bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review of the Safety and Tolerability of Injectable Prolonged-Release Buprenorphine (Buvidal) in Adults With Opioid Dependence
Authors: Williams Laura , Saima Saima
Published: July 2023

Aims

Widely available opioid substitute treatments have numerous limitations including the potential for non-compliance, misuse, diversion and accidental overdose. The advent of a prolonged-release, injectable form of buprenorphine may be the solution to overcoming these issues, as well as reducing the intrusion on the patient's daily life. Initial trials have shown success in achieving a significantly higher percentage abstinence compared to placebo. This systematic review and meta-analysis will examine efficacy, safety and tolerability data.

Methods

A systematic review and meta-analysis, including all randomised controlled trials reporting raw data on efficacy, safety and side effects of injectable buprenorphine. Included articles were identified using PubMed, Ovid (EMBASE and MEDLINE), Google Scholar and Cochrane Library.

Participants were either community outpatients or hospital inpatients, aged over 18 years, with opioid use disorder. Interventions were prolonged-release injectablebuprenorphine of any preparation or dosing schedule, compared to a control such as sublingual buprenorphine or placebo.

The primary outcome measure was treatment efficacy, specifically treatment retention and negative urine drug screen results. The secondary outcomes measures were drug related adverse events, severe adverse events, nonfatal serious adverse events, mortality, discontinuation, and drug overdose.

Six articles were selected for inclusion following assessment using our exclusion criteria. Study quality was assessed using the CASP tool and Cochrane Risk of Bias 2. Review Manager 5.4.1 was used for data synthesis.

Results

Our primary endpoint was efficacy, using treatment retention and negative urine samples as surrogate markers. Regarding treatment retention there was a statistically significant increase in the ‘Buvidal’ group compared to the control group (OR = 1.46, 95% CI = 1.12 to 1.89, P = 0.005). There was also a statistically significant increase in negative urine samples in the ‘Buvidal’ group compared to the control group (OR = 1.38, 95% CI = 1.26 to 1.52, P < 0.00001).

We examined a number of secondary outcomes which focussed on safety and tolerability data. These showed no statistically significant differences between the two groups (drug overdose (OR = 0.09), drug related adverse events (OR = 1.75), severe adverse events (OR = 0.93), nonfatal serious effects (OR = 0.65), mortality (OR = 1.63) and discontinuation (OR = 1.52)).

Conclusion

The studies have shown the efficacy of ‘Buvidal’ was statistically significant in comparison to the control groups, with no difference in their side effect profiles.

To our knowledge, this is the first systematic review and meta-analysis of its kind, and our results support the hypothesis that ‘Buvidal’ is an effective and safe treatment for opioid use disorder.
Unspoken: Verbal Sexual Harassment by Patients in Psychiatry
Authors: Butler-Laurence Jo , Huang Xiaofei Fiona
Published: July 2023

Aims

Patient-initiated verbal sexual harassment (PIVSH) is common in the healthcare workplace, however institutes often neglect to address it. Objectives: (1) Define extent of PIVSH among staff at South London and the Maudsley Trust (sLaM), (2) Characterise the impact of PIVSH on staff, (3) Understand barriers to reporting PIVSH, (4) Inform policy and training to support staff.

Methods

A questionnaire from Scruggs et al. (2020) was adapted with types of PIVSH on a standardised scale of severity from ‘most’ to ‘least’ harassing. The anonymous, retrospective, online survey was disseminated to sLaM staff via Trust-wide communications, staff networks and Whatsapp groups. Descriptive statistics were used to analyse quantitative data (PIVSH frequency, confidence to respond to PIVSH, reporting practices). Respondents used free text to describe the impact of PIVSH, reasons for not reporting harassment, and views on the role of the Trust and supervisors in addressing PIVSH. Qualitative data were analysed using thematic analysis and externally validated.

Results

42 responses were received across staff groups. 95.2% respondents had experienced PIVSH in the last year. 26.2% had formally reported an incident of PIVSH, with only 30.8% stating the report had been actioned by a senior. ‘Less severe’ harassment types were the most common, and the type staff were least confident to address. Five themes were identified in thematic analysis:

1.

Nature of PIVSH: Unwanted, covert, influenced by victim demographics, the situation, and motivation of the perpetrator

2.

Response to PIVSH: Victim's emotional and practical response, and of the wider MDT

3.

Impact on trainee: Personal (desensitisation, feeling unsupported) and professional (time off, moved teams, avoidance of wards)

4.

Barriers to action: Practical barriers to reporting (lack of time, complexity) and organisational culture (‘patient unwell’ justification, trivialisation, lack of trust in management)

5.

Areas of improvement identified: Written policy on PIVSH clearly communicated to staff and patients; wider cultural changes of zero tolerance to PIVSH; open discussion and reporting, backed up by education and training; formalised support post-PIVSH event

Conclusion

There is a negative impact of PIVSH on staff at sLaM and it is not properly recognised. The NHS is its staff and we cannot afford to neglect their well-being. Action as a result of this survey will include:

1.

Creation of a training package with Maudsley Simulation

2.

Development of informational posters for clinical spaces

3.

Write up-to-date trust policy on PIVSH
Our Care Improvement System
Authors: Cuhraja Alina , Sullivan Jill , Boellinghaus Inga , Wray Josephine , Charles Michael , Oluwole-Moore Olukunle , Williams Hugh , Jones Emma
Published: July 2023

Aims

Our Care Improvement System is an integrated quality and performance system designed to develop co-ordinated approach to managing performance at all levels of the organisation, ensuring everything we do is aligned to achieving our goals set out in our Trust strategy. The aim of this programme is to help the team move away from typical firefighting routines, towards a more structured routine of problem solving, applying quality improvement tools and methodology.

Methods

Five members of multidisciplinary team (MDT) in a Lewisham Community Mental Health Team were chosen as the core working team. They underwent four-month training programme which was one day per month plus weekly team coaching sessions from the Trust's Quality Improvement lead. One targeted measure was identified. This was to focus on improving patient discharges for more manageable caseloads, and ultimately provide a better staff and patient experience. A3 methodology was adopted to provide a structured framework for thinking through the problem. This included: problem statement, current situation, aims statement, root cause analysis, change ideas, actions, progress and benefits, and insights. In parallel, daily improvement huddles (15-minute long team meetings) were adopted to enable the team to problem solve other identified improvement work. The huddles follow a set structure of reviewing work in progress, new improvement opportunities, work that needs to be escalated and celebrated. This work was gradually widened to include the entire team.

Results

The team's caseload was observed to be continuously going up from 200 in September 2021 to 264 in October 2022. We aimed to increase the number of safe discharges and to sustain a steady team caseload. Root cause analysis utilising a fishbone diagram identified barriers to discharge, such as lack of MDT approach and structure to discharge planning. Change ideas included creation of standard work, describing how an MDT discharge meeting would work. Actions were agreed to implement structured weekly MDT discharge meetings where four cases are discussed and safe discharge plans agreed, sharing responsibility for discharge decision. This has allowed us to reduce and maintain a steady caseload with 258 patients in January 2023.

Conclusion

Implementing Our Care Improvement System has not only provided a structure to our improvement work and improved our caseload but has also consolidated our team in working together for a common goal. We have naturally implemented structure to all other team meetings, which have now become more focused and productive, making our team a more rewarding place to work.
Getting a Handle on Handover: Improving the E-Handover Process for Duty Doctors in Psychiatry
Authors: Ong Emily , Docherty Emma , Cuthbertson Gillian , Wong Eugene
Published: July 2023

Aims

Effective handover is a vital aspect of patient safety and continuity of care. On-call junior doctors (the Duty Doctor) in psychiatry inpatient wards in University Hospital Hairmyres (UHH) and University Hospital Wishaw (UHW) use an electronic handover tool (e-handover) to supplement handover. This lists outstanding jobs and information to be aware of. This project aimed to improve the handover process by making amendments to the e-handover.

Methods

A Plan, Do, See, Act (PDSA) cycle structured the project. An electronic survey was sent to all 30 Duty Doctors. This contained a Likert scale, 1 being negative and 10 being positive, to rate the handover process, alongside space for free text comments to be given. Thematic analysis identified common themes within these comments.

Changes were implemented in response to the survey findings. Space was added to the e-handover for each patient's care team (parent team), as well as their contact details. The Duty Doctors were informed of the changes and a post-intervention survey was sent six weeks later.

Results

There was a total of 22 responses (73.3%) to the pre-intervention survey. Themes identified from the free text comments included: Organisation of tasks; Ease of use; Reliability; Inappropriate use; Technical issues; Handover update; Task information and Ward information. The most common theme was inappropriate use of e-handover. It was identified that tasks were being added to the e-handover that would be more appropriately actioned by the parent team.

There was a total of 12 responses (40%) to the post-intervention survey. A demonstrable improvement in the rating of the handover process was found. Free text comments showed that the changes made were helpful. Common themes were identified from the comments. One theme was ‘Missing information’, which included a lack of clarity on the date a job was added to the e-handover. Future changes could include adding space to the e-handover for this information.

Conclusion

Following the adjustments made to the e-handover there was an improvement in the satisfaction amongst the Duty Doctors.

One limitation identified was the lower response rate for the post intervention survey. We postulated that this was due to the survey being distributed when junior doctors changed clinical rotations and left the Duty Doctor role. This could be considered for future improvement cycles.

Additionally, free text comments from the post intervention survey could be utilised to inform future improvements.
Assessment of Cardiovascular Disease Risk in Adults With Severe Mental Illness Admitted to Acute Psychiatric Unit Using QRISK-3 Assessment Tool: A Quality Improvement Project
Authors: Elbadrmany Ibrahim , Sakhuja Divya
Published: July 2023

Aims

The purpose of this QI project was to assess risk of CVD (cardiovascular disease) in adults with SMI (severe mental illness) admitted to acute psychiatric ward as risk can be reduced by relevant changes in lifestyle, optimizing treatment of relevant comorbidities, and by drug treatment, if appropriate. Nice guidelines for CVD risk assessment and management were followed for those with CVD risk of 10% or more.

Methods

This QI project focused on patients with a diagnosis of severe mental illness admitted to ward Ty Cyfannol, YYF hospital, ABUHB in South Wales from 1st April 2021 to 30th November 2021. QRISK®3-2018 risk calculator used to estimate risk of cardiovascular disease. Patients younger than 25 years old at the time of QI project were excluded as QRISK tool is only valid for patients aged 25–84 years. Patients who already had a diagnosis of Ischaemic heart disease or stroke/transient ischaemic attack were also excluded as per criteria of QRISK3. Total number of patients included in this project was 43 patients. Data were collected from patients’ medical records including their weights, heights, routine physical examinations and laboratory investigations requested during their admission. In order to maintain anonymity, patients were assigned to their hospital number. This information was saved in a password protected Excel Spreadsheet.

Results

The mean age of patients was 43.3 ± 11.06 years ranging from 25-69 years. Most patients were males (65.1 %). Schizophrenia was the most prevalent diagnosis (32.5%) followed by emotionally unstable personality disorder (18.6%). 72% out of total 43 patients were smokers. The mean BMI was 23.6 ranging from 17 to 31. 41.9% had their BMI ≥ 25, 8 patients out of those with BMI equal to or higher than 25 scored 10 or more on QRISK3. 13 (30.2%) patients were estimated to have high CVD risk using QRISK3 assessment tool, of whom 76.7% (n=10) aged 55 years or more. 69.2% (n=9) were current smokers, 23% (n=3) were diabetic and 15.2% (n=2) had hypertension.

Conclusion

The findings of this project conform the consensus that people with SMI are at a higher risk of having CVD. Therefore, this should emphasize the importance to assess CVD risk in patients with SMI and to manage modifiable risk factors accordingly and to incorporate the assessment of cardiovascular risk in patients with severe mental illness in day-to-day practice in mental health inpatient units.
RCPsych Leadership and Management Fellowship Scheme (Lmfs): An Lypft Project on Equity, Transcultural Intelligence and Inclusion
Authors: Elisha-Aboh Christiana , Nightingale Sharon
Published: July 2023

Aims

The Royal College of Psychiatrists (RCPsych) Leadership and Management Fellowship Scheme (LMFS) is aimed at accelerating a fellows’ leadership and management development using a combination of structured leadership development programmes and a local apprenticeship model. It is open to all higher trainees, utilising special interest time over 12 months.In most establishments, certain groups are more prone to prejudice; whether due to age, gender, ethnic origin, sexual orientation, religion, career progression or disability. Leeds and York Partnership Foundation Trust (LYPFT) values diversity and strives to foster growth within a multicultural workforce and patient group. Equity accepts the difference between persons and ensures everyone reaches full potential, using individualised support. The aim was to create a culturally aware, inclusive and dynamic workforce. This project set out to achieve its objectives through four pillars.

Methods

Pillar 1-Initiating the local Medical Workforce Race Equality Standards (MWRES) LYPFT action plan: Appointment of the MWRES lead through advertisement and interviews. Pillar 2-Raising awareness on patient, carer and community involvement through a transcultural workshop: A virtual workshop anchored by four professionals and three patients, with lived experience was held, after which survey results were analysed. Pillar 3-Supporting International Medical Graduates (IMGs): Supporting IMGs through raising awareness on challenges and completing the regional handbook. Pillar 4-Interdisciplinary Undergraduate Education: Raising awareness on diversity and inclusion through undergraduate interdisciplinary education.

Results

Pillar 1: An MWRES lead was appointed after interviews and is now in office. Pillar 2: Results of survey questions from the workshop around awareness of barriers minority groups experience, available transcultural resources, transcultural issues, local protocols and resources, and likelihood to intervene against discrimination; showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Pillar 3: The Health Education England, Yorkshire & Humber IMG handbook has been completed and results from the survey included. Pillar 4: Students reported an improvement in their learning following the session. The weighted improvement on equity and transcultural issues for the pre and post teaching intervention improved from 5.391 to 7.126.

Conclusion

Overall, the aims of the four pillars of the project were successful achieved, with positive feedback received. LMFS encourages trainees to develop their leadership and management skills through local mentoring structures and should be encouraged. This is a clarion call to all professionals to adopt a culturally informed approach in all aspects of their practice; related to the workforce and patient care.
NHS Ayrshire and Arran Sustainability and Well-being Committee - Assessing and Improving Trainee Well-being
Authors: Fraser Sam , Barrett Megan , Clark Sophie , Pulley Racheal
Published: July 2023

Aims

To promote the Royal College's core principles of sustainable psychiatry, Junior Doctors at Ayrshire Central Hospital formed the Sustainability and Well-being Committee. The principle aim through 2022, following the COVID-19 pandemic, was to maximise junior well-being - knowing a sustainable workforce is one that feels supported and fulfilled by work and working conditions.

Methods

Through meetings with junior doctors, qualitative information on factors impacting well-being in the work place was gathered, and three targets for improvement were identified.

The following domains and interventions were implemented:

1.

Improve working environment: The doctor's office was sized for 2 staff maximum - despite staffing levels consistently in excess of 20 junior doctors. Additionally, there was no natural light. We obtained a new significantly larger office space, with natural light.

2.

Comfort break area – Doctors identified that having an area with comfort seating to take breaks and socialise away from patients and visitors would be beneficial. We obtained a seating area and a coffee machine, maintained by the junior doctors.

3.

Access technology – Absence of desktops and IT issues with older laptops was impairing productivity and morale. We obtained 4 new desktop computers, and personal laptops for core trainees.

A digital questionnaire was used to collect quantitative data retrospectively, from doctors currently working in the department, or who had done so in the last 6 months.

Likert scales were used to assess pre and post-intervention levels of well-being, and ranking intervention impact on this. Doctors also identified future areas of intervention going forward into 2023.

Results

A total of 16 responses were obtained, and 100% of these agreed that feeling supported and good working conditions was important to maintaining wellness and productivity. Pre-intervention average wellness was rated 5.2 (with 1 being extremely poor, and 10 being extremely good), this increased to 8.1 post-intervention. Improved working environment had the most significant impact on well-being.

Respondents identified environmental sustainability as target for improvement in 2023, potentially through improved recycling, reducing meat consumption and car sharing. Further well-being interventions e.g., walks, promotion of Balint group and social events were also suggested.

Conclusion

Interventions from the trainee-led Sustainability and Well-being Committee through 2022 improved working environment and subjective well-being. This demonstrates that junior staff can successfully initiate and lead projects to promote and improve sustainability in psychiatry. Results indicate that junior staff are willing to actively participate in interventions to improve well-being, and environmental sustainability in 2023.
Implementing ‘Train 2 Retain’ Simulation Training Programme for the Mental Health Liaison Practitioners: A 6 Month Pilot Project
Authors: Javed Qaiser , Easwaran Sruthi , Shamim Aamer
Published: July 2023

Aims

The authors designed a unique simulation training programme exclusively for the liaison practitioners based in Aintree University Hospital Mental Health Liaison Team (MHLT). The simulation training aimed to improve the knowledge, confidence and competence of liaison practitioners through exposing them to realistic mental health related scenarios in an Accident and Emergency department (AED) and teaching them clinical skills in a safe environment.

Methods

The programme had been delivered by a Liaison Psychiatrist, core and higher trainees in once-monthly session lasting 45 minutes. Six clinical scenarios were picked based on the most common AED presentations. Scripts for all six scenarios were prepared in advance and both content and quality were checked with a liaison consultant psychiatrist. The scenarios depicted the journey of a patient being referred by the AED doctor to MHLT. Various clinical skills were embedded in the training programme including history taking, risk assessment, eliciting psychopathology, brief physical examination, managing co-morbid physical and mental health conditions, use of Mental capacity and Mental Health Act, and collaborative working with AED colleagues. Each station lasted 10-15 minutes and was accompanied by pre-briefing and debriefing with a higher trainee and experienced liaison psychiatrist for a further 30 minutes.

Liaison practitioners rated their confidence managing common but complex scenarios on Likert scales from 1 to 5 immediately before and after the session. Free-text questions explored practitioner's favourite aspects of the training, areas of further improvement and topics they would like the authors to include in the future training. Feedback had guided subsequent programme development and topic selection.

Results

The strength of the target audience was between 6 and 15 nurses per session, with increasing attendance at each session. Dropouts were mainly related to their busy shifts in AED. On average, Likert scale scores were between 1-2 before and 5 after sessions (100% in all feedback forms), indicating a statistically significant improvement in overall confidence and competence. Participants highlighted the format, real-life performance, quality of clinical scenarios and power point slides including group discussions as the most useful aspects of the training. 100% of respondents felt that the content covered was useful and the session content was pitched at the appropriate level.

Conclusion

Overall, 'Train 2 Retain' Simulation training was well-received amongst liaison practitioners. Embedding simulation training can improve the confidence and skills of liaison practitioners working in a busy AED setting which will improve well-being and staff retention. The next phase in the development of the training will be to include competence-based assessment and involving practitioners from other liaison services within the trust.
Improving Physical Health Recording in Brent Early Intervention Service (EIS)
Authors: Kessab Selim , Bahia Sukh , Mohammed Merfet , Fleet Jake
Published: July 2023

Aims

By July 2021, we will increase the percentage of full recording of physical health data for 90% of patients

Methods

-Completion of recording (green results) was measured using Tableau Software for a 10 week period from Jan- March 2021 (baseline), then monthly during the study

•

PDSA cycles were conducted between April and July 2021 with analysis and changes tested monthly as per PDSA methodology. This informed future interventions.

•

We involved staff in designing a flowchart/protocol of how to book patients into the well-being clinic and sought opinions on how recordings could be improved.

Results

•

In March, prior to any changes being implemented, staff were reminded to complete recording of physical health data. This improved percentage of recordings up to 62% by 1 st April.

•

Following this, a training session about the well-being clinic was arranged for all EIS staff.

•

A further session was arranged for staff to devise a flowchart of how the process will operate and generate further ideas.

•

A reminder system was put in place with the team leader emailing care co-ordinators monthly.

•

By 1 st July, percentage of complete recordings were 73%.

•

We decided to continue with the project and to increase the frequency of reminders to fortnightly. This helped to improve the percentage of complete recordings to 90% by September 2021.

Conclusion

•

We learnt that education and training amongst all staff was needed to improve the recording of physical health data.

•

Improved utilisation of the physical health well-being clinic helped to streamline physical health assessments and helped to reduce the workload of EIS staff (also promotes sustainability).

•

Involving staff in designing and implementing changes leads to better adherence in improving physical health recording.

•

More time was needed for the interventions to be implemented in our service (target reached later than original timeframe), but this should now be sustainable.

•

Reminder systems will need to continue to ensure that performance is maintained, with further training provided as required.
An Evaluation of Core Trainees’ Views on Clinical Rotations in the West Yorkshire Psychiatry Training Scheme
Authors: Laud Rose , Isaacs Terrence , Elisha-Aboh Christiana , Leung David
Published: July 2023

Aims

Gathering honest feedback on experiences of clinical rotations is vital to allow improvement of training. However, our current local systems lack anonymity, which may lead to reduced confidence in providing honest views. Aim: To provide trainees with a method of giving honest and protected feedback to improve future training posts.

Methods

A Survey Monkey feedback form which was sent to core trainees across West Yorkshire in July 2022. This allowed feedback for up to 6 rotations, meaning those finishing CT3 could retrospectively review all their placements. The data were analysed by the project leads, grouped into themes, and anonymised.

Results

We received responses for a total of 57 posts from 23 core trainees (total trainees July 2022 = 71), some of whom responded for multiple posts. Types of posts reviewed included: General Adult (40.4%), Older Adult (24.6%), Child and Adolescent Mental Health (8.8%), Forensics (7%), Learning Disability (5.3%) and Psychotherapy/Liaison (3.5%). 10.5% of responses did not specify the speciality.Overall, respondents strongly recommended 51.8% (n=29) and recommended 12.5% (n=7) of posts to other trainees. Respondents strongly did not recommend 5.3% (n=3) and did not recommend 1.8% (n=1) of posts to other trainees. Positive themes included having a range of experiences and a supportive team. Trainees valued having a range of cases with appropriate autonomy. They liked having a job that was busy enough to gain the required experience but not too busy to impede training and learning opportunities. An accessible and supportive supervisor who provided regular supervision with completion of work based placed assessments was also important.Negative themes included lack of regular supervision and heavy workload, which impacted a trainee's ability to attend teaching and participate in other aspects of professional development. Feedback for inpatient posts suggested that physical health obligations sometimes limited training opportunities.

Conclusion

Our results have shown that training needs are varied between trainees. It is therefore important that trainees have honest discussions with their supervisors about their needs and areas for development. Overall, trainees would recommend the majority (64.3%) of posts reviewed, however areas for improvement were highlighted. These may include extra training opportunities and increased physical health support. The main limitation of our evaluation was the low survey uptake (32.4%) in comparison to total trainee numbers. We hope that sharing our findings with both trainers and trainees will improve future responses.
Improving Education Around High-Risk Psychotropic Medication in Supported Living Facilities
Authors: Madhusudanan Shweta , Fapohunda Mosun , Rickard Joy , Best Christine , Loothfaully Sanaa
Published: July 2023

Aims

Of the medication-related incidents that have been reported in supported living placements, many involved high-risk psychotropic medications such as Clozapine, Lithium and Sodium Valproate. An evaluation of these incidents found problems with administration and inadequate monitoring. Consequently, a virtual education programme was commissioned to educate support staff in living placements in South West Hertfordshire which showed strong positive evidence that the training session improved learning and management surrounding psychotropic medication. This education programme has now been expanded to supported living facilities in the North of the trust to further ameliorate safe medication management and care provision within these placements. The aim of this teaching programme is to provide an educational platform to improve the knowledge and risks associated with Clozapine, Lithium and Sodium Valproate in an effort to reduce medication-related incidents within the placements.

Methods

Virtual training was developed and delivered for support staff across supported living facilities in the Northern directory of the trust. This teaching was collaboratively designed and delivered by a multidisciplinary team including pharmacists, doctors and nurses. The virtual nature of the session lent increased accessibility to staff members from various regions.

Results

28 staff members from 6 support living facilities covering a resident population of over 65,000 people attended the 3-hour virtual education programme. Quantitative studies run on the pilot lecture in the high-risk psychotropic learning programme found strong evidence that this training leads to increased understanding of the administration, management and risk profiling of the aforementioned high-risk medication.

Conclusion

Education surrounding high-risk medication will reduce long-term incidences of medication-related adverse events. The expansion of this learning programme to the entirety of the Hertfordshire trust is a step further in improving patient care within local mental health services.
“The Only Way Is Up; Lets Do It!”- a Quality Improvement Project for Physical Health Improvement for Patients Diagnosed With Schizophrenia at a CMHT in Glasgow Using Smart Interventions
Authors: Marron Brooke , Anderson Lindsay , Cheema Fahd , Dow Eleanor , Hutchison Stuart , Kazmierczyk Marcel , Bindra Jasmeet , Dourish Jonathan , Richardson Julie
Published: July 2023

Aims

Cardiovascular death is the leading cause of early mortality in patients with schizophrenia. We audited physical health monitoring (via Lester tool) of all patients diagnosed with schizophrenia over the past year. There were 163 patients, 60% were up-to-date on blood tests, but only 28% had an up-to-date ECG. We found poor documentation of lifestyle risk factors (smoking/alcohol/weight) and recording of interventions that were offered to modify these. We felt it was important to try a pro-active model of engagement and intervention in order to improve outcomes and empower patients in collaboration with GPs.

Methods

A subset of the cohort (35 patients) were invited along for an all-inclusive check up with a doctor at the psychiatry clinic (blood tests, discussion and advice regarding lifestyle risk factors and on-site ECG utilising the new Kardia 6L) lasting 30 minutes. Information was collated and then distributed via a letter to the GP, the consultant psychiatrist and the patient.

Results

Of the 35 patients invited to attend the physical health check-up, 18 (51%) attended. All patients then underwent physical health monitoring and discussion of how to improve their risk factors. The Kardia6L allowed for QTc monitoring to occur quickly and easily in the outpatient setting and was liked and accepted by patients. We found that most patients were overweight (88%) and were undertaking less than 30 minutes of exercise a day (50%). Half of the patients required active medical intervention (statin, blood pressure or diabetes medication). The Kardia6L allowed us to attain 88% compliance with achieving up-to-date ECGs and provided instant results to the clinicians/patients.

Conclusion

In this first phase of the quality improvement project we were able to show that half of the patients were willing to attend for in person monitoring. Patient engagement was better as intervention was being delivered at their usual CMHT by their Psychiatrists. The model of a shared letter between patient, GP and psychiatry encouraged shared responsibility for carrying these issues forward. From participating in the project the psychiatry team plan to review patient's medication and develop a robust intervention plan regarding weight loss/exercise/diet from the CMHT in collaboration with GPs as there are clear issues affecting our patient's health long term. The Kardia6L proved to be a quick/easy way to monitor QTc safely in an outpatient setting and allowed us to provide this as one step process at CMHT without requiring referral to Cardiology while improving compliance with annual ECGs.
The African and Caribbean Doctors Buddy Group (ACDBG) at HPFT- Hertfordshire Partnership University NHS Foundation Trust
Authors: Robinson Lianne , Fapohunda Mosunmola , Giwa-Osagie Abiemwense , Ogunleye Bolanle , Okhiria Oritseweyinmi , Aina Olalekan
Published: July 2023

Aims

There are increasing amounts of documented evidence that Black and Ethnic Minority (BME) NHS staff are more likely to face exclusion and discrimination. The MWRES- Medical Workforce Race Equality Standards Report details the disadvantages faced by BME doctors in the NHS. This piece of work shows a strategy to support doctors of African and Caribbean origin working in HPFT. Launched in 2021, the HPFT African and Caribbean Doctors Buddy Group (ACDBG) is a group for all doctors of any grade working in HPFT from African and Caribbean backgrounds. The group aims to bring together doctors of these backgrounds to build a group of clinicians who advocate for equity for African and Caribbean patients and medical professionals. Another key focus of the group is to support and motivate each other, focusing on individual health and well-being and sharing mutually beneficial experiences.

Methods

Doctors of the groups' ethnic backgrounds across all grades identified 34 (20.1%) African-Caribbean doctors out of the 169 BAME doctors in Hertfordshire Partnership University NHS Foundation Trust (HPFT). Of this, there are 30 doctors of African and 4 of Caribbean backgrounds, with 14 in Consultant, 7 in Staff Grade, Associate Specialist and Specialty (SAS) and 13 in Training posts.

The identified doctors received an invitation to attend the group meeting. Attendance was optional; membership was free with no long-term commitment. The group has an active social media presence to communicate and attract interested colleagues.

Results

The group has met at least three times a year to provide opportunities for meaningful engagement and networking. These have included formal meetings as well as informal dinner events. Feedback from attendees has been very positive, with members mainly commenting on having found support from fellow members in navigating new experiences or learning from how others have sorted culturally unique challenges encountered in their working lives. Our international doctors have expressed joy in finding a resource to obtain guidance in settling into work and support with career development.

Conclusion

Feedback received from members of the group indicate that the doctors have found the group extremely useful. It gives an opportunity for expressive communication to promptly address concerns of any form or nature, on a personal or collective level, thereby improving positive well-being and career progression. Their positive experiences in pastoral care improved inclusion, productivity, retention and ultimately quality of care provided to service users.
Co-Production of a Digital Symptom Self-Management Resource for Patients With Functional Neurological Disorder
Authors: Sudra Miten , Lee In Woo , Mohanarajah Giruchaandan , Suthanthirakumaran Methushaa , Williams Verity , Dunlop Alan , Alschamaa Ranya , Collison Wendy , Faruqui Rafey
Published: July 2023

Aims

Patients with Functional Neurological Disorder (FND) experience neurological symptoms which may impair motor control, sensory function, or awareness. Long waiting lists before treatment mean the risk of relapse during this period is high. A lack of knowledge around FND also results in a lower quality of life. Therefore, it is important patients with FND receive appropriate psychoeducation to empower them to understand and manage their symptoms. We aimed to strengthen our symptom self-management booklet for patients in a community neuropsychiatry setting, using a co-production model and taking forward improvements into a digital audiovisual format.

Methods

We used co-production as part of a quality improvement project (QIP) at East Kent Neuropsychiatry Service to identify improvements to our existing symptom self-management booklet and apply these in the production of a digital resource. Initially, the symptom self-management booklet was distributed to 10 patients, awaiting further assessment and treatment, chosen by the multidisciplinary team following triage appointments. Two weeks later, 7 patients reviewed the booklet with 4 medical students by phone and qualitative and quantitative feedback was obtained from patients and carers. Quantitative feedback was collected using an adapted 20-point Ensuring Quality Information for Patients (EQIP) tool. Informed by this feedback, scripts were developed for the audiovisual resource. The scripts were further reviewed by a medical student, 2 multidisciplinary team members and 3 Trust Communications Department members.

Results

The first QIP cycle highlighted the importance of the symptom self-management booklet. Most patients had used the booklet. Patients found it a helpful source of information. Two patients noticed a considerable improvement in their quality of life, others did not due to the short length of booklet use. . EQIP tool demonstrated an improved score of 80.51% compared to previous round of feedback (53.33%). Carers identified the booklet as reassuring. Additional links to external information was identified as an area for development.

Patient feedback informed the development of scripts for the audiovisual resource. Consultation with the Trust Communications Department identified three themes of improvement: accessibility to patients, increased clarity and concise language, and an appropriate visual format, therefore scripts were further refined.

Conclusion

Our QIP shows the value of a psychoeducation and symptom self-management tool for FND patients which was positively received by patients and carers. Collaborating with patients in the digitalisation of this information allows for a more accessible resource which effectively addresses patient concerns and empowers symptom self-management.
Prevalence and Outcomes of First-Episode Psychosis With Substance Misuse Within an Outpatient Setting
Authors: Wee Ryan , Ozer Mikail , Anwar Lubna
Published: July 2023

Aims

Misuse of certain drugs is a common precipitant of first-episode psychosis (FEP). Substance misuse is known to exacerbate psychotic symptoms, and it is unclear if substance misuse at the time of initial presentation impacts outcomes of care in FEP. Here, in this quality improvement project (QIP), we aimed to quantify the prevalence of drug misuse within an outpatient early intervention service (EIS) and determine the outcomes (in terms of time-to-discharge and discharge destination) of service users based on their substance misuse history.

Methods

In this QIP, we randomly sampled 100 patients referred to and discharged from an outpatient service for psychosis (Barnet EIS). We excluded patients who were referred to the service but were discharged due to referral rejection, non-attendance at psychiatry review and/or other reasons. Data regarding demographic and clinical information, the nature of substance misuse, and discharge destinations were obtained through a review of electronic health records, including GP letters and hospital notes. The time-to-discharge was defined as the time between referral acceptance and discharge from EIS. As this work is part of a QIP, written consent was not obtained to conduct this project.

Results

Of 100 patients obtained from the discharged caseload, 38 patients were accepted and reviewed in Barnet EIS. 24 patients (63.2%) had no substance misuse history at the time of initial FEP, while 14 patients (36.8%) had some substance misuse history. Of the 14 patients with substance misuse, cannabis was most frequently used. The average age of patients was 27.2 ± 1.4 years old. The age of onset of psychosis was similar between patients with and without substance misuse (two-sample t-test, p = 0.74).

In terms of discharge destination, patients with and without substance misuse were discharged back to their GPs at similar proportions (chi-square test, p = 0.81). Finally, the number of days patients spent under the care of Barnet EIS was similar between patients with and without substance misuse (two-sample t-test, p = 0.54).

Conclusion

In this QIP, over 30% of patients presenting with FEP reported substance misuse. The most common recreational drug used was cannabis. Discharge destinations and the time spent in EIS were broadly similar between patients with and without substance misuse. The relatively high rates of substance misuse in FEP found in this study have important implications for commissioning additional services – such as urine drug testing or drug liaison services – within EIS teams.
An Audit of Information Provided to Paramedics / A&E Staff on Transfer to the Colchester General Hospital
Authors: Zinchenko Oksana , Shoka Ahmed , Hamza Yaser , Mujtaba Aamir , Mtika Vincent , Riding Stephanie
Published: July 2023

Aims

Following feedback from paramedics and staff, escorting patients to the A&E, concerns were raised when some information was missed during the verbal handover from patient/escorting staff to the ambulance/A&E staff. At times the purpose of the transfer was not clear. Essex Partnership University NHS Foundation Trust (EPUT) “Discharge and Transfer Clinical Guidelines” ( CG24) provides clear guidelines to staff when a person is transferred while in the care of the Trust to another service such as another acute trust or, discharged from EPUT services completely. However, there are no current guidelines available for transferring patients for clinical reasons: in case of emergency or acute medical condition, for specialist treatment or investigation. The standard was used: the “Ambulance handover to emergency care standard V1.0” created by Professional Record Standards Body (PRSB). 100% of patients should have a support letter from doctors with relevant information shared with paramedics or the A&E department on transfer to a general hospital. The scope of the audit was Peter Bruff Mental Health Assessment Unit and Ardleigh Acute Inpatient Ward.

Methods

The data were collected retrospectively from notes available on the electronic health record database (Paris). The audit tool focused on quantitative and qualitative data collection on patient transfer.

Inclusion criteria: all patients admitted to the Peter Bruff MH Assessment Unit (male and female) and the Ardleigh Ward (female) over the period from 1 September to 15 September 2022. All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.

Results

There were identified 18 male and 33 female patients on the Peter Bruff MH Assessment Unit. 2 patients were sent to the A&E via ambulance and 4 patients attended the A&E with staff escort. A support letter was available on one occasion. Compliance 17%.

Within the analysed period there were 15 female patients identified on the Ardleigh ward. 5 patients attended the A&E. A support letter was available on two occasions. Compliance 40%.

Conclusion

All transfers should be managed in a sensitive way ensuring all communication is clear, to promote robust information sharing between inpatient wards and A&E.

A template of the care summary and handover letter was created, which provided a standard structure of headings that is meaningful to clinicians and patients.
Atypical Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report
Authors: Grant Heidi
Published: July 2023

Aims

Neuroleptic malignant syndrome (NMS) is a rare condition experienced by patients taking typical and/or atypical antipsychotic medications. There are well-established diagnostic criteria for NMS. However, differentiating it from serotonin syndrome and malignant hyperthermia—particularly in the intensive care setting--is problematic and thus remains a diagnosis of exclusion. A case report of a patient with atypical NMS in intensive care is described and the subsequent learning points gleaned from the patient are presented.

Methods

A 28 year-old female was admitted to the intensive care unit (ITU) following a self-inflicted traumatic injury. The patient was known to local mental health services and her medical history includes personality disorder, anxiety and depression. Regular psychiatric medications prior to hospitalization included flupentixol and quetiapine. Remifentanil was administered in a continuous infusion for sedation as the patient was intubated and ventilated. Valproic acid and levetiracetam were given for seizures.

Repeated spikes in temperature, rigidity and slightly elevated creatine kinase (CPK) were observed in the patient. Autonomic dysfunction was also noted; the patient experienced bradycardic episodes that increased in frequency and duration. On two occasions, this resulted in asystole and cardiopulmonary resuscitation (CPR) had to be commenced with return of spontaneous circulation following CPR. Mental status changes were unable to be assessed due to ongoing sedation of the patient. On the advice of the clinical pharmacist, remifentanil was switched to fentanyl. Quetiapine and flupentixol were also discontinued after consulting with the psychiatric team. In addition, the patient responded quickly to dantrolene administration and to active cooling.

Results

Main diagnostic criteria for NMS include hyperthermia, rigidity, mental status changes and autonomic dysfunction. The definition of atypical NMS includes three of these four criteria. Serotonin syndrome was ruled out as the patient was not taking any selective serotonin reuptake inhibitors (SSRI) nor selective serotonin-norepinephrine reuptake inhibitors (SNRI). Malignant hyperthermia was also considered as the patient had received a volatile anaesthetic gas, isoflurane, for sedation purposes; however, symptoms persisted long after it was stopped.

Conclusion

Atypical NMS is a diagnosis of exclusion that must be considered in patients in an intensive care setting who experience refractory hyperthermia. A multidisciplinary team is essential in caring for critical care patients who exhibit symptoms of NMS, including psychiatry, neurology, and clinical pharmacy.