bluuebunny/crossref_metadata_2025 huggingface dataset:
The diagnosis and management of adult ADHD in HMP Elmley, a Category B remand prison
Authors: McCurdy Kathleen , Igbinomwanhia Nosa
Published: June 2021

Aims

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent disorder in young adult prisoners. This audit aimed to identify how many residents are prescribed medication treatment for ADHD in HMP Elmley and whether those seen by the prison psychiatrists have been managed in line with NICE guidelines. We also audited waiting times and time to follow-up appointments. This was done with the overall aim to identify potential areas for development.

Method

We performed a spot audit of all residents in HMP Elmley who were prescribed ADHD medication on 4th November 2019, using their electronic patient records. Appointments with the psychiatrists were then subdivided into initial assessments and follow-up appointments for the purpose of analysis. Performance was measured against NICE Guideline [NG87]: Attention deficit hyperactivity disorder: diagnosis and management. We also calculated the waiting times for initial appointment and follow-up appointment.

Result

We found that 33 of residents were on ADHD medication at the time of the audit, approximately 3% of the prison population. 64% of those had a pre-existing diagnosis and 36% had been given a new diagnosis at HMP Elmley. Of those newly diagnosed 100% had undergone a Diagnostic Interview for Adults in ADHD (DIVA) assessment for diagnosis.

Baseline physical health checks had been performed in 68% of patients prior to starting medication and a cardiovascular examination had occurred in 9%. At follow-up 100% of patients had their physical observations and weight checked and their symptoms reviewed.

91% of patients were started on methylphenidate or lisdexamfetamine as first line treatment, with the rest started on atomoxetine and the reason for this documented.

100% patients were offered general psychological support.

There was a mean 22 day wait for an initial appointment (range 0-65) and a mean 20 day wait from starting medication to a psychiatric follow-up appointment (range 8-37)

Conclusion

The number of residents treated for ADHD in HMP Elmley is relatively low (3%) compared to the estimated prevalence in prison population.

The key areas for improvement are in baseline cardiovascular examinations and physical health evaluations. The waiting time between initial psychiatric appointment and follow-up is another area where improvement is needed and this will form the basis of a quality improvement project.

Future steps include setting up a specific ADHD clinic with an allocated nurse practitioner to support, producing a template for ADHD assessments and follow-ups, producing a local policy on ADHD and developing specific resources for ADHD psychoeducation.
Audit of inpatient smoking cessation advice
Authors: Mohamed Flensham , Bader Mohamed
Published: June 2021

Aims

Audit carried out to assess whether or not patients had been asked about their smoking status during admission onto an acute adult mental health ward, as well as if they had received any smoking cessation advice or offered nicotine replacement therapy.

Background

•

Physical health outcomes in patients with serious mental illness (SMI) are consisitently worse than the general public This is due to multiple factors; adverse effects of medication (including metabolic syndromes with psychotropics) as well as poor lifestyle factors such as smoking status

•

Patients with an SMI are 3–6 times more likely to die due to coronary artery disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease.

•

Smoking cessation is a potent modifiable risk factor that can prevent mortality and reduce morbidity.

Method

A cross-sectional review of all 34 inpatients across four general adult acute psychiatric wards.

Patient records were explored using the Aneuran Bevan Health Board admission proformas to identify evidence of smoking status and whether advice was offered.

Result

Smoker but not given cessation advice n = 13 (38%)

Not asked about smoking n = 11 (32%)

Smoker and given cessation advice n = 4 (12%)

Non-smoker n = 6 (18%)

Conclusion

Patients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers (identified smokers and patients not asked about smoking status).

A consideration to be taken into account is that on admission, a patient's physical health status may be unknown, with the additional difficulty of a patient's acute distress complicating the physical examination, smoking status and modification of patient's smoking status may not be the highest priory in that context.

Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status.

There is a lack of smoking cessation literature available on the wards and patients are often unaware of what options are available to quit smoking.

The audit simply determined whether or not assessors were documenting smoking status, it does not measure the quantity or quality of smoking cessation advice provided.

Further quality improvement projects should be launched, with focus groups as the intial step at further investigating inpatient smoking rates, as well as attempting to reduce them in a more systemic way.
Audit of physical health monitoring in a forensic psychiatric community caseload
Authors: Sud Neeti , Lacey Michael
Published: June 2021

Aims

Adherence to Cumbria Northumberland Tyne and Wear NHS Foundation (CNTW) Trust physical health monitoring guidelines for a caseload of community forensic psychiatry patients residing at Westbridge supported accommodation was audited to identify areas for improvement in practice. It was also our aim to highlight the delay in obtaining non-urgent investigations due to the need to minimize COVID infection transmission risks.

Method

Data were collected from mental health and acute trust electronic records (Rio and ICE) of all patients taking antipsychotic medications currently care coordinated by the Westbridge Forensic Community Mental Health Team (FCMHT) between January 2020 and January 2021 (8 patients). Analysis of compliance with standards set by Trust guidelines was made.

Result

In the chosen audit period, compliance with physical health monitoring standards was below target of 100% (80% compliance for bloods, 50% for ECG). Reasons for non-compliance were unexpected restrictions in service availability (e.g. temporary closure of walk-in ECG clinic) and one omission of sending a prolactin levels request.

Conclusion

The need for practice adaptation and advance planning by team in anticipation of potential delays was identified. Request for routine bloods and ECGs will now be made two months before the annual due dates to compensate for delays in the new process with plan to continue re-audit yearly.
Audit of antipsychotic prescribing and monitoring for the management of behavioural and psychological symptoms of dementia
Authors: Thomas Catrin , Bhattacharyya Sharmi , Bond Elizabeth
Published: June 2021

Aims

To assess the use of a piloted shorter version of the local Checklist for Antipsychotic Initiation and Review (CAIR) form by an Older Persons Community Mental Health Team (OPCMHT), and to assess whether the National Institute for Health and Care Excellence (NICE) guideline on use of antipsychotics for the management of behavioural and psychological symptoms of dementia (BPSD) is being adhered to.

Method

Retrospective audit analysing notes of all patients currently open to the OPCMHT that are prescribed an antipsychotic medication for the management of BPSD. Patients with a diagnosis of any subtype of dementia and prescribed any antipsychotic were included. Data collected from paper notes using an audit proforma.

Result

The total number of patients was 11. The most common diagnosis was Alzheimer's disease (45%), followed by mixed type dementia (36%), vascular dementia (9%) and Lewy Body dementia (9%). The majority of the patients reside in their own home (64%) whilst the remaining 36% reside in a residential home for the elderly and mentally infirm. The CAIR form was present in 73% of the patient's notes, however only 37% had the new, piloted, shorter version of the CAIR form. Of the CAIR forms present, only 63% were fully completed. There was documented evidence that 100% of patients had an assessment of underlying causes of their challenging behaviour; that non-pharmacological interventions were tried first; and that target symptoms were identified. There was evidence of a discussion with the patient or carer about the risks and benefits of antipsychotic use for all patients, however the details of the discussion was often vague. All patients had a review of the antipsychotic medication within the last three months.

Conclusion

There was evidence that pre-prescribing assessments are being undertaken for all patients. There needs to be clearer documentation of the discussions had with patients and carers about the risks and benefits of using antipsychotic medications for management of BPSD. A teaching session was held at the team meeting to highlight the risks and benefits. The team will ensure that they provide a health board approved leaflet to each patient and carer following their discussion. Only 73% of the patients had a CAIR form in their notes and the team favour the original version. The team will revert back to using the original version of the CAIR form as it has more space allocated to document ongoing reviews. We will re-audit in 6 months time.
On-call medical seclusion reviews: are we meeting MHA code of practice (COP) requirements?
Authors: Turner Oliver , Leung David
Published: June 2021

Aims

Are Junior Trainee, Medical Seclusion Reviews complaint with MHA COP Criteria?

Objectives

Are we seeing newly secluded patients on time?

Are we documenting these reviews in clinical notes?

Do documented reviews meet criteria stated by the MHA COP 26.133?

Are we informing Higher Trainees of the need for MDT reviews?

Background

Seclusion is an important aspect of inpatient care. MHA COP Chapter 26 provides guidance for documenting seclusion reviews, ensuring safeguards are in place to protect patient's safety and human rights. Secluded patients require a medical review within 1 hour, and four hourly thereafter, until a higher trainee or Consultant undertake an MDT Review. In our Trust, LYPFT, trainees undertake these reviews. There is noted discrepancy in seclusion review documentation. This audit identifies our compliance with time limits, and whether documentation meets the required criteria in the MHA Code of Practice

Method

Our Sample includes all Out-of-Hour Junior Trainee Medical Seclusion Reviews between 01/01/20 and 01/04/20 at LYPFT. Seclusions were identified from on call logs, and clinical notes were reviewed for a documented seclusion review. The date and time of seclusion are recorded, whether a 1 or 4 hourly review, and the time of review. We recorded any mention of: physical health; mental state; observation levels; recent medication; medication side effects; risk to others; risk to self and the need for ongoing seclusion.

Result

56 episodes of seclusion were identified; all 56 had a documented medical seclusion review. 49 reviews were on time, 4 were late with a documented reason, and 3 were late without. There was documentation of the Higher Trainee being informed in 53 reviews.

No seclusion reviews mentioned all MHA COP criteria. We more frequently mentioned patients’ physical health (51), psychiatric health (52) and need for seclusion (54). 46 seclusion reviews mentioned risk of harm to others; only 3 mentioned risk of self-harm. 25 seclusion reviews mentioned medication, and 5 mentioned review for side effects. 5 seclusion reviews mentioned observation levels.

Conclusion

Our Junior Doctor Seclusion Reviews were not meeting the MHA Code of Practice Criteria, and we believe this to largely be due to lack of awareness of the standards. As such, results have been disseminated to Junior trainees in weekly teaching. We created a medical seclusion review template, adopted by the Trust, to ensure documentation compliance with the MHA COP. Junior doctor inductions now include a presentation regarding Seclusion, the reviews and documentation. We will re-audit in 12 months.
Reducing high dose antipsychotic therapy (HDAT) in a community mental health team (CMHT)
Authors: Walsh Richard , Patel Sonn , Loddo Valentina , Fahy Rebecca , Walsh Elizabeth
Published: June 2021

Aims

The consensus statement (CR190) of The Royal College of Psychiatrists states that the benefit of prescribing HDAT does not outweigh the risk of the increased side effect burden. HDAT is defined as the “daily dose of a single antipsychotic exceeding the upper limit for that drug as stated in the Summary of Product Characteristic (SPC) or British National Formulary (BNF),” and as the cumulative daily dose of two or more antipsychotics (for combined prescription). The prevalence of HDAT has been shown to vary widely and protocols for monitoring poorly implemented. In 2018 we completed a baseline survey of the prevalence of HDAT within our CMHT. We assessed our prescribing practice as compared to seven best practice audit criteria, which were adopted. Our aim is to resurvey closing the audit loop to 1) establish the current prevalence of HDAT and 2) assess the impact the intervention on prescribing practice.

Method

Multi-disciplinary case notes for all registered patients were studied. A database was created including sociodemographic details, chart diagnosis, and medication. The proportion of patients prescribed antipsychotic medication was identified. The dose of each medication was converted into a percentage of BNF maximum recommended dose for that drug. For combined antipsychotic prescription, the cumulative dose was obtained adding the single percentages together. Exceeding 100% was regarded as HDAT. All HDAT patients were assessed against identified audit criteria as outlined by the Humber NHS Foundation Trust.

Result

Of a total of 246 patients, 177 (72%) were prescribed antipsychotic medication. Of these, 14 (8%) were in receipt of HDAT. This compared to 68% prescribed antipsychotics and 9% in receipt of HDAT in the baseline audit. The average cumulative dose for every category (oral medication, depot and both) was calculated with a range from 1% to 168% (mean = 70%) for oral antipsychotic (single/combined), 1% to 193% (mean = 50%) for depots and 20% to 257% (mean = 95%) for combination of oral and depot. This compares with ranges of 1.6% to 215% (mean = 44.3%) for oral antipsychotic (single/combined), 0.04% to 100% (mean = 25.8%) for depots and 21% to 425% (mean = 119.6%) for combination of oral and depot in the baseline audit. Similar to the baseline survey no patient met all seven audit criteria but there was better adherence overall with best practice guidance. Blood and ECG monitoring were the most consistent parameters measured.

Conclusion

Lower HDAT was achieved post intervention. Results, whilst positive, indicate the need for ongoing audit to maintain best standards.
A brief novel intervention for acrophobia (fear of heights)
Authors: Smith E. Naomi
Published: June 2021

Objective

To investigate a unique brief intervention, which offers a combination of neuro-linguistic programming and practical graded exposure therapy, to overcome a fear of heights.

Background

A fear of heights or acrophobia is common and often deters people from perusing activities like climbing. It can also interfere with routine activities of daily living.

Case report

This two-day intervention is set in the Peak District (Derbyshire, UK) and works with a maximum of eight individuals to four instructors. The first half-day involves working with a psychotherapist using neurolinguistic programing techniques. The next 1.5 days involves graded exposure using abseiling over gradually increasing heights, to a final height of approximately 40 feet.

Discussion

All eight individuals on the two-day course felt their fear of highs had significantly decreased. All eight individuals would recommend this intervention to others suffering from a fear of heights.

Conclusion

It is noteworthy that the group undergoing this intervention were self-selected and highly motivated to overcome their fear of heights. The sample size was small and outcome measures were subjective. However, this is a novel and effective approach to helping people overcome their fear of heights. Further research with larger sample sizes would be beneficial in further assessing the impact of this intervention.

Declaration: Permission was granted by the organizers of this intervention to submit an abstract to conference. There are no conflicts of interests. This intervention is run by a private company ‘Will4Adventure’, I have no finical or other interests in this company. I privately funded my own place on this course.
The person behind the label: co-production as a tool in teaching about borderline personality disorder
Authors: Adwok Nyakomi , Nightingale Sharon
Published: June 2021

Aims

The overarching aim of the session was to address and reduce stigma around Borderline Personality Disorder among doctors. The three main objectives were:

To increase empathy and understanding around Borderline Personality Disorder by exposing junior doctors to service user perspectives outside a clinical setting;

To address knowledge gaps identified by junior doctors in a self-reported questionnaire disseminated prior to the teaching session;

To offer junior doctors a basic psychological framework to base their assessment and formulation of service users with personality disorders.

Background

‘Borderline Personality Disorder: The Person Behind the Label’ was the title of the first co-produced teaching session in the Leeds and York Partnership Foundation Trust (LYPFT). Prior to the teaching session, an online questionnaire was sent out to trainees. The results highlighted three key issues:

Negative attitudes towards service users with personality disorders;

Poor subjective knowledge of the psychological models of personality disorders;

Perception among trainees that they do not receive adequate training to deal with the challenges service users with personality disorders present.

Method

A teaching session was co-produced by a team of two service users, a principal clinical psychologist within the Leeds Personality Disorder Network (PDN) and a core Psychiatry trainee. It was delivered in a 75 minute session to 40 attendees consisting of both trainee doctors and consultants.

Result

Feedback was collected immediately after the session through the use of anonymous feedback forms. The response to the training was overwhelmingly positive with all 28 respondents rating the session as 4/5 or 5/5 on a satisfaction scale ranging from 1 (poor) to excellent (5). Key themes from the feedback included appreciation for the service user perspective and teaching on psychological theory. The fourth question in the questionnaire: “How will this teaching impact your work?” produced the highest number of responses (25/28) and provided evidence that the above listed objectives of the session were met.

Conclusion

Co-produced teaching has great potential to address negative attitudes around highly stigmatised conditions by bridging the gap that often exists between service users and mental health professionals.
Virtual clinical examinations: are they the new ‘normal'?
Authors: Barakat Mahmoud , Slevin Hannah , Nijjar Reshmi , Ramamurthy Kavitha , Hackett Latha , Mahadevan Dushyanthan
Published: June 2021

Aims

The North West School of Psychiatry run a yearly structured clinical examination to help Core Psychiatry Trainees develop their training competencies and prepare for the MRCPsych Clinical Assessment of Skills and Competencies (CASC). Historically, this has been face-to-face with logistical difficulties, high cost, low trainee uptake and challenging in recruiting examiners. Following the COVID-19 pandemic and the subsequent shift to virtual consultations and examinations, the team implemented an innovative virtual Skills test. The main aims were to improve the test's quality and the trainee uptake, adapt the test delivery to a Health Education England (HEE) online platform, and establish cost-effectiveness in the post-COVID world.

Method

A working group was formed to develop the Skills test, and in May 2019, the test was delivered face-to-face, implementing 5 cycles of 8 stations over 3 days. The same group adapted the test for online delivery, and in August 2020, 3 cycles of 8 stations were delivered. Feedback was collected, with adaptations made for a second Skills Test in December 2020.

Result

96.4% of trainees rated their overall experience and the test organisation in the 2019 test as excellent or good (82.1% and 85.7 excellent, respectively). 93.5% of examiners rated their overall experience and the test organisation as excellent or good (45.1% excellent for both). In the August test, 95.8% of trainees rated their overall experience as excellent or good (58.3% excellent). 100% of trainees rated the test organisation and the online format as excellent or good (70.8% and 50% excellent, respectively). Although 100% of examiners rated the overall experience, the test organisation and online format as excellent or good, some felt the stations were not long enough to allow for technical issues. In the December test, higher proportions of trainees rated the overall experience (80%), organisation of the test (80%) and online format (70%) as excellent.

Conclusion

The virtual test is shown to be a viable and successful alternative to the face-to-face test in preparing trainees for their CASC, and trainees felt it was excellent preparation for the new online CASC format. It had some clear advantages, such as saving on consumables, reducing the financial costs of running the test, improving the test quality, and increasing the trainee uptake. It is more eco-friendly and reduces fuel emission, raising the question of how the test should be delivered after the COVID-19 pandemic.
Improving quality of psychiatry training in Northern Ireland through the introduction of postgraduate education fellows
Authors: Boucher Catherine , Connolly Roisin , Doris Michael , Gorman Colin , McMorran Michael , Sheridan Aisling
Published: June 2021

Aims

To improve postgraduate psychiatry education and training in Northern Ireland.

Background

Historically within Northern Ireland there has been a postgraduate Member of the Royal College of Psychiatrists (MRCPsych) teaching programme delivered to core trainees in preparation for MRCPsych examinations. There has been no official teaching programme for higher trainees. Northern Ireland Medical and Dental Training Agency (NIMDTA), in collaboration with the Royal College of Psychiatrists in Northern Ireland and all five Trusts developed the novel idea of introducing Postgraduate Education Fellows, to oversee and improve core training, and to develop a bespoke higher training programme.

The Postgraduate Education Fellows met to collate information from various sources in relation to issues within the current teaching programme and address these along with the development of new initiatives. The fellows further act as a point of contact for all trainees within their Trust to provide advice and support with education if needed.

Method

One higher trainee was appointed to the role of Postgraduate Education Fellow in each Trust within the NIMDTA deanery for a term of 1 year.

The starting point was delivering the pre-established teaching timetable and gaining feedback from core trainees to identify areas for improvement. The next phase involved piloting traditional and contemporary methods of feedback. A further development was designing a mock paper A delivered under exam conditions. Two mock Clinical Assessment of Skills and Competencies (CASC) exams were organised under exam conditions, offering other trainees the opportunity to act as simulated patients and examiners.

The third aspect of this role involved creating a programme of higher trainee seminars. Baseline data were collated and identified key areas that higher trainees felt they needed further training and guidance in.

Result

Using baseline data on the current teaching programme and from higher trainees as well as incorporating quality improvement methodology, we have been making small changes to each aspect of the teaching programme and evaluating the changes made. The feedback from trainees has been positive as evidenced by quantitative and qualitative feedback. 8 candidates sat our first mock CASC with a 100% pass rate in their MRCPsych CASC examination. There has been a positive response to the higher trainee seminar programme.

Conclusion

This programme has produced good outcomes to date and sets foundations for the future development of post graduate psychiatry education in Northern Ireland.
The blues, and an almost shocking surprise – Unexpected PE in a catatonic patient, that almost had ECT
Authors: Cheah Michael , Mohamed Ashma , Mathilakath Anand
Published: June 2021

Aims

To present a case of a near-miss, where an unexpected Pulmonary Embolism (PE) was identified in a patient with psychotic depression and catatonia, who almost had Electroconvulsive Therapy (ECT). Our aim is to highlight the importance of Venous-Thrombo Embolism (VTE) risk assessment in all psychiatric inpatients, particularly those with catatonia, and those about to undergo ECT.

Method

A 53-year-old female admitted with her first presentation of psychotic depression, catatonia, poor oral intake, and significant weight loss in the community for months prior to admission. She was recommended for emergency ECT as the severity of her self-neglect was becoming life threatening. Her first ECT session was cancelled due to low potassium levels prior to ECT, which proved to be a fortunate event. She developed sudden onset chest pain the next day, and following further medical investigations; was diagnosed to have a bilateral PE, and subsequently treated with Apixaban. Due to the potential risk of ECT dislodging the clots, treatment was done by optimising medication alone; Venlafaxine 300 mg, Mirtazapine 45 mg, Haloperidol 6 mg. She made a slow but successful recovery, and was discharged home, with ongoing support from Early Intervention in Psychosis services.

Result

We conducted a literature search, and it is well known that there is an increased risk of VTE in catatonic patients, as well as other psychiatric inpatients; due to anti-psychotic medication. Furthermore, cases have been reported where ECT was associated with increased risk of death in patients with known VTE/PE.

On retrospective review of the patient's risks of developing VTE in the community, it was clear, that she was at very high risk of developing VTE. It was also noted that she should have had a VTE risk assessment on admission, in accordance with NICE guidelines; where all acute psychiatric inpatients should have this assessed as soon as possible.

Conclusion

Through a process of assessment and treatment, VTE is often preventable. Identification of high-risk patients on admission to hospital is therefore crucial. It is thus, imperative that a comprehensive VTE risk assessment is completed on admission and regularly reviewed.

This case highlights the risk of missing VTE assessments in WAA Inpatients, particularly those with catatonia, about to undergo ECT, which could have been fatal. As such, VTE/PE risk assessment in such patients, about to undergo ECT, is particularly crucial.

Clinicians need to have a high index of suspicion of VTE/PE, particularly in patients with catatonia.
SW Neuronet – neuroscience for psychiatrists update day
Authors: Churchhouse Gabrielle , Sinclair Lindsey , Morris Simon George
Published: June 2021

Aims

The Royal College of Psychiatrists Neuroscience Project was established to promote greater integration of modern neuroscience into psychiatric training and practice. Regional “Neuronets” are being established to develop local learning opportunities. As the Southwest Neuronet, we sought to establish a high quality and sustainable regional educational event promoting modern neuroscience in psychiatry.

Method

We developed and ran two events in collaboration with the Neuroscience Project, a whole day in-person event in September 2019 and a half day online event in January 2021. Attendees were invited from the Southwest with the latter event being shared more widely through other “Neuronets”. Both featured talks by leading experts in the neuroscience of psychiatry. The first was themed around “Neuroscience from the lab to the clinic”, building on basic research methodologies to their applications in clinical psychiatry. Our pandemic era online event, “Neuroscience of psychosis”, was structured around an evolving clinical case. Both featured interactive elements using audience polling technology to gather views and collate questions. Feedback was gathered through an online survey with individual session ratings and event ratings.

Result

154 people attended the in-person event from across the South West Division. This included psychiatry trainees, consultants and a small number of other mental health professionals. 382 people signed up to our online event with 262 attending live and others watching recorded sessions. Feedback response rates were 42% and 33% respectively. Feedback on the practical arrangements was highly positive, particularly highlighting pre-event communication. Attendees valued the high calibre of speakers and particularly rated topics of psychiatric genetics, novel antidepressants, and autoimmune psychosis. Environmental sustainability was a prominent theme in our first event with support for our paperless approach but highlighted further potential to reduce waste associated with catering. Overall, attendees valued the opportunity to build on knowledge of basic research techniques but also wished to see greater focus on clinical applications of neuroscience, which we had responded to with the inclusion of a clinical case to frame our online event.

Conclusion

These events provide a prototype for low-cost regional neuroscience in psychiatry education events, in-person or online. Sustainability in terms of cost, human resources for organisation, and environmental impact are all important considerations for such events. We plan to continue to run these annually, forming part of the legacy of the Neuroscience Project. In line with feedback received, we seek to maximise the clinical relevance but also share novel research techniques encountered in the literature.
Evaluating adult forensic staff knowledge of olanzapine long-acting injection post injection syndrome: a service improvement project
Authors: Clark Annalie , Boyle Onagh , Farrell Suhanthini , Evans Catrin
Published: June 2021

Aims

Post injection syndrome (PIS) is a serious complication that can occur after Olanzapine Long Acting Injection (LAI). It can occur without any derangement in physical observations. It is important that patients are monitored appropriately following administration of Olanzapine LAI to ensure that symptoms of PIS are appropriately identified and managed. This project aimed to evaluate the current level of knowledge about PIS in two staff groups within an Adult Forensic Service – in-patient nursing staff and junior doctors and advanced practitioners (APs) providing medical cover to inpatient wards.

Method

Electronic surveys evaluating knowledge about the symptoms of PIS, monitoring requirements and management of possible PIS were circulated to inpatient nursing staff, junior doctors and APs working within an Adult Forensic Service in the North West of England.

Result

1) Nursing staff knowledge – 26 nursing staff completed the survey. 4.5% of nurses correctly identified all symptoms of PIS and 72.7% believed that tachycardia or hypotension occur in PIS. 22.7% of nurses identified the correct management plan if a patient feels unwell following Olanzapine LAI. 40.9% would only request a medical review if physical observations were abnormal. 2) Junior doctor and AP knowledge – 6 doctors and 6 advanced practitioners completed the survey. 17% of doctors and APs correctly identified all symptoms of PIS. 50% believed hypotension or tachycardia were symptoms of PIS. 25% of doctors and APs identified correct management of PIS and 16.7% believed that the patient should be managed on the psychiatric ward unless physical observations became abnormal.

Conclusion

Levels of knowledge about the symptoms and management of PIS are low within this Adult Forensic Service. Knowledge of PIS and management of suspected PIS needs to be improved in nursing staff, junior doctors and advanced practitioners to ensure correct identification and safe management. In response to these findings, a care plan for monitoring of patients after Olanzapine LAI was developed. This included a structured monitoring proforma for completion post depot administration and instructions for managing suspected PIS. This care plan is kept in the front of the drug chart of all patients prescribed Olanzapine LAI. One-page educational summaries on PIS were written and circulated to nursing staff, junior doctors and APs. Information on Olanzapine LAI use and PIS were included in junior doctor induction materials and on-call handbook, to improve trainee awareness and knowledge.
Bridging the gap – MTI experience to an excellent MTI experience – An experiential, theme driven, concordance verifying study
Authors: Enara Arun , Garg Kabir , Kanchana Ramachandran
Published: June 2021

Aims

To collate experiences of international medical graduates (trained psychiatrists) on the Medical Training Initiative (MTI) and equivalent programs (International Medical Fellowship (IMF)/CESR Fellowships) in the United Kingdom and to understand shared themes.

Method

Three psychiatrists with the experience of being part of MTI/IMF program, for a minimum of 1 year, participated in theme guided, focussed discussions to understand common experiences. These discussion where limited to 3 broad headings. Opportunities to grow, what we wish the college knew and what we wished the trusts and supervisors knew. The experiential accounts were captured and circulated among a group of 20 MTI/IMF/CESR fellowship doctors and rated on a 5 point Likert scale varying between strongly agree to strongly disagree.

Result

The findings suggest that the expectations and experiences of the psychiatrists on such programs share some common themes. Most of them had varied experiences under the theme ‘opportunities to grow’. The suggestions for what these doctors ‘wished the trusts, college and supervisors knew’ had a good concordance among the 20 doctors who reviewed the themes and suggestions. The details of the themes and commonalities will be discussed at the conference.

Conclusion

The expectations and experiences of the doctors on MTI/equivalent program share common themes. Bridging the gap between MTI experience to an excellent MTI experience would involve identifying such shared experiences, that could potentially guide development of processes, thereby making these training fellowships better tailored to each trainee.
Regional survey into trainee experience of core psychotherapy training
Authors: Evans Lauren , Belam Georgia
Published: June 2021

Aims

This project aims to assess the experience of psychiatry core trainees who have undertaken core psychotherapy training (CPT), to identify what is experienced positively and potential areas of improvement.

Background

Psychotherapy is an necessary part of core psychiatry training, requiring one short and one long case to complete core training.

Method

An anonymous online survey was drafted, containing both qualitative and quantitative questions, to assess trainees experiences of CPT. It was circulated via Trust email (locally) and Twitter (nationally).

Result

A total of 35 responses were received: 21 core trainees, 12 higher trainees, 1 consultant, and 1 staff grade doctor. 6 respondents had completed a short case only; 2 a long case only; 25 both; and 2 neither.

Confidence in psychotherapy knowledge was rated on a 1–5 scale (1: significantly below average to 5: significantly above average). Theoretical knowledge improved from a 2.57 average before CPT to 3.63 following, and clinical application improved from 2.43 before to 3.66 following.

Knowledge prior to delivering CPT was most commonly obtained from Balint group (71.4% of respondents) and MRCPsych courses (65.7%).

The main barriers to obtaining psychotherapy experience were: accessing supervision (60.0% of respondents); not enough patients (53.3%); and a lack of guidelines on accessing supervision and patients (43.3%). Additionally, getting time away from day jobs was identified as a concern, particularly among LTFT trainees.

Important learning points from CPT identified by trainees were: knowledge of psychoanalytic concepts, such as transference and counter-transference; differences between the theoretical models; an alternative approach to formulation; and how these skills can be useful in all clinical encounters, such as maintaining rapport, boundaries, and time-keeping. The useful role of supervision was also highlighted.

Conclusion

This project serves as an introductory look into how trainees view their experience of CPT, and potential areas for improvement.

Themes for improvement, arising from qualitative responses, are: clear reading list, including introductory materials; clear guidelines at induction, including supervisor contact details; improved access to supervision; patients to be allocated; protected time for psychotherapy, with extra support for LTFTs; shadowing; increased choice of modality; and more formal teaching on psychotherapy. These are key areas to be targeted to improve the trainee experience, particularly for those who risk delays in their training.
Evaluating virtual role play based learning to improve the confidence and competence of Junior Doctors undertaking on call shifts in inpatient Psychiatry
Authors: Gardner Katherine
Published: June 2021

Aims

To enable junior doctors to practice their clinical skills in managing psychiatric emergencies via virtual role plays, and to gain confidence and competence in their skills in acute psychiatry. Lecture based learning about psychiatric emergencies is a part of the induction programme for all junior doctors starting their placements however practical learning and practice of skills in this area is not. The COVID-19 pandemic has further exacerbated this issue by providing an additional challenge to the delivery of face to face teaching for junior doctors both in clinical and educational settings.

Method

The author offered a virtual role play based teaching session to two cohorts of Junior Doctors (GP trainees and foundation trainees) who were starting their psychiatric hospital placements at Surrey and Borders Partnership. The virtual sessions were conducted over Microsoft teams. This session had been run once before as face to face teaching (F2F) in January 2019 (N = 9) prior to the COVID-19 pandemic. Data from this session were compared to data obtained from the virtual sessions in November 2020 and January 2021 (N = 16).

Pre and post study questionnaires were administered via Microsoft Forms. Each session lasted 1 hour and consisted of 3 different role play scenarios based around acute psychiatric emergencies. One junior doctor volunteer acted as the ‘patient’ in each scenario and another volunteer as the ‘doctor’. The other participants all acted as observers. Each scenario lasted 10 minutes with ten minutes for feedback from the researcher afterwards using the ALOBA framework.

Categorical, ordinal data were collected using a Likert scale and general qualitative feedback was also gathered.

Result

The questionnaire return rate was 100% for F2F teaching and 57% for virtual teaching. 100% of participants felt that F2F role play was an acceptable way to practice skills in acute psychiatry vs 75% of participants who felt this about virtual role play. 100% of participants found that F2F role play was ‘quite’ or ‘very’ effective in improving their confidence and perceived competence in acute psychiatry vs 88% of participants who felt this about virtual role play.

Conclusion

Virtual role play based learning is an acceptable and effective method in improving the confidence and perceived competence of junior doctors undertaking on call shifts in inpatient psychiatry but it appears to be less effective than face to face role play based learning. The researcher will act upon the qualitative feedback obtained which suggested ways in which the virtual session could be improved.
Motivators and deterrents in choosing a career in psychiatry; making the most of psychiatry school events
Authors: Kazmi Nosheen , Lewis Emily , Rodrigues dos Santos Catarina Cardoso , Olety Sahana
Published: June 2021

Aims

In response to the Royal College of Psychiatrists’ recruitment strategy, a bi-annual Psychiatry School event was set up in the North West of England. The Psychiatry School aims to inspire medical students and foundation doctors to choose a career in Psychiatry with two days of workshops on different sub-specialties and various aspects of the career pathway. A previous service evaluation has shown attending the event improves attitudes towards psychiatry.

The aim is to assess whether improving attitudes to psychiatry has been sustained and gain a clearer understanding of the motivators and deterrents in choosing a career in Psychiatry to better inform future events.

Method

An online questionnaire about positive and negative aspects of psychiatry was sent to attendees of the Autumn North West Psychiatry School 2020 before and after the event.

Result

The total number of completed questionnaires was 62.

53.6% people were considering applying for core psychiatry training prior to the event and this rose to 85.3% in the post event questionnaire.

Motivators for a career in psychiatry prior to the event included having a better holistic understanding of patients and wide range of sub-specialities. There was a common theme of interest in research opportunities. Dynamic patient-doctor relationship, exploring issues in depth and treating diverse populations were key motivators.

It is encouraging to note that 100% responders felt their positive views on psychiatry were validated.

The majority of deterrents were disregarded and attendees felt positive about choosing a career in psychiatry.

Conclusion

Following the event, the only negative view on a career in Psychiatry was the concern about the potential impact on one's own mental health. This is an important issue (highlighted in the Royal College of Psychiatrists Position Statement) that deserves consideration at future events to highlight potential effects on Psychiatrists wellbeing and how these can be avoided or mitigated.

The wide variety of sub-specialities and opportunities for research were key areas that motivated attendees and we will continue to deliver engaging workshops around these themes.
An innovative method of expanding the support for doctors returning to training in psychiatry after a period of extended leave: the Sheffield Mindful Support Programme
Authors: Linnington Helen , Alhaj Hamid
Published: June 2021

Aims

To offer regular continuous professional development opportunities covering both clinical and non-clinical skills to trainees and trainers and enhance their experience and skills to increase their wellbeing and resilience.

Background

There are approximately 50,000 doctors undertaking postgraduate training in England. Of these, 10% (5000) are taking approved time out of training at any time. A 2017 HEE survey revealed that doctors returning to work reported numerous concerns. Based on these and with the backdrop of the Bawa-Gaba case HEE's Supported return to Training programme (SuppoRTT) was developed.

We at Sheffield Health and Social Care NHS Foundation Trust devised a unique “Mindful SuppoRTT” initiative and were successful in securing funding from HEE. Part of which was the organisation of a conference aimed at various groups of doctors including those who have previously had time out of training, are currently out of training and those considering time out.

The Sheffield Mindful SuppoRTT Programme not only aimed to provide a structured and systematic process for planning and returning from absence, but also focussed on enhancing performance through promoting the wellbeing of participants and supporting them with important clinical and non-clinical skills.

Method

2-day twice yearly conferences, which covered training on speciality specific as well as non-technical skills were organised. The clinical workshops covered interactive sessions of common and emergency clinical scenarios. A wide range of non-technical skills such as an introduction to mindfulness, tai chi, resilience, team-working and leadership, “Thinking Environment” and meditation were introduced and developed using bespoke training. Feedback was collected at the end of each conference day. The attendees were asked to use a 5-point Likert scale (5 being the highest) to rate their satisfaction with the day and to highlight which sessions they found most and least useful.

Result

The attendee satisfaction rate was high. The first conference had ratings of 56% of attendees scoring 5 (excellent) and the remainder scoring 4 (very good). The second conference achieved even higher satisfaction ratings with 94% of attendees scoring 5 and the remainder scoring 4.

Conclusion

The conference had high attendee satisfaction. The hope is to expand on its success and open it up to delegates from all specialities within HEE South Yorkshire and the Humber. Evaluation of the long-term impact of this programme is also warranted.