionals, the MEED Score Calculator was included in the Kernow Local Medical Committee newsletter to raise awareness amongst Cornwall GPs. It is also due to be added to local clinical referral guidelines for GP referrals to eating disorder services. Additionally, we aim to make further improvements to the Calculator based on user feedback.

We hope for knowledge of this simple tool to spread throughout relevant primary and secondary care settings, making MEED Scoring more accessible and quicker for healthcare professionals. We anticipate that with this, we will see improvement in the robustness of physical monitoring and the quality of referrals. Thus, reducing risk of adverse physical health outcomes in this vulnerable cohort.
Understanding Trainees’ Current Likelihood of Raising Concerns
Authors: Ibbett Vicki , Padda Manjinder , Thomas Katie , Harsh Rajendra , Davies Sian , Mirza Tabassum , Hubbard Katherine , Gul Ainy , Kulman Khadija , Fatima Marium , Shaw Amy , Kulman Ella , Saeed Razan , Pantall Shay-Anne , Scally Ruth
Published: July 2023

Aims

Raising concerns is a duty for all doctors. However, a scoping exercise within a large mental health Trust demonstrated that trainees experience difficulties in raising both patient safety and training concerns. As part of a trainee-led quality improvement (QI) project within this Trust, our aim was to develop a pulse survey to capture the current likelihood of trainees raising concerns and factors influencing this.

Methods

An online survey was developed using ‘plan do study act’ (PDSA) methodology. The initial draft was informed by data from the Autumn 2021 scoping exercise. The survey was refined using a collaborative trainee-led approach. It was tested by trainees involved in the QI project followed by two other trainees and was revised accordingly.

Trainees across all training grades were invited to complete the survey through various communication channels. The pulse survey will be repeated monthly with a two-week response window.

Results

Ten trainees out of 103 responded to the first pulse survey open from 18th to 31st January 2023 (response rate 9.7%). Seven respondents were core trainees and three were higher trainees.

Respondents were more likely to raise patient safety concerns than training concerns (average score of 3.8 out of 5, where 5 equals ‘very likely’, versus 3.4 out of 5 respectively). Of the three respondents who had experienced a patient safety concern in the past 2 weeks, only two had used any existing process to raise it. These data were replicated for training concerns.

No respondents were confident that effective action would be taken if they raised a training concern, while less than half of respondents were confident that effective action would be taken if it were a patient safety concern.

The reasons for the low response rate are likely varied. However, there may be some similar underlying reasons for low engagement in surveys and low engagement in raising concerns. Given this, a more negative picture of trainees’ likelihood of raising concerns may have been portrayed if more trainees engaged in the survey.

Conclusion

Engaging trainees to provide insight into their likelihood of raising concerns is challenging. Despite the low response rate, this initial pulse survey demonstrated that trainees continue to experience barriers to raising concerns. PDSA methodology will continue to be used to optimise the monthly pulse survey response rate. The key QI outcome measures will also be integrated into pre and post intervention surveys as a pragmatic approach to evaluate specific change ideas.
Reviewing the Effectiveness of Clozapine Monitoring in Community Patients: Including the Monitoring of Physical Health Through Blood Monitoring & Reporting of Side Effects
Authors: Kahtoon Amina , Pathania Sangram
Published: July 2023

Aims

Clozapine is an atypical antipsychotic used mainly in treatment resistant schizophrenia. Clozapine is known to have various side effects including neutropenia, agranulocytosis, constipation, hypersalivation, myoclonus, tachycardia, dry mouth, gastrointestinal reflux, and hypotension. Therefore, it is important that patients have regular monitoring of their physical health through blood tests and side effect monitoring. The Glasgow anti-psychotic side effect questionnaire allows patients to report side effects whilst on clozapine. This can then be used to review patients’ symptoms and treat them as required. The aim of our project was to review compliance of current blood monitoring of patients on clozapine with NICE guidelines and elucidate the effectiveness of the Glasgow anti-psychotic questionnaire in reporting of side-effects. Thirdly, we aimed to introduce a robust new monitoring system to ensure that clozapine monitoring was optimum.

Methods

Compliance of the current blood monitoring was checked by reviewing the blood results for all 68 patients on clozapine. The latest blood results were compared to observe if they were within the required timeframe as per NICE. Secondly, the Glasgow antipsychotic questionnaire was distributed to patients on clozapine and then data collated. Following, this a new computer spreadsheet monitoring system was introduced to improve compliance. This allowed patients with overdue monitoring to be flagged up.

Results

The overall compliance for the various blood parameters varied from 3% to 100% (glucose- 3%, prolactin- 19%, lipid profile- 68%, HbA1c- 69%, liver function- 72%, renal function- 74%, and full blood count- 100%). Following the introduction of a new monitoring system the overall compliance improved as follows (glucose- 8%, prolactin- 32%, lipid profile- 81%, HbA1c- 61%, liver function- 90%, renal function- 88% and full blood count- 100%). We observed a 41% uptake of the Glasgow antipsychotic questionnaire. The most common reported side effects included hypersalivation (86%), GI side effects (nausea and gastric reflux- 64%), postural hypotension (56%) and anticholinergic side effects (blurry vision and dry mouth- 46%).

Conclusion

The findings show that the previous system was not effective. The introduction of a computer-based spreadsheet to flag up patients for clozapine monitoring has substantiality improved compliance with guidelines. The Glasgow anti-psychotic self-reporting questionnaire is effective in allowing patients to report the symptoms that they are experiencing. These changes continue to be utilised in our team.
Improving Patient ECG Experience Within Perinatal Mental Health and Enabling Better Antipsychotic Physical Health Monitoring
Authors: Kendall Cameron , Livesey Emma , Arnold Sally
Published: July 2023

Aims

An ECG should be undertaken as part of physical health monitoring for newly admitted patients and as part of antipsychotic initiation and monitoring. This project compared patient experience between a traditional 12 lead ECG and a 6 lead hand held ECG device (KardiaMobile 6L device). The intention was to make ECGs within perinatal mental health better tolerated, subsequently improving physical health monitoring. On our mother and baby unit, patients were reluctant to expose the chest area to have a 12 lead ECG performed due to factors including breastfeeding and feeling self-conscious about postnatal body changes. Inability to perform 12 lead ECGs, due to lack of patient consent, increased the chance of antipsychotic prescribing without baseline monitoring. We sought to find an alternative, more acceptable way to monitor physical health in this cohort, so we could improve the safety of prescribing medications and patient care as a whole.

Methods

Data were gathered prospectively over a three-month period, on our eight-bed perinatal inpatient unit. Each patient had a 12 lead ECG performed on admission and then a hand held 6 lead ECG performed for monitoring purposes. Patients with pre-existing cardiac comorbidities were excluded. All ECGs were interpreted by a trained clinician, and patients provided formal feedback on their experience of having a traditional 12 lead ECG and a handheld ECG undertaken.

Results

14 patients were included. All preferred the hand held ECG compared to the traditional 12 lead. Patients felt the 12 lead ECG was intrusive, describing feelings of anxiety and being uncomfortable, particularly with the amount of wires and stickers required. With the hand held device patients felt more relaxed, found the procedure easier to have done, and that it was quicker to be undertaken. All agreed they would be more likely to have regular ECGs performed if it was with the hand held device.

Conclusion

Although a 12 lead ECG is gold standard, in patients who decline a traditional ECG, this handheld ECG would be a safer alternative rather than no ECG being undertaken.

Patient feedback is overwhelmingly positive towards the use of the handheld ECG device, particularly as less body exposure is needed. In addition the shorter time to undertake an ECG is advantageous within the perinatal setting, as mothers are also busy caring for their infants.

The greater acceptability in this cohort should lead to better physical health monitoring, both improving patient experience and prescribing safety.
Clear Records: Exploring Patient and Staff Experience of Ward Rounds to Inform and Improve Ward Round Communication and Documentation
Authors: McKnight Rebecca , Singh Neeti , Ali Imran , Hooley Robyn
Published: July 2023

Aims

1.

To improve ward round efficacy and efficiency.

2.

To make ward rounds more patient informed and create an updated ward round patient “preparation sheet”.

3.

To improve collaboration and communication between the multidisciplinary team (MDT).

4.

To review and modify ward round/Care Programme Approach (CPA) proformas.

Methods

1.

Quality Improvement training was delivered to the MDT.

2.

An anonymous Likert scale survey was completed by the MDT (n=10), to gather views on ward round experience and documentation.

3.

Patients: 2 interactive, breakout sessions (n=4) were facilitated to:

•

Explore their experience of ward rounds through discussion and Likert scale questionnaires (n=4).

•

Review the existing patient preparation sheet and coproduce a revised version.

4.

MDT: 4 interactive, breakout sessions were facilitated with staff (n=10) to create a:

•

Process map of ward rounds.

•

Fish bone diagram of the challenges within ward rounds.

•

Reverse fish bone diagram, to consider solutions.

•

Revised ward round and nursing proformas.

5.

A driver diagram was developed to generate change ideas.

6.

A scoping exercise was completed, comparing ward round proformas within the rehab division, to consider areas of best practice.

7.

A Plan Do Study Act (PDSA) cycle was initiated.

Results

1.

Patient discussion and questionnaire feedback re: ward round experience was positive. Patients felt “respected”, “supported,” “understood team roles” and “plans” within ward rounds.

2.

Patients mostly agreed with the current format of the patient preparation sheet, however wanted a visual prompt, for their recovery areas. A diagram, “My recovery wheel”, was designed, to include diet, hobbies, mood, exercise, substances etc.

3.

Staff felt “respected”, and “listened to” and “understood their roles” in the staff survey; MDT proformas and time keeping were highlighted as requiring improvement.

4.

The fishbone diagram identified challenges within: staffing, procedural factors, time, resources/equipment, training and education, communication, proformas and patient engagement.

5.

New, succinct, MDT ward round proformas were designed, with focus on rehab goals, in order to facilitate the patient journey and discharge pathway.

6.

A ward round prompt sheet for the chair was created.

Conclusion

1.

Both MDT and patients feel largely positive re: ward round experience.

2.

The improved patient preparation sheet is more patient centred, after being co-produced with patients.

3.

The MDT highlighted multifactorial challenges pertaining to ward rounds running in an efficacious and efficient manner.

4.

The next cycle of the project will focus on testing the new forms and change ideas.
Increasing the Efficiency Of Community Mental Health Team (CMHT) MDT Meetings in Birmingham & Solihull Mental Health NHS Foundation Trust (BSMFT)
Authors: Menon Anannya , Sain Kallol
Published: July 2023

Aims

Multidisciplinary team (MDT) meetings provide a timely opportunity per week where a range of professionals involved in the service user's care come together to discuss patients and make an informed decisions as a team. With an increase in psychiatry community mental health team (CMHT) caseload (referrals in March 2021 were +5%), it is paramount we think of more efficient ways of running routine CMHT practises. Our aim was to identify the inefficiencies that surround the Aston & Nechelle's weekly MDT meetings & derive feasible modifications to make the protected team discussion time more efficient.

Methods

The PDSA (Plan-Do-Study-Act) cycle quality improvement methodology was used. A mixed qualitative & quantitative methodology was utilised. An observational study was carried out pre-intervention by two new members over 20 MDT meetings. Qualitative data were collected by identifying the key delays in MDT. Comparison of pre-intervention & post-intervention efficiency was established by quantifying the percentage of MDTs overrunning their allocated time. Satisfaction of the MDT members (n=10) with the new practise was also recorded via a questionnaire post-intervention. Our data collectors identified three main primary drivers: Systems, process & documentation.

Results

The interventions under process included a structured agenda, table of patients for discussion & allocating designated roles within MDT. The primary driver of System, focused on creating AccurX proformas as a way to ease the use of AccurX (an integrated software program in Rio for securely contacting patients) during MDT. MDT members were trained informally to use AccurX & Smartcard (NHS spine search for patient demographic details). Finally, a standardised documentation style was trialled by creating proformas with a streamlined set of options under each agenda.

Pre-intervention showed that >90% of MDTs were starting late & >50% were running over the allocated time. Post QI implementations, 80% of MDTs ran within allocated time. 90% of people found the MDT has increased efficiency, with 30% rating it as ‘very efficient’.

Conclusion

The current CMHT MDT meetings have scope for more efficient practises. We should consider feasible modifications in the realm of system, process & documentation as a stepping stone to increase efficiency. This QI project suggests benefits for the wider implementation of such interventions to other CMHTs within the area.
Remembering Your Memory Appointment! a Quality Improvement Project Looking to Improve the Attendance of Memory Assessment Service (MAS) Appointments in the East North East Older Peoples Services (ENE-OPS) of Leeds, Through the Formalisation of a Pathway
Authors: Michael Gabriel , Williams Jordan , Nightingale Sharon
Published: July 2023

Aims

After experiencing disappointment due to numerous patients not turning up to their memory assessment service (MAS) appointments as well as the effect of losing man-hours due to this we decided to investigate how best to improve the attendance rates of our MAS patients. The initial frustration occurred when several patients for multiple team members were not attending their appointments. When followed up they stated that they had not received the required letters or follow up telephone calls prompting them to attend their appointments. This led to the initial hypotheses that a formal structure was required in part to aid in the delivery of this service and improve attendance.

Methods

We initially investigated the percentage of patient's that did not attend their appointments from the period of August 2022 to December 2022. This was achieved utilising the trust's data collection team. From these initial raw data we processed and calculated the delay between appointment allocation and a letter being sent out as well as basic percentages of patients not attending each month. What we realised was that there was no strict average and our admin team were not aware of any pathway that they could utilise as a guideline for the management of patient appointments. We therefore outlined the overall process of the appointment pathway and formed this. Upon this foundation we subsequently ironed out the optimal points of contact between our admin team and patients and when this could be accomplished and documented. The aims of these points of contact overall was to improve the rates of patients not attending their appointments and improving our target of appointment attendance. We subsequently re-evaluated our patient attendance five months after the formation of the posters, which were affixed in the admin and memory nurse rooms at our base.

Results

The results overall were quite promising and did appear to show a change based upon the formalisation of the MAS appointment pathway.

Conclusion

The results showed a positive improvement to the attendance rate of the MAS patients and also demonstrated the empowerment that a team can have when a formal pathway is in place. This fully completed audit cycle demonstrated the importance of such a pathway and how to address what is often a multi-faceted problem for many community based services. Our conclusion appears to support our hypotheses that a formal pathway can often improve the provision of a service.
Increasing the Interval Between Anti-Psychotic Depot Injections for Service Users on 3-Weekly Injections: A Quality Improvement Project
Authors: Pandey Aditi , Hussain Parisah , Perumal Ruben , Khoury Marc El , Smith Clare
Published: July 2023

Aims

Our aim was to improve service user satisfaction by increasing the interval between their depot injections where clinically feasible. By doing this, we aimed to reduce attendance at the South Kensington and Chelsea Community Mental Health Team (SK&C CMHT) depot clinic by 25% over a period of 3 months, improving the workload for nurses running the clinic.

Methods

Our first baseline measure was data gathered about service user satisfaction with their depot. Our second baseline measure was the average number of service users attending the depot clinic per week between May and November 2022. The balance measure was a medical review 3 months post-interval change to ensure there were no negative impacts from this change.

10 service users on 3-weekly anti-psychotic depots were identified. Our team devised criteria to select service users who were appropriate for our project. This included: a stable mental state, minimal side effects on the current dose, no breakthrough symptoms, good engagement with the depot clinic, and scope to increase the current dose. These service users were discussed with their care coordinator, consultant and depot clinic nurse. If the criteria were met, the dose and interval change was discussed with our pharmacist. Finally, service users were consented and their depot charts were amended.

Results

The interval between depot injections for 2 service users was increased from 3 to 4 weeks on December 5th, 2022. The other 8 service users failed to meet the criteria set out in our methodology.

These 2 service users were asked to fill in a questionnaire on January 23rd, 2023. They reported that “it was not comfortable having an injection” and that “having it every 4 weeks was better” and “less hassle”. Their first medical review did not raise any safety concerns.

On average, 20 service users attend the SK&C CMHT depot clinic every week. There was no change in the average number of patients attending the depot clinic in the last two months as only 2 service users had their depot interval successfully altered.

Conclusion

Service users on depot injections can benefit from increasing the interval between their injections where clinically feasible. We would like to repeat this project for service users on 2-weekly depots and reassess if that makes an impact on satisfaction levels and attendance numbers at our depot clinic.
Community Mental Health Team (CMHT) Book Club: A Staff Well-being Improvement Project
Authors: Perumal Ruben , Hussain Parisah , Pandey Aditi , Smith Clare , Marriott Sarah
Published: July 2023

Aims

COVID-19 lockdown had reduced face-to-face interaction amongst staff with work-from-home and hybrid models adapted by most NHS organisations which had impacted team morale and reduced learning opportunities within the team. Book clubs are an effective way to enhance social process of learning especially in mental health. Our aims were to improve face-to-face interaction to boost morale within the Community Mental Health Team (CMHT) and increase the reading habit within the team around mental health fiction.

Methods

A questionnaire was sent initially to gauge interest on the idea of a book club and how it should be conducted. Next, we digitalised the book club with a WhatsApp group to facilitate discussion on selection of books and the first book was selected via polling (The Fat Lady Sings by Jacqueline Roy). After 4 weeks reading time, we gathered on a selected day (30th September 2022) for moderated discussions with potluck-style lunch. Anonymous feedback was collected via surveys. The cycle was repeated on 28th October 2022 (second book was Inheritance of Loss by Kiran Desai).

Results

Questionnaire to gauge interest and how the book club should be conducted revealed that the majority preferred a once-a-month discussion during working hours on a mental health and/or social care-related fiction of about 200-300 pages in length. The 8 respondents were made up of 6 doctors, 1 nurse and 1 social worker.

Feedback surveys on the impact of the book club on interaction with colleagues showed 30% improvement after the first book club (50% to 80%) and was 100% after the second cycle. Respondents also noted 60% improvement in interest in mental health-related fiction and 60% felt that the book club and discussions generated would help them in their day-to-day work in psychiatry (this figure rose to 100% after the second cycle).

Conclusion

Staff well-being is paramount to ensure staff satisfaction and reduce burnout. Initiatives to address this must be tailored to specific teams. It is also essential to encourage medical education in informal settings to create a culture of learning and improvement from healthcare professionals of diverse backgrounds.