bluuebunny/crossref_metadata_2025 huggingface dataset:
A Feasibility Study of Floatation-REST for Fatigue: An Idea That Was Worth Floating
Authors: Todd James , Critchley Hugo , Cordova Michael , Eccles Jessica , Colasanti Alessandro
Published: August 2024

Aims

Floatation-REST (restricted environmental stimulation therapy) has shown promising potential as a therapeutic intervention in psychiatric conditions such as anxiety and anorexia nervosa. We speculate that the sensory deprivation might act as a kind of interoceptive training. Within our lab, interoceptive trait prediction error has been used to predict states of anxiety in autistic adults. There is also emerging research conceptualising interoceptive mismatches potentially playing a role in fatigue. Our aim was to run a feasibility study assessing the tolerability of Floatation-REST for participants with disabling fatigue. We also aimed to establish the feasibility of gathering data on mechanistic measures, such as heart rate variability (HRV) and interoception, during floatation.

Methods

Participants were recruited via online advertisements and were screened to check they scored at least 36 on the Fatigue Severity Scale (FSS). Pertinent medication changes and previous float experience within the last 6 weeks were amongst the exclusion criteria. Baseline measures included: Modified Fatigue Impact Scale (MFIS); Body Perception Questionaire; hypermobility questionnaire and Tellegen Absorption Scale. Participants completed four 90 minute sessions of floatation-REST across a 2–6 week period with 1 week of ecological momentary sampling (EMS) before and after. Immediate pre and post float measures included testing interoceptive sensibility, accuracy and awareness. HRV was measured during floatation. Change in energy was measured by retrospective subjective assessment, changes in validated fatigue scales and EMS.

Results

Baseline MFIS scores (median = 67.5; range = 55–77) indicated a high degree of severity of participant fatigue. 15 participants were recruited to the study. 13 participants started the float intervention and 11 completed all four sessions. No drop out was due to poor tolerability. Most adverse events were mild, expected and related to the pre/post float testing. HRV data was successfully captured throughout all sessions. Participant surveys described improvements in energy levels, sleep and relaxation and 73% “strongly agreed” to an overall positive effect. Furthermore, both statistically and clinically significant reductions were noted in the mean FSS scores (56.9 to 52.6; p = 0.044) and the MFIS scores (67.0 to 56.4; p = 0.003). Detailed energy assessment was obtained by EMS with 37 to 86 data points per participant.

Conclusion

Floatation-REST appears to be a feasible intervention for people with severe fatigue. EMS, HRV data, interoceptive data and other measures were reliably recorded. Reported subjective benefits were supported by an improvement in objective fatigue scores, though the lack of a control group makes these improvements speculative at present.
Lessons From a Crisis: A Thematic Analysis on Occupational Stress in Staff in an Acute Paediatric Teaching Hospital in Ireland
Authors: Ward Shay , Donohue Grainne , McNicholas Fiona , Murray Johanna
Published: August 2024

Aims

The COVID-19 pandemic placed increased pressure on service provision and healthcare worker [HCW] wellness. As the pandemic recedes, staff need an appropriate response to facilitate individual and organisational recovery, to minimise long-term healthcare worker burnout and to be better equipped for future crisis in healthcare. The aim was to explore and reflect on the experiences of staff working during the COVID-19 pandemic in an acute paediatric hospital to determine an appropriate response in the post-crisis work environment.

Methods

A Qualitative research design using responses from open ended questions from one hundred and thirty-three clinical and non-clinical staff (89% clinical) from an Irish paediatric teaching hospital. Reponses were thematically analysed.

Results

HCWs experienced frustration, uncertainty, anxiety and stress, during the pandemic crisis. This included communication inconsistencies, inadequate support and staffing and other resource shortages, leaving staff at high risk for long-term burnout as the pandemic recedes. Three themes were developed detailing this; 1) Support, 2) Communication and 3) Trust.

Conclusion

This research supports the long-standing need to increase mental health service investment and to implement an appropriate response to regain and maintain a healthy workforce, post COVID-19. This response should address the biopsychosocial needs of the individual and healthcare organisations should work dynamically, creatively and collaboratively to ensure the psychological safety of its workforce moving forward.
MIND the GAP: Psychiatry's Scottish Trainee Enhanced Programme (STEP) to Reduce Differential Attainment
Authors: Cooper Michael , Hegde Rekha , Cheema Fahd
Published: August 2024

Aims

Build relationship and understanding between International Medical Graduates (IMGs) and supervisors in core psychiatry through the Scottish Trainee Enhanced Programme (STEP) to help facilitate belonging and support a vulnerable group. Thus improving training outcomes.

Methods

There are various different areas to the PsychStep Programme.

A handbook is distributed to all IMGs which has been created in accordance with the Royal College of Psychiatrists (RCPsych) IMG Guide.

A trainee created video guide for the RCPsych portfolio is provided with the aim of this reducing anxiety around its use.

A Scotland wide WhatsApp group was created for peer support.

The final part of the programme was attendance of trainees and crucially supervisors at two half day sessions. Joint attendance is crucial in fostering supportive relationships. Content was delivered via workshops by IMG consultants with lived experience. Topics covered included communication skills, success factors, reflection, cultural transition and cultural competence. These sessions were evaluated using both scale questions and free text.

Results

There were 6 participants in this programme. All participants reported on evaluation that they felt this course made them:

•

Feel welcome to psychiatry.

•

Realise that other trainees faced the same challenges as them.

•

Felt supported in their Journey.

All participants stated that their trainer attended the virtual sessions with them and that them being in attendance helped them understand specific challenges they would face as an IMG.

Themes identified on free text feedback from trainees were advice on how to reflect and the support that is available in general. The opportunity for shared personal experiences was also highlighted as a positive.

Themes identified on trainer feedback were guidance around both provision of a supportive environment and the importance of having open discussions with trainees.

Conclusion

This programme has an important role in helping IMG trainees in psychiatry succeed. Success stories of IMG consultants provided knowledge and hope for them. The IMG trainees felt better able to effectively engage with supervision following participation in this programme.

Outcomes from this programme to date highlight opportunities to build on this in the future. The organisers of this course hope to increase future attendance and share good practice across other specialities.
Child and Adolescent Mental Health Conditions and Crisis Management: Bespoke Education of Local Police Forces
Authors: Foster Michael , Nadir Haya
Published: August 2024

Aims

The aim of this work was to improve police force understanding of the mental health difficulties of children and their management in challenging situations.

Nationally, approximately 18% of children aged 6–16 years are likely to have a mental disorder, with the frequency increasing in regions such as North Staffordshire where there are areas of significant deprivation. During the COVID pandemic, children's wellbeing, school attendance, and isolation all worsened resulting in a tripling of urgent referrals to some crisis mental health services. Owing to underfunding and reduced resources in the NHS, the police services have had to spend more time dealing with children's mental health crises, with some forces identifying insufficient training for understanding and de-escalating these emergencies.

It was hypothesized that the preparation and delivery of bespoke training sessions, coupled with pre- and post-assessments, would help enhance police understanding of the conditions and strategies in managing these crises.

Methods

Extending previous approaches, each teaching session covered the presentation, diagnosis, and management of autism, conduct disorder, and emotional dysregulation in children, along with de-escalation. A pre- and post-session quiz was completed addressing each of the four topics. Data collection took place in October 2023 with 19 pairs of quizzes completed by local police and community support officers. Given the size and nature of the data, a non-parametric bootstrap resampling method was used to assess whether the teaching produced a statistically significant improvement in each topic and overall score.

Results

Mean differences in scores with 95% confidence intervals (CIs) were obtained for the 19 pairs of quizzes for each mental health condition and all conditions taken together. With maximum of 16 marks possible in each condition, there were statistically significant improvements in mean scores for autism, 1.9, CI: [1.6,2.3]; conduct disorder, 2.2, CI: [1.7, 2.7]; emotional dysregulation, 2.4, CI: [2.0, 2.7]; and de-escalation, 0.9, CI: [0.5, 1.4], and for all conditions 7.4, CI: [6.5, 8.5].

Conclusion

Bespoke children's mental health training sessions were found to deliver significant improvements in police knowledge of crisis management and de-escalation in children affected by autism, conduct disorder, and emotional dysregulation. Given the unprecedented demands on police services, training sessions of this kind could serve as a training tool to reduce both the intensity and duration of crises they have to handle. More sessions have already been requested within the authors’ local NHS Trust.
Improving Public Awareness of Climate Anxiety: A Medical Student Led Initiative
Authors: Hassoulas Athanasios , Finnie Abigail , Shore Emily
Published: August 2024

Aims

Climate change, and the effects thereof, present challenges in all domains of life. Mental wellbeing is an often-overlooked area when considering the direct and indirect impact of climate uncertainty. Worrying about the outcome of current and future climate events and experiencing distress at the perceived lack of action taken by world leaders has given rise to reports of climate anxiety. Whilst not a diagnosable psychiatric illness, individuals experiencing climate anxiety report to experience excessive worry and fear that may impair activities of daily living. In addition, anxiety over the climate and environmental matters may exacerbate existing conditions such as generalised anxiety disorder (GAD).

Methods

In an effort to raise public awareness of climate anxiety, a leaflet was designed by medical students for dissemination in General Practice surgeries, along with an interactive electronic version of the leaflet being made available for online dissemination. The World Health Organization's (WHO) guidance on health literacy in empowering communities and diverse audiences was adopted in the design of the leaflet. Key information was reported using interactive means that enabled the audience to engage with the content of the leaflet and to consider the impact of climate anxiety on mental wellbeing. A survey was embedded at the end of the leaflet, using a QR code, to collate feedback from the public and from clinicians on the usefulness and educational value of the leaflet.

Results

The leaflet was shared with General Practitioners affiliated with the School of Medicine at Cardiff University, to disseminate at their surgeries, and was promoted by online and social media channels affiliated with the School of Medicine. Members of the public reported that the leaflet highlighted the importance of mental health considerations in relation to the climate crisis and provided a good overview of climate anxiety. Clinicians also reported the overall usefulness of the leaflet as a resource of information on climate anxiety.

Conclusion

Climate anxiety is a relatively new phenomenon that most people are not familiar with or know little about. Raising public awareness of the impact the climate crisis might have on mental wellbeing is crucial. Of equal importance is improving clinical awareness of climate anxiety as a risk or perpetuating factor of existing anxiety and/or mood disorders, such as GAD.
Addressing an Identified Need: Training in Serious Incidents Investigations and Coroner's Inquests for Psychiatric Trainees in Kent and Medway NHS and Social Care Partnership Trust (KMPT)
Authors: Moisan Maria , Williams Verity , Ayanda Segun , Daly Rachel , Valsraj Koravangattu
Published: August 2024

Aims

Navigating a Serious Incident (SI) investigation and participating in a Coroner's Court proceedings can pose challenges for psychiatry trainees. The Higher Training curriculum emphasizes active participation in activities that enhance patient safety and care quality. This project aims to enhance patient safety and trainee confidence by improving training on SI investigations and Coroners Court proceedings.

Methods

Using Quality Improvement (QI) methodology, in the first cycle an initial survey was distributed to all psychiatry trainees and middle grade doctors working in Kent and Medway (n = 67) to establish baseline knowledge and confidence levels in areas related to risk assessment & management, SI investigations and Coroner's Inquests.

In response to the identified need for training, we organized the Initial Training Event with support from Deputy Chief Medical Officer for Quality and Safety, Patient Safety Team and Medical Education Department. The half-day, in-person event was opened to all doctors and featured 5 sessions: Serious Incident Investigation Process, Thematic Review of Suicides, Systems Engineering and Human Factors in Patient Safety, Learning from Mortality and Structured Judgement Review along with ‘Being Involved in Investigation – An Investigator's Guide’. Data from a survey of attendees (n = 47) informed the development of a tailored training session for psychiatry Core and Higher Trainees.

Results

The initial survey received 32 responses (response rate: 47.76%). 71.88% of respondents had little to no understanding of SI investigation processes. Remarkably, 87.5% expressed strong interest in receiving training on conducting SI investigations. 90.62% were extremely or very interested in receiving training on participating in a Coroner's Inquest.

47 doctors attended the Initial Training Event. 30 responded to the feedback questionnaire (47.76%). All doctors found the training useful, with over 90% rating it ‘very’ or ‘extremely’ useful. 97% felt that the training would improve their clinical practice in terms of patients’ safety. After the training, 60% understood the process of conducting an SI investigation a moderate amount; 33.33% understood the process a lot or to a great extent. Nevertheless 92.86% felt a need for additional training in SI investigations. 63.33% suggested making training available yearly, and 36.67% favoured making it mandatory training.

Conclusion

This project identified a significant need for training in SI investigations and Coroner's Court proceedings among psychiatric trainees. An Initial Training Event developed from the first QI cycle survey data received positive feedback. The next phase involves developing a tailored training program that addresses identified knowledge gaps. Further considerations include making this training a regular event.
Evaluating the Training the Trainer Course for Psychiatry Higher Trainees in the West Midlands
Authors: Murugan Meena , Sangoi Bijal , Nainar Feroz
Published: August 2024

Aims

The Royal College of Psychiatrists sets out ‘Education and Training’ as one of the High Level Outcomes (HLOs) in its GMC approved curriculum for higher speciality trainees in Psychiatry. The West Midlands (WM) School of Psychiatry runs a well-established 3-day Training the Trainer (TTT) course to support acquisition of teaching skills and key capabilities to help prepare trainees to become trainers as Consultants.

We aim to explore the views and attitudes held by WM Psychiatry higher trainees towards the current TTT course and other teaching opportunities available across the region.

Methods

An anonymous online scoping survey was sent to all WM Psychiatry higher trainees, via Microsoft Forms, in January 2023. This comprehensive survey included questions on the trainees’ awareness of the TTT course and available teaching opportunities, as well as support and barriers in accessing these. We designed dichotomous, rating and free text questions to generate both quantitative and qualitative data.

Results

Key findings of the survey included:

•

27 out of 40 trainees responded. All subspecialty training programmes were represented.

•

Many trainees were aware of the WM TTT course (81%). No trainees had accessed private TTT courses.

•

Most trainees felt the current available opportunities allowed them to meet the curriculum requirements (82%) and felt their supervisor could provide support in gaining teaching experiences (93%).

•

Only two-thirds of trainees felt the current opportunities prepared them to be an effective Consultant trainer (67%). Some were also uncertain of teaching opportunities available in the deanery (41%).

•

Trainees expressed a preference of learning through small group tutorials, interactive workshops and experiential learning.

•

Trainees requested incorporating content around innovative technology in medical education including artificial intelligence and simulation as well as formal qualifications in medical education.

Conclusion

The project has shown that the current TTT course is effective in supporting Psychiatry higher trainees meet their curriculum requirements, however there is a scope to adjust the content to meet their changing needs and align with digital advancements in medical education. We suggest the course should be delivered in a more interactive and engaging manner for example using breakout rooms and workshops. To ensure all trainees are aware of the course and teaching opportunities available, an information leaflet outlining the TTT course will be sent out as part of the induction process. It is hoped that with these improvements, the needs of Psychiatry higher trainees will be better met as they move forwards in their careers and become Consultant trainers.
Royal College of Psychiatrists Paediatric Liaison Network: Training Initiative, 2021–2024
Authors: Rengit Ashy
Published: August 2024

Aims

The primary objective of this project was to gather information from psychiatric trainees across the UK regarding paediatric liaison psychiatry training. It was envisioned that a national survey would yield important information regarding trainee awareness of this sub-specialty, and their training experiences.

The secondary objective of this project was to build an online resource, that could practically address unmet training needs in this area.

Methods

A national survey was undertaken between 29th November 2021 and 17th January 2022, with trainees from RCPsych Liaison Psychiatry, and Child & Adolescent Psychiatry faculties, invited to participate.

Following this survey, the predominant themes in trainee feedback informed the design of an online resource for psychiatry trainees interested in paediatric liaison psychiatry.

Results

Overall, 40 trainees across the UK completed the survey, detailing their views and experiences of paediatric liaison psychiatry training.

While 65% of trainees were aware of paediatric liaison psychiatry as a field, only 37.5% had exposure to the specialty. Approximately 48% of respondents were in training programs that included paediatric liaison psychiatry placements.

Common challenges in accessing paediatric liaison training included; lack of qualified trainers, limited paediatric liaison psychiatry services locally, and competing training commitments. Trainees highlighted the need for a wider network to raise awareness of this sub-specialty, and advertise formal clinical/ research opportunities.

Following this survey, an online resource was constructed with input from the wider Paediatric Liaison Network (PLN) membership, including the following features –

•

Clinical opportunities – Paediatric liaison psychiatry department contacts for trainees to access training opportunities.

•

Research & Education – Resources useful for trainees interested in paediatric liaison psychiatry.

•

Careers – Articles on different career pathways in paediatric liaison psychiatry.

Conclusion

Trainees predominantly reported systemic issues with accessing experience in paediatric liaison psychiatry, especially regarding training program structure and local clinical systems. It is likely that time, and the involvement of health and training providers, is required to address these issues.

However, it is hoped that building this digitally accessible initiative is a step forward in raising awareness, and supporting trainees in building positive experiences within paediatric liaison psychiatry.

Many thanks to all the psychiatry trainees, and members of the Paediatric Liaison Network, who supported this digital project with their feedback. For further details on this initiative, please visit – https://sites.google.com/view/plntrainees/pln-home.
The Use Of Coaching as a Novel Tool in Medical Education to Support Psychiatry Trainees in Developing Leadership Skills
Authors: Szczap Aleksandra
Published: August 2024

Aims

In recent years, there has been an increasing recognition of the importance of leadership skills to doctors. However, these skills are not usually formally taught or assessed. This study aims to evaluate the impact of using coaching as a novel technique to support Psychiatry trainees in developing leadership skills.

Methods

This poster summarises a primary research study which evaluated an educational intervention using a mixed-method approach.

All Higher Psychiatry Trainees at the Tavistock and Portman NHS Foundation Trusts were given an opportunity to enrol on the Coaching for Consultant Psychiatrist Leadership Pilot Programme. Those who enrolled (coachees) were offered five 90-minute one-to-one sessions with Psychiatry consultants (coaches) who received training in Coaching for Leadership. Coachees completed a self-assessment questionnaire examining their views on their own leadership skills before and after completing the programme. Questions used were adopted from the High-Performance People Skills questionnaire (HPPS) – a tool used to collect 360° feedback as part of leadership training. Coachees and coaches also attended separate focus groups to discuss their subjective experiences of receiving and providing coaching. Thematic analysis was carried out.

Results

Eight coaches and seven coachees participated in the study. Most HPPS self-assessment scores post-intervention have increased after completion of the course. Overall coachees' satisfaction with their leadership skills increased from 3.4/5.0 to 4.0/5.0 after completing the programme.

Focus groups yielded rich qualitative data. The themes identified were: a broad range of reasons for Trainees and Consultants to join the programme, positive impact on coaches’ coaching skills, positive impact on coachees’ leadership skills and ideas on how to improve the programme to inform future curriculum design or improve implementation of any educational interventions.

Conclusion

Psychiatry Trainees’ self-perception of leadership skills can improve after receiving coaching. They find coaching helpful due to its individualised nature and the fact that it promotes the application of skills in real-life settings. Coaches also benefit by gaining new skills in coaching and leadership. Coachees and coaches share similar motivations for joining, including the desire to learn new skills, support others and be supported. More research is needed to evaluate the practical aspects of delivering coaching for leadership programmes as part of speciality training, but its potential is promising.
Reducing Emergency Prescriptions (FP10s) Requiring Electronic Shared Care Agreement (ESCA) by North Hub Community Mental Health Team (CMHT), Birmingham & Solihull Mental Health Foundation Trust (BSMHFT)
Authors: Bakshi Alisha , Bell Zora , Stafford Matthew , Jennings-Cole Kate , Ceesay Sanna
Published: August 2024

Aims

The community mental health team (CMHT) is actively involved in reviewing mental health patients who require commencing psychotropic medications. The responsibility to prescribe the psychotropic medications falls on the CMHT for the first 3 months. After this period, if the patient's mental health is stable, the prescribing role can be transferred to the GP by completion of an electronic shared care agreement (ESCA).

This project aimed to improve the management of emergency prescriptions (FP10s) requiring ESCA within the North Hub CMHT, BSMHFT focussing on reducing administrative time in receiving numerous urgent phone calls for repeat prescriptions, timely completion of ESCA and updating the electronic prescribing system.

Methods

Data collection was done by logging the numbers of the following on a weekly basis:

1.

FP10s issued.

2.

Calls related to FP10s.

3.

ESCA sent.

Baseline data was collected over 11 weeks to analyse practice. Plan-do-study-act (PDSA) cycle was used to improve the processes from January to August 2023. Identified PDSA cycles included:

1.

Clinician prompt reminders to check ESCA status.

2.

Document FP10s instances on issue and inform patient about ESCA during outpatient appointments.

3.

A 4-week system for managing FP10s at reception desk.

4.

Increase consistent use of and access to EPMA.

Data was collected again for 4 weeks in December 2023 to assess sustainability of the implemented changes.

Results

This project resulted in a 14% reduction in the number of FP10s requiring ESCA and a 27% reduction in the number of calls for FP10s from January to August 2023. Data measuring sustainability in December 2023 showed a total reduction of 64% from the baseline of 28 FP10s per week at the beginning of the project (January 2023) to an average of 10 FP10s issued per week in December 2023.

Conclusion

In conclusion, patients benefit from having a clear understanding of where their medications will be issued from thus improving their experience with the mental health service. Having effective processes in the CMHT enables medical professionals to complete the ESCA in a timely manner. Altogether this reduces burden on all professionals and reduces costs of prescribing by transferring the prescribing responsibilities to GPs. This project has been effective in reducing the number of weekly emergency FP10s issued. The 4-week system of managing FP10s at reception has now been included in the Medication Management's new procedure and guidance and is being introduced across all CMHTs in BSMHFT.
Physical Health Monitoring in Waverley Community Mental Health Recovery Service (CMHRS)
Authors: Calvosa Steve
Published: August 2024

Aims

To audit the recording of physical health parameters for the clients of Waverley Community Mental Health Recovery Service (CMHRS).

To ensure Trust and NICE guidelines are met for monitoring of:

1)

Psychiatric drug prescribing.

2)

Psychiatric disease monitoring.

3)

Past medical history and biophysical parameters relevant to prescribing decisions.

To develop a clinical review process for the clients to ensure that physical health parameters are monitored longitudinally.

Methods

A random sample of 100 patients from Waverley CMHRS was analysed. The data was collected between November 2022 and January 2023. The process involved establishing the cohort, dividing the caseload for review, and applying an audit questionnaire. The questionnaire was applied to both SystmOne Electronic Patient Records and GP Shared Care Records to assess compliance with physical health monitoring in both secondary and primary care. All data collected were compiled onto an Excel Spreadsheet. The level of compliance for monitoring of each parameter was calculated and audited against Trust and NICE guidance.

Results

For secondary care:

1.

Compliance with physical health monitoring requirements is consistently low.

2.

Higher levels of compliance (>50%) for height, weight, Audit C (Alcohol), Smoking status.

3.

Lowest compliance levels observed for: blood tests, ECG request, substance misuse status, sleep, medication side effects.

4.

Evidence of a comprehensive physical health review was found in 1% of patients.

For primary care:

1.

95% of patients from our sample consented to giving access to their Shared Care Record.

2.

Compliance with physical health monitoring requirements in primary care was higher.

3.

Compliance was particularly high (> 87%) for: height, weight and BMI, BP, evidence of alcohol monitoring, evidence of smoking monitoring.

4.

Smoking monitoring is the parameter with the highest level of compliance (95%).

5.

Parameters are monitored more regularly.

Conclusion

The audit identified gaps in the documentation and assessment of physical health parameters within Waverley CMHRS. Compliance with monitoring requirements was significantly lower in secondary care, highlighting the need for intervention. Conversely, primary care demonstrated higher adherence to monitoring guidelines. The results show deficiencies in physical health monitoring that need to be addressed to ensure comprehensive psychiatric care.

The project was crucial in optimizing physical health monitoring within Waverley CMHRS. Recommendations include targeted training, improved communication between primary and secondary care, and the designation of physical health coordinators. An action plan was developed with assigned responsibilities and a timeline for implementation. A re-audit will follow to assess the impact of implemented changes.
Reducing the Use of Physical Restraints in Patients With Dementia Who Are Admitted to Acute Old Age Psychiatry Wards With Agitation
Authors: Goveas Richard , Lai Damien , Yao Fengyuan
Published: August 2024

Aims

The Institute of Mental Health is the only tertiary Psychiatric Hospital in Singapore. It has two 29 bedded inpatient wards which provide acute care for the elderly with severe mental health conditions including dementia. Restraints are one of the methods employed in managing agitation in patients with dementia. The physical consequences of restraints are reduced mobility resulting in decreased muscle tone and mass, bone demineralisation, orthostatic hypotension, and atelectasis. This results in patients who are more prone to falls, aspiration pneumonia, deep vein thrombosis/pulmonary embolism and ulcers. The psychological consequences include aggravating agitation, feelings of humiliation, negative emotions like anger and despair. Hence, we embarked on a program to reduce the use of physical restraints in the management of agitation in patients with dementia.

Methods

Baseline restraint hours were collected from 7am to 9pm for all dementia patients who were restrained for agitation for a period of 5 months. Patients on Geri chair with seatbelt used primarily for fall prevention were not included. The Pittsburgh Agitation Scale was used to measure agitation.

The nursing staff were trained on the Enriched model for targeting behaviour and on the VIPS (Valuing people, Individualised care, Personal perspectives, Social environment) framework for person centred care. Restraint hours were collected post intervention as well as benzodiazepine usage data over both periods to monitor any changes in the usage.

Results

The baseline data (preintervention) over a 5-month period determined that patients with dementia who were agitated were being restrained on an average for 3.33 hrs per day from the period of January to May 2021. Following the training of nursing staff on the enriched model of care and the use of VIPS framework for person centered care the restraint hours reduced to 1.48hr per day over 5 months from January to May 2022. Benzodiazepines usage went down from 0.34mg at baseline to 0.17mg per dementia patient per day post intervention.

Conclusion

Nonpharmacological interventions (enriched model and VIPS framework for person centered care) using a multidisciplinary team approach is effective in the management of agitation resulting from dementia and should be used as a first line in the management of such conditions.
Using a Systems Wide Approach to Improve Medical Emergencies in a High Secure Forensic Psychiatry Setting
Authors: Marron Brooke , Maguire Cormac
Published: August 2024

Aims

Patients with severe mental illness are at a significantly higher risk of poor physical health outcomes than the general population and die on average 15–20 years earlier. The Royal College of Psychiatrists has published extensively on how to improve routine physical health monitoring in this cohort. Despite this, there is little data or guidance on improving emergency medical care for this cohort. We aimed to analyse and optimise the process of patients being sent to general hospital on an emergency basis.

Methods

A review was undertaken of the clinical notes for medical emergencies over a 12 month period by two core psychiatry trainees. Site visits and interviews with local A&E department clinicians, the covering General Practitioner and pharmacy were completed. A questionnaire was distributed to all nursing staff to gather their perspective on the considerations for emergency medical transfers out of The State Hospital.

Results

On review of the case notes, 44/44 emergency outings were deemed to be clinically necessary for investigations/interventions that would not have been possible on-site. Qualitative methodology highlighted a disconnect amongst staff groups and stake holders regarding thresholds for transfers relating to medical emergencies leading to a high level of staff dissatisfaction.

Conclusion

The interface between psychiatric and medical services is an area of risk to patients. Levels of staff confidence, knowledge and available resources all contribute to the risk of transfer. Further work is required to explore other aspects of patient care and treatment which can be impacted as a consequence of emergency transfers.
Effective Induction Programme for Higher Specialist Trainees: A Quality Improvement Project
Authors: un Nisa Zaib , Krishnan Deepa , Junaid Kehinde , Suárez Lori Edwards , Lankappa Sudheer
Published: August 2024

Aims

To create a safe and effective induction programme for Higher Specialist Trainees (HST) at Nottinghamshire Healthcare NHS Foundation Trust.

An effective induction improves trainees' satisfaction, they feel welcomed and valued. It improves patient safety, retention, and recruitment (GMC Report 2020).

Methods

Based on GMC report, published in 2020, a survey was developed locally and data for 2021 HST induction was collected using digital platform. Initial stakeholder analysis completed, and relevant parties were invited to share the results. Two key deliverables were identified after consultation, one was a dedicated induction programme for HST which was co-produced along with trainees and stakeholders. The other deliverable was updating the induction booklet. The proposed induction plan was implemented in August 2023, the survey was repeated to the new HST cohort following induction via digital platform. Results of the survey were analysed via mixed methods (qualitative & quantitative).

Results

The surveys conducted in 2021 and 2023 were compared and there was an increase in response rate from 50% to 64%. The domains were devised from GMC standards and assessed by if staff had received everything in the domain within a week of starting their placement and results evaluated using a t-test.

Domain A is gaining access to places and system (keys, fobs, security passes, computers, ID badges, mobile phones, IT system). This significantly improved from 27% to 88% with a p-value of < 0.001.

Domain B is physical orientation of the setting (staff facilities such as lockers, parking, library, and site layout). This significantly improved from 45% to 88% with a p-value of < 0.018.

Domain C is gaining day to day knowledge (HR, rota, annual leave, study leave, pay-roll, mandatory training, e-expenses, and guardian of safe working). There was no significant change between 9% and 19% with a p-value of < 0.48.

Domain D is an understanding of expectations (duties and responsibility during working hours, on-call, team introduction). This significantly improved from 9% to 69% with a p-value of < 0.002.

HSTs were given the chance to add comments and the responses in 2023 were more positive “excellent induction compared to previous years” compared with 2021 when HSTs felt isolated and devalued “worst ever induction in whole career in NHS”.

Conclusion

Overall, the results of the 2023 survey showed considerable improvement in all the key areas of induction within one week of starting the placement. Domain C demonstrates a challenge still and needs further work.
An Audit of the First Stage of Service Development Initiatives Undertaken as Part of a Quality Improvement Process to Improve the Screening and Management of Older Adults Presenting With Delirium in Queen's Hospital (NELFT)
Authors: Paul Jeeano , Smith Gareth , O'Connor Stephen
Published: August 2024

Aims

To improve the detection of delirium amongst patients aged over 65 in Queen's Hospital, and then incorporate a clearer management pathway for these patients to be treated safely with more appropriate intervention and better follow up care. As part of the management pathway, the aim was to increase the delirium referrals made to the local Dementia and Delirium Team for quicker implementation and education regarding non-pharmacological interventions in treating delirium, whilst ensuring that Psychiatric Liaison Service (PLS) referrals for delirium were also appropriate.

Methods

A multi-phase approach to quality improvement and service development for patients with delirium has been adopted, and the first step is to improve the screening of patients over 65 years old with delirium and then to refer to appropriate teams accordingly. Our first intervention was changing the PLS referral form. It has been simplified with less input data required, and now includes a mandatory 4AT screening score for delirium, as well as a mandatory referral to the Dementia and Delirium Team for any patient with positive screening for delirium. The intervention was implemented in November 2023, with pre and post intervention data collected in October and December 2023 respectively. Data was collected prospectively and retrospectively using medical notes.

Results

Queen's Hospital PLS received a total of 60 older adult referrals in October 2023 and 49 referrals in December 2023, of which the total proportion of referrals diagnosed with delirium was 47% and 35% respectively (12% absolute reduction). The proportion of patients referred to the PLS team with delirium, who did not require further intervention after initial assessment, had reduced by 29% (87% to 58%). The proportion of patients with delirium referred to PLS, who had also been appropriately screened and referred to the Dementia and Delirium Team prior to PLS assessment, has also increased by 4%. There has been a marked increase in total delirium referrals to the Dementia and Delirium team after intervention, from 31 referrals in October to 85 referrals in December (174% increase).

Conclusion

There is an improvement in screening for delirium, with marked increase in referrals made to the Dementia and Delirium team. There is a decrease in uncomplicated delirium referrals who do not require further PLS intervention and can be appropriately managed with the Dementia and Delirium team input.
Improving Carers’ Engagement for Patients Admitted to Psychiatric Intensive Care Unit (PICU): A Quality Improvement Project
Authors: Hossain Simona , Clark Lois , Pettifor Emily , Satisha Shantala , Youn Sua
Published: August 2024

Aims

The project aims to improve carers’ engagement for patients admitted to our male Psychiatric Intensive Care Unit by improving communication between staff and carers; and by involving carers more in patients’ care.

Hypothesis:

Among patients admitted to PICU, there is inconsistency in communication with carers and in involving carers in patients’ care. We expect an improvement in these parameters with the quality improvement project.

Background:

Within PICUs, patients with severe psychiatric illness face social isolation. Challenges arise when carers are not engaged, impeding patient support and personalised care. Involving carers becomes crucial for informed decision-making, ensuring both patients and carers actively participate in the care process. National Association of PICUs and The Royal College of Psychiatrists' Guidance for PICU sets out recommendations regarding timelines and types of interventions to be offered to carers.

Methods

Initial baseline data was collected by reviewing patient electronic notes.

We then tested interventions to improve carers’ engagement by using the Plan-Do-Study-Act (PDSA) methodology over 2 cycles. In the first cycle, we engaged the nursing staff by presenting the baseline data and recommendations to improve carers’ engagement. In the second cycle, we introduced an admission protocol to ensure carers were engaged consistently. The parameters assessed were documentation of carers details; contacting carers within 24 hours of admission; documenting carers' views in care plan; inviting carers to Care Plan Approach (CPA) meetings and offer an appointment for carers with staff.

Data was collected after each PDSA cycle to monitor change.

Results

Of the patients admitted to PICU, 29% had their carers’ details documented at baseline, 40% after the first PDSA and 80% after the second PDSA. 42% of carers were contacted within 24 hours of admission at baseline; 66% and 30% after the two PDSA. 50% of carers had their views included in the care plan at baseline; 0% and 30% after the interventions. At baseline, 42% of patients’ carers were invited to the CPA meeting, 66% and 30% after the two PDSA cycles. 50% of patients’ carers were offered an appointment with staff at baseline, 66% and 30% after the two interventions.

Conclusion

As a result of this quality improvement project there has been an improvement in engaging carers of patients admitted to PICU. This was not sustained for the second cycle due to many regular senior staff being on leave during Christmas. The next steps will be to implement this consistently and produce a carers’ information pack.
Quality Improvement Project – Producing an Information Poster to Improve Easily Accessible Practical Information to Junior Doctors Whilst On-Call at Fieldhead Hospital
Authors: Winder-Rhodes Harriet , Thompson Amelia , Nazari Jamshid
Published: August 2024

Aims

To create an information poster for the doctors’ on-call room and doctors’ office at Fieldhead Hospital (a Psychiatric Inpatient Hospital in Wakefield) to improve readily available practical information to doctors whilst on-call.

Background – Psychiatry on-call shifts can feel daunting, especially if this is the clinician's first (and perhaps only) exposure working as a doctor within this specialty. Psychiatric hospitals are not equipped to deal with physically unwell patients which can be challenging especially as the only junior doctor on-call out of hours. Although there is a comprehensive induction programme, doctors in training raised concerns that there is insufficient, readily available practical information whilst on-call.

Methods

Surveys were sent out to doctors in training to ascertain their initial viewpoints about producing a poster and which information they feel should be included. Doctors included were foundation years, GP and core trainees on their psychiatry placement in the South West Yorkshire Partnership NHS Foundation Trust. Both qualitative (free text responses) and quantitative information (yes/no responses) were obtained via SurveyMonkey. An initial draft poster was produced and sent out to all doctors in training as well as the project lead and clinical lead. The poster was amended accordingly. The posters were printed and displayed in the on-call rooms and doctors’ office.

Results

Four respondents responded to our initial pre-poster survey. They were highly receptive to the suggestion that this information would be in poster format to provide easily accessible information to help whilst on-call. Key topics identified for the poster included navigating logistical issues and information on-site, clerking new admissions and the relevant investigations required, important telephone numbers, personal safety and where and how to access relevant information and guidelines.

Feedback regarding the initial draft poster survey and the included information was also positive. Seven respondents replied and overall, they felt that the poster provided the relevant information. The project supervisor and clinical lead also provided constructive feedback and identified that locating risk assessments and discussing with a consultant when a patient is recalled to hospital on a CTO should also be included. The initial draft poster was amended following this feedback.

Conclusion

In conclusion, we found that there was an unmet need for easy to access logistical information regarding on-call work. The on-call poster provided the necessary information in a succinct and clear manner which the trainees benefited from.
Digitalising Regional Induction for Junior Doctors in Mental Health and Learning Disabilities Department of Betsi Cadwaladr University Health Board
Authors: Loo Jiann Lin , Zachariah Vinila
Published: August 2024

Aims

Induction training is a crucial part of starting work in a new organization as it orientates new staff to their work role and environment, which ensures that they can work safely and competently. Given the wide geographical area of North Wales, there is logistic difficulty to continue with face-to-face induction sessions for new junior doctors. A digital format for regional induction for new doctors from all sites was introduced in 2021. This virtual induction has dealt with the accessibility problem effectively. Nevertheless, there seemed to be some ongoing issues regarding organising the session with speakers due to overlapping clinical duties. Therefore, a quality improvement project has been initiated to improve the delivery of the sessions with minimal disruption to clinical duties. This paper is aimed to share the preliminary experience of the process of digitalisation of the induction programme.

Methods

The pilot regional induction with the above changes was carried out on August 4, 2023 via Microsoft Team Meetings and was accessible to new starters from all three sites in North Wales. The sessions consisted of talks from consultants, the lead clinical pharmacist, the ST in psychiatry and clinical services/Rota coordinator. The induction was divided into morning and afternoon sessions. The participants consisted CTs in psychiatry, GPSTs, and FY trainees. The session was recorded and a pre-recorded session on history taking was introduced. Any queries about pre-recorded session were answered by the chair of session.

Results

It was found that an estimated time saved per induction was 285 minutes with an overall saving for 3 inductions per year of 14.25 hours. The estimated cost saved (based on the lowest pay scale in NHS, £) was £151.13 with an overall saving for 3 inductions per year of £453.39. There were two Assessments of Teaching (AoT) and two Direct Observations of Non-Clinical Skills (DONCS) signed.

Conclusion

Digitalising the regional induction helps to save both time and cost for the health board. It also reduces the risk of speakers in availability. Furthermore, the recording can be sent out early to all the JDs before they join MHLD, which can facilitate a quicker orientation into the new role. It is also a good opportunity for core and specialty trainees to achieve competencies for leadership and teaching.