bluuebunny/crossref_metadata_2025 huggingface dataset:
Are the staff in Heddfan Psychiatric Unit, Wrexham Maelor Hospital, are adhering to the personal protective equipment (PPE) guidance as per Public Health Education, England? a QIP
Authors: Dhandapani Asha , Soundararajan Sathyan , Sambhi Rajvinder , Baker Catherine
Published: June 2021

Aims

The aim of this audit is to assess whether healthcare staff are correctly donning and doffing PPE when entering and leaving the wards (changed to donning and doffing PPE when within 2 metres vicinity of a patient).

Method

Consultants/ Junior doctors/ Ward managers/ Staff nurses/ student nurses/ Health care support workers/ Occupational therapist/ Psychologists/ Student nurses/ Housekeeping staff, were all included in this Audit. None of the staff was aware of this Audit and this was an entirely random observation. We used a standard proforma in order to audit. Followed by the Audit, we trained the staff in the unit and then re-audited.

Result

98% of them wore mask whilst in the ward and 94% of them washed their hands after doffing. 36% did not wear them appropriately and about 10-14% did not wear PPE at all. A mere 7 out of 50 alone used hand gel. Overall the donning and doffing of PPE was not being followed and adhered to according to the standards from PHE as per the first Audit. In particular, during donning only 1/3rd of them donned the PPE as per guidance. Likewise, the doffing technique was also poor, with only half of them removing the apron and mask correctly. Unfortunately, only 7 of the 50 people were observed to have used hand gel in between the doffing. This could be potentially increasing the risk of the spread of the coronavirus.

We had trained almost 150 staff members in the Heddfan unit with regard to PPE/ donning and doffing.

Handwashing prior to donning was achieved by all the staff. All the staff, that is 100 % of them adhered to the donning technique in line with the guidance in comparison to just 64% during the first Audit. Whilst hardly just 1/2 to 2/3rd of the staff followed the doffing technique adequately, the second audit showed that only 2 of the 50 staff did not follow the guidance. A meagre/ handful of them followed the utilisation of hand gel in between the tasks of doffing during the first Audit. Almost 90% of them followed the technique properly during the second Audit. Thus showing that the PPE training was successful.

Conclusion

Following the PPE training that was provided to them there was a good response from the staff and this went on to show how effectively we have managed the prevention/ contamination of virus in our unit.
Are the rapid tranquilisation nice guidelines adhered to, in patients with agitated/aggressive behavior? a QIP
Authors: Dhandapani Asha , Soundararajan Sathyan , Sambhi Rajvinder
Published: June 2021

Aims

To explore whether the NICE guidelines for rapid tranquilisation are adhered to in the Psychiatric intensive care unit (PICU/ Tryweryn).

Method

Data were collected by core trainees. Standards were taken from NICE guidelines NG10. All patients who had received rapid tranquilisation, that were in PICU from August 2019 to February 2020 were considered in this a.

Result

During the first PDSA, we discussed with the staff in the ward regarding the protocol. Prior to actually starting the second audit, the adherence was noted to be low. However following persistence and having created a protocol jointly with the ward manager, we could see the difference. The staff were appreciated for their efforts in maintaining 100% adherence. The same was intended to be continued with some positive reinforcement from the auditing team. Over the first 2 months, 12 patients received Rapid Tranquilisation. Out of these 12, we randomly selected 4 patients to find the adherence of the NICE guidelines to be 100 per cent. The predictions regarding the adherence to protocol showed that the PDSA was successful.

During the second PDSA, the adherence was 100% again. The adherence to the protocol has been followed for not just the sample that was selected, but for the entire set of patients who received the Rapid Tranquilisation. Following this QIP, we formatted the proforma which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and response to medication.

Conclusion

The utilisation of de-escalation techniques and behavioural support plans that was person-centred in turn brought down the rate of Rapid Tranquilisation successfully. Thus placing our PICU as having the least restraints in the UK in 2019 (Second least 3/ month). Our PICU was awarded the prestigious Nursing Times Team of the Year Award for their pioneering work.

Following this QIP, we then formatted the proforma for Rapid Tranquilisation which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and patients response to medication. The PICU will continue to maintain this 100% standard and we would then consider extending the Audit to both Open wards and PICU in entire North Wales.
Improving knowledge and confidence in the acute management of eating disorders and resulting complications
Authors: Fynes-Clinton Sarah , Price Clare , Beckford Louisa , Shahjahan Maisha , McKeown Brendan
Published: June 2021

Aims

This project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.

Background

A recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.

Method

This project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.

We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.

Result

The response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.

To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.

Conclusion

By using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.
Identification of patients with mood disorder following admission with hip fracture with a view to starting treatment and provide advice
Authors: Giles Karla Louise , Macpherson Lisa , Martin-Hernandez Maria del Pilar , Wilson Helen , Hall Philip , Thompson Keri , Bailey Sarah
Published: June 2021

Aims

The aim of this quality improvement project is to improve identification and management of mood disorder in patients over 65 years admitted to Royal Surrey County Hospital (RSCH) with hip fractures by introducing a standardised assessment tool to guide appropriate interventions.

Background

The signs of depression in the elderly can be subtle and often go unnoticed. The multidisciplinary team (MDT) at RSCH observed that low mood could negatively impact on a patient's recovery, affecting pain thresholds and leading to poor engagement with rehabilitation. Proactive identification and management of mood disorder is an important part of Comprehensive Geriatric Assessment but not routinely performed in patients with hip fracture admitted to RSCH.

Method

Notes and discharge summaries of patients with hip fracture admitted over a four-month period were retrospectively reviewed to establish if patients were screened for low mood. A mood screening tool was chosen and implemented prospectively over a four-month period. Occupational therapists and junior doctors completed a Cornell Score for all patinets. Those identified with depression or probable depression were issued verbal advice, an information leaflet and follow-up arranged.

Result

Ninety-eight patients were included in the retrospective cohort. No patients were formally identified as having depression or probable depression, and there was no indication that mood was considered or assessed at any point during admission. During the four-month prospective period, 90 patients were admitted to RSCH with hip fracture and 86 patients (96%) were screened for low mood. Four patients were excluded due to a terminal prognosis. Of the patients screened, 9% had major depression and 16% probable depression. Feedback from our occupational therapists and doctors was positive, with the tool being relatively easy to use in patients with or without cognitive impairment. Much of the assessment could be incorporated into their initial assessment or in gaining collateral history from next of kin. Anecdotally, considering patients psychological well-being had a positive impact on inpatient therapy sessions guided the MDT in supporting the patient appropriately.

Conclusion

Implementation of a standardised and validated mood screening tool enabled us to identify that a quarter (25%) of the patients admitted following a hip fracture had, or probably had depression. This allowed us to intervene with simple measures such as verbal advice and an information leaflet and consider pharmacological intervention where appropriate.
“Beth”: the development of a digital personalised health record and patient portal for use in clinical practice
Authors: Gillett George , Arroyo Barbara ,   The Beth Team
Published: June 2021

Aims

To design & develop a clinically scalable personalised health record and patient portal to;

Improve patient safety through improved communication and information sharing between staff, patients and carers, and improved access to safety plans for patients.

Increase the uptake of virtual appointments and video calls rather than over-reliance on telephone calls for clinical care

Empower patients to access supported self-management and self-directed care using digital resources

Background

Current mental health services often rely on telephone calls, letters, text messages and email, which often repeat information to the detriment of the patient. Likewise, care plans and appointments are given in paper cards, which can be lost or become out-dated. Furthermore, service-users often have no access to curated resources, symptom-tracking tools or ability to document their personal treatment targets in medical notes.

Method

Based on service-user feedback, clinical need and the above aims, a digital personalised health record and online portal was developed for patients to record personal goals & coping strategies, access crisis plans, view appointments, track symptoms, complete clinical assessments, communicate with their care-team and access self-management materials. The tool, ‘Beth’, was named after the Bethlem Royal Hospital and was launched in July 2020 to all patients in the South London and Maudsley Trust.

Result

Across the Trust, the tool currently has 710 active users. Features used include; accessing care plans and safety plans, communicating with care teams, organising and viewing appointments, undertaking clinical assessments to inform measurement-based care, tracking symptoms and progress, developing a secure diary, and accessing free & trusted self-management resources.

Conclusion

We have developed “Beth,” a digital personalised health record and patient portal for use in widespread clinical practice. The tool allows patients to take an active role in their care-planning, enhances communication between patients, carers and clinical teams and may improve service efficiency and patient safety. Future development may customise the tool further to incorporate new features and optimise usability for patients and clinicians alike.
Substance misuse teaching: a patient safety issue
Authors: Thornton Mary , Harborow Lucy , Roberts Emmert , Kalk Nicola J. , Kelleher Mike
Published: June 2021

Aims

Clinical substance misuse presentations are commonly managed by Psychiatry Core Trainees (CTs) out of hours. However, specialist teaching is not included in the Maudsley Training Program (MTP) induction. We aimed to investigate whether this was of clinical concern and, if so identify interventions to address it.

Background

The association of substance misuse disorder and mental illness is widely recognised. The Adult Psychiatric Morbidity Survey 2014 reported that half of people dependent on drugs other than cannabis were receiving mental health treatment. Substance use substantially impacts clinical risk; 57% of patient suicides in 2017 had a history of substance misuse. It also effects emergency psychiatric services: 55-80% of patients detained under S136 are intoxicated. Therefore, it is imperative for patient safety that CTs can assess and manage these patients appropriately.

The Royal College of Psychiatrists recognises the need for specialist substance misuse knowledge and skills, and lists this as a key ‘Intended Learning Outcome’ for CTs. Unfortunately, the availability of specialist drug and alcohol service placements for CTs has significantly declined. Only one placement is available per MTP rotation. Teaching is therefore relied upon to gain these competencies.

Method

Using a cross-sectional survey we explored CTs confidence in recognising and managing substance misuse presentations, knowledge of where to seek guidance and asked for teaching suggestions. We surveyed two CT1 cohorts in 2017 and 2019.

Result

Fifty-one CTs took the survey. Of these 92% did not feel prepared to manage acute substance intoxication or withdrawal and 96% would like relevant teaching at the start of CT1. Furthermore, 67% did not know where they could seek guidance.

CTs felt confident at recognising and managing alcohol related presentations. However, they were less confident in recognising opioid withdrawal, how to safely prescribe opioid substitution therapy (OST), and the usual doses of OST (65%, 94%, 94% rated ‘neither confident nor not confident’ or below, respectively). CTs were not confident at recognising GBL and cannabinoid withdrawal, principles of harm minimisation, assessing readiness to change, delivering Brief Interventions and teaching patients to use Naloxone.

Conclusion

The results were exceptionally similar between cohorts, demonstrating reliability of our findings and that CTs lack of substance misuse knowledge is a significant clinical concern.

To address this deficit of knowledge, we are writing an introductory lecture with supporting guidance in the induction pack, developing an online video resource, and moving key substance misuse lectures to earlier in the MTP taught programme.
Developing a local service to improve the provision of palliative care to people who use substances
Authors: Immadisetty Vyasa , Palipane Natasha , Reed Tracy , Gupta Srirupa , Pickett Beverley , McDowall Fiona , Thompson Julia
Published: June 2021

Aims

To develop a new service model that engages and improves the provision of palliative care to PWUS.

Background

Although people who use substances (PWUS) continue to die prematurely compared to the general population, they are now more likely to die from chronic diseases rather than from drug-related deaths. Challenges to providing palliative care to PWUS include delayed care-seeking behaviours, complex drug interactions and lack of healthcare provider experience.

Method

An informal factorial analysis elucidated population needs through: a review of local databases to estimate the prevalence of palliative need, a thematic review into the deaths of patients in specialist drug services and, a survey of health practitioners’ knowledge and attitudes. These informed the service development phase which involves three key components: 1. A systems approach to increasing patient identification, incorporating key multi-disciplinary stakeholders across hospital- and community-based care 2. Targeted training of healthcare providers and 3. Medicines management for symptom palliation amidst concurrent substance use (including substitution treatments).

Result

The palliative needs of PWUS are under-identified: the local substance service was not partaking in the palliative referral pathway. Only 7% of a local hospice's annual caseload was recognised as having substance use problems. The care pathway was described as fragmented. Although >80% of surveyed palliative care practitioners had experienced caring for PWUS, confidence and knowledge around managing withdrawal, pain and opioid substitution therapies was poor.

Conclusion

A new pathway is designed to identify PWUS and in their last year of life at key treatment points e.g., accident and emergency, ward-based care. The pathway will then streamline referrals to relevant specialist services depending on complexity of palliative/dependency need. Teaching resources and prescribing guidelines have been developed in collaboration with secondary care pain specialists.
Planning effective mental healthcare in prisons: findings from a national consultation on the care programme approach in prisons
Authors: Jethwa Jemini , Townsend Kate
Published: June 2021

Aims

The Care Programme Approach (CPA) can be an effective tool in coordinating the care and treatment needs of people with mental illness and learning disabilities. Within prisons settings, the CPA has been poorly implemented and the principles underpinning this approach have been lost. The aim of this research was to look at the key themes identified as part of a consultation process to develop quality guidance on planning effective mental healthcare in prisons in relation to the CPA.

Method

The consultation exercises included telephone interviews and hosting a national consultation event to represent the views of prisons nationally. It was conducted by the Quality Network for Prison Mental Health Services, a quality improvement initiative organised by the Royal College of Psychiatrists’ Centre for Quality Improvement.

Result

The results derived from the consultation process indicates that CPA in prisons is inconsistently adopted and that there is lack of confidence in the process from prison mental health teams, particularly with how to engage community mental health teams.

Conclusion

This concludes that there is a substantial need for standardisation and consistency in the application of the CPA process within prisons, for the purposes of enhanced care delivery, greater continuity of care, and improved patient outcomes. The Quality Network for Prison Mental Health Services used the findings from this consultation to produce a national guidance document on planning effective mental healthcare in prisons, which can be accessed for free by all prison mental health teams.
North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people
Authors: Tolmac Jovanka , Lewis Alun , Mohammed Azer , Fellow-Smith Elizabeth , Redelinghuys Johan , Girelas Braulio
Published: June 2021

Aims

Specialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.

Our aims:

To reduce length of inpatient stay

To enable admission of young people as close to home as possible

To improve resource efficiency, capacity and capability of managing young people in crisis in the community.

Method

A number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.

Result

After four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.

Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.

Conclusion

There have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.
Use of clonidine in the management of opiate withdrawal in community patients
Authors: Kelsey David , Hoezoo Pierre , Grewal Pardeep
Published: June 2021

Aims

Clonidine has been used to alleviate symptoms of opiate withdrawal. No validated prescribing schedules exist for the use of Clonidine in opiate detoxification in community patients. We have devised a Clonidine prescribing schedule for adult outpatients seeking opiate detoxification.

Background

Opiate cessation following prolonged use produces a central noradrenergic (NA) response in the locus coeruleus (LC), causing symptoms that can result in reinstatement of use. Pharmacotherapies for withdrawal are thought to work through decreased NA release in the LC by agonising pre-synaptic alpha-2 adrenoceptors. Clonidine has been used since the 1970s. However, it is off-license in the UK, and superseded by Lofexidine. Though both cause hypotension, this is less marked with Lofexidine, which may be anxiolytic and considered better tolerated. Lofexidine is no longer available in the UK. Specialists may need to resort to Clonidine for those seeking opiate detoxification.

Method

We performed a feasibility study with the primary outcome being tolerability of an outpatient clonidine schedule. Patients (n = 7) were aged between 18 and 65 years (mean 32). Six were prescribed buprenorphine as opiate substitution (OST), and one methadone.

Exclusion criteria were in keeping with BNF contraindications.

An ECG was obtained for each patient before treatment. A urine drug screen and Clinical Opiate Withdrawal Scale were taken to confirm opiate dependence and withdrawal. Patients self-monitored withdrawal using the Subjective Opiate Withdrawal Scale and daily blood pressure measurements. Standard adjuvants for withdrawal were prescribed.

A test dose of 100mcg Clonidine was given to assess for hypotension. If tolerant they received 100mcg QDS, reducing over eight days.

Patients were contacted by their recovery worker twice during the period.

Result

Five of the seven completed the course, two dropped out due to hypotension. No other adverse effects warranting discontinuation were encountered. Patients reported fatigue and light-headedness as their most troublesome side-effects. Of 3 patients who returned SOWS scores, 2 reported decline by 21/64 and 14/64 respectively. One reported an increase of 49/64 over 8 days. 3 of the 5 subjects who completed the course were not abstinent at completion, citing opiate withdrawal symptoms as causative.

Conclusion

There is scope for the safe use of clonidine in the community for motivated individuals. Adequate monitoring of heart rate and blood pressure is required. Starting doses at 100mcg QDS appear well tolerated. Prescribers may wish to reduce this over a longer period to encourage completion and improve tolerability. Further research is needed.
Staff's perspectives on physical activity in acute mental health general adult wards
Authors: Lekka Nikoletta , Nunns Samantha , Verity Robert
Published: June 2021

Aims

Physical activity (PA) has multiple health benefits for people with severe mental illness (SMI). Nevertheless, people with SMI engage in less exercise and more sedentary behaviour than the general population. Additionally, inpatient settings can exacerbate barriers to PA and facilitate sedentary behaviour. Staff's attitudes towards PA promotion may influence patient engagement. The aim of this study was to explore staff's views on PA for acute psychiatric inpatients, including enablers and barriers.

Method

An online anonymous survey with free text was sent to all 85 multidisciplinary team (MDT) members of two acute general adult wards, including nurses, doctors and allied health professionals. A qualitative approach was used to gain deeper understanding of the participants' perspectives. Manual thematic analysis was completed to identify discrete themes.

Result

Response rate was 64%, with 54 professionals responding. Notably, 100% agreed or strongly agreed that exercise is beneficial to physical and mental health. Nevertheless, 72% felt it was not easy to do PA with patients during their shift, while many reported they were able to encourage exercise but were unable to accompany patients to sessions. Specifically, participants reported lack of time (40%), high level of clinical activity (32%), lack of staff (30%), lack of PA resources inside the wards (20%) and conflicting priorities (18%), stopping them from helping patients to do more exercise. However, they felt more staff (28%), time dedicated to PA (26%), on-ward resources (18%), access to the gym and gardens (18%), staff dedicated to PA (16%) and staff trained in facilitating PA (10%), would help participants promote PA on the ward. Other suggestions to enable PA included a change in ward culture, valuing and promoting PA, daily patient encouragement by all MDT members instead of only occupational therapists, and PA promotion as part of mental health treatment and as physical health strategy. Finally, 70% of participants said they exercised regularly, although some reported lack of time or motivation, work commitments and workload-related exhaustion reducing their ability to exercise.

Conclusion

Participants acknowledged the importance of PA for physical and mental health. Furthermore, they described multiple enablers and barriers. Prioritising PA during admission, providing on-ward activities, educating/training staff, reiterating that PA promotion is within all MDT members' job roles, and offering organisational support can contribute to improved PA provision and regular involvement of patients.An integrative approach to mental health and wellbeing, promoting PA in inpatient psychiatric settings is required.
A community service review of the quality of inpatient discharge summaries from six inpatient wards at St Charles Hospital: an initial audit and quality improvement recommendations
Authors: Mahmoud Omar , Munjiza Jasna , King Jacob
Published: June 2021

Aims

To discuss whether Discharge summaries include important information to community mental health teams .

To identify patterns and produce recommendations for change by Quality improvement methods .

Method

A convenience sample was selected of the first 5 patient discharges from each of the 6 adult inpatient wards at St Charles Hospital. This represented a total of 30 reviewed summaries. Outcome items were generated following discussion with community psychiatric colleagues based on those aspects of an admission thought to be of most use to a community mental health team. These were; reason for admission, diagnosis, circumstances of admission, progress on the ward, risk assessment, physical health, legal status on discharge, discharge medication, discharge management plan, contact details. Basic identification was also recorded as was the ward and date of discharge

Result

•

Only 3.3% (1/30) of discharge summaries were complete of all items.

•

However 23.3% (7/30) were almost complete, failing to record only a single item, and a further 2 missing only 2 of 10 items. There was a bimodal distribution (Graph 1).

•

Seven (7/30) discharge summaries provided no information. Of these, four (4/7) discharge summaries were written in the progress notes directly, rather than using the discharge summary proforma.

•

The ‘reason for admission’ item was a clear low outlier with only 2/30 reporting this piece of information. For a number of cases, this was recorded unhelpfully as “in crisis”.

Conclusion

There was limited evidence of systemic patterns,however some wards showed internal stark differences with some summaries complete or almost complete and others empty.

The key findings from this report are the high number of discharge summaries which have either no responses to them (7/30). This may indicate that the writer did not know how to use the current discharge template, and therefore support with using this is indicated. For those with a very low (7/30) number of item responses, we might conclude that these discharge summaries were written by someone with knowledge of using the system, but for another reason did not complete the majority of the items asked, and for this reasons are not immediately clear. Similarly, as highlighted above the main low outlying result relates to the apparent widespread practise of writing “in crisis” as the ‘reason for admission’, unfortunately to community teams this is an unhelpful and self-evident response.
Microsoft teams virtual handover system
Authors: Mohan Mohit , Scally Ruth , Reed James , Cavaropol Calin
Published: June 2021

Aims

Accurate and timely handover of clinical information is of great importance to continuity and safety of care. Psychiatry doctors typically cover a number of sites across a catchment when they are on-call. Consequently, handover between on-call teams and day teams in psychiatric hospitals is reliant on using the nursing staff as an intermediary to flag concerns or relying on the day teams proactively checking the notes on daily basis for outstanding tasks.

The key objective of this project was to use Microsoft teams to establish a handover system that is efficient, safe, reliable, easy to use and replicable.

Method

A microsoft teams group was created comprising of all the medical staff members working at inpatient units across three sites that are part of Birmingham and Solihull Mental Health Trust. These members were divided into two groups - the ‘on-call team’ and the ‘day team’. Within the ‘day team’, every consultant was grouped with their junior doctors to form multiple subgroups.

A system was established wherein the two teams could communicate with each other by posting a message and tagging the appropriate team. A provision was made to create a channel for every ward to allow for easy segregation and monitoring of tasks.

Qualitative information about the use of the tool was monitored by monthly focus group meetings. A formal review of the messages was conducted after 8 weeks to assess the following parameters:

Number of messages posted

Number of messages acknowledged

Number of safety-related incidents

Result

Initial evaluation of the results suggests that the new handover system was perceived to be safe, accurate and efficient while being intuitive and hassle-free. This increased the quantity and enhanced the quality of communication between the ‘on-call’ and the ‘day teams’ and allowed for early completion of tasks while reducing the number of safety-related incidents.

Conclusion

The Microsoft teams proved to be a viable alternate tool to create a virtual handover process that is efficient, safe, reliable and user-friendly. It also has the potential to enhance the communication between inpatient and community teams.
Reducing the use of oral psychotropic PRN medication in acute mental health inpatients
Authors: Moore Zoe , Morrow Rachel , McGee Meta
Published: June 2021

Aims

Project aim:

To reduce the use of oral psychotropic PRN* medication on Ward 3 AMHIC (Acute Mental Health Inpatient Centre) by 20% by May 2020

(*PRN = Pro re nata/As required)

On Ward 3, we identified a number of unintended negative consequences of PRN medication to both patients and staff.

These included issues with over-use, dependence and side effects; as well as loss of staff ownership and challenging interactions with patients, (including escalation to aggression).

Following the success of our Child and Adolescent Mental Health Inpatient colleagues in this area, we decided to embark on a project to change practice within our ward.

Method

In order to quantify the problem, we first collected baseline data on current use of psychotropic PRN medication.

As a multidisciplinary project team, we then brainstormed potential contributory factors and displayed these visually as a driver diagram.

This divided our project into 3 main areas:

1)

Safe prescribing

2)

Safe administration,

3)

Safety culture.

Project measures were also agreed as follows:

Outcome: Number of doses of oral psychotropic PRN medication administered per week

Balancing: Violent incidents; IM administrations of psychotropic medication

Process: Time taken to complete interventions; Patient and staff satisfaction. Change ideas were selected and implemented sequentially, using Plan-Do-Study- Act methodology.

These included:

1)

Weekly review of PRN prescribing

2)

Nursing administration sheet

Data were collected weekly and plotted on our run chart.

Result

By the end of May 2020, we had exceeded our initial goal, reducing the weekly median number of doses of oral psychotropic PRN medication administered by over 30%.

Our balancing measures remained stable and we gained useful insights and development ideas from a staff survey.

Further change ideas were planned for implementation over the months that followed, however, the impact of the COVID-19 pandemic meant that the project lost some momentum.

Conclusion

Despite running into some difficulty over recent months, the team remain motivated to maintain and build upon our previous success.

In the past few weeks, “Calm Cards”, (a patient-centred intervention promoting use of individualised alternative coping strategies), have been introduced.

We hope that the outcomes of this intervention will be positive, both in terms of further reducing use of PRN medication and encouraging development of skills which can be utilised beyond the hospital environment.

We also intend to share our learning with colleagues and explore the possibility of introducing the project to other wards within the hospital.
A quality improvement project on nicotine replacement therapy in Shannon Clinic (Northern Ireland)
Authors: Moss Eileen
Published: June 2021

Aims

The aims of this quality improvement project were to determine if Nicotine Replacement Therapy was being prescribed correctly in Shannon Clinic in Northern Ireland and also to improve the rates of correct prescribing of Nicotine Replacement Therapy in the aforementioned unit.

Background

There are several different types of Nicotine Replacement Therapy currently available. Shannon Clinic is a smoke-free clinical environment therefore patients who smoke are offered Nicotine Replacement Therapy on admission. When I was working at Shannon Clinic I became aware that there was no clear guidance available to medical staff on the wards regarding prescribing Nicotine Replacement Therapy and therefore I decided to carry out this quality improvement project.

Method

An audit of drug charts was done on the patients who were under the care of the consultant that I worked with. In total nine drug charts were included in the audit. After the audit was complete, I produced a poster to show how to correctly prescribe Nicotine Replacement Therapy. A copy of this poster was placed on each ward in Shannon Clinic. After a period of time the drug charts were re-audited to see if there had been an improvement in the rates of correct prescribing of Nicotine Replacement Therapy.

Result

In total, 22% of the drug charts which were included in the audit had Nicotine Replacement Therapy prescribed incorrectly on them. After the inclusion of a poster outlining how to prescribe Nicotine correctly on each ward in Shannon Clinic, 0% of drug charts had Nicotine Replacement Therapy prescribed incorrectly on them. This was an improvement of 22%.

Conclusion

This quality improvement project was successful at reducing the rates of incorrect Nicotine Replacement Therapy in Shannon Clinic. In the future it is my hope that this quality improvement project should lead to the correct prescribing of Nicotine Replacement Therapy for all patients in Shannon Clinic. It should also lead to an increased awareness regarding the different types of Nicotine Replacement Therapy for medical staff working in this clinical unit.
Bridging the gap: improving liaison psychiatry documentation quality to meet the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) treat as one recommendations at newcastle hospitals
Authors: Ou David , Ibrahem Sara , Basirat Sahar , Brown Sarah
Published: June 2021

Aims

This project aimed to assess and improve the quality and frequency of documentation from Psychiatric Liaison Team (PLT) to ward-based medical colleagues against the Treat as One recommendations. From experience, we hypothesised that written documentation of information crucial to patient care is not consistently meeting standards. This communication breakdown directly affects patient safety, potentially introducing additional risks to our already vulnerable patient group.

Effective communication between PLT and our medical colleagues bridges the gap in providing continuity of care and ensures patients’ mental and physical health needs are met in acute trusts. The NCEPOD found that there remains many barriers to high quality mental healthcare provided to patients in general hospitals and recommended 7 elements that PLT documentations should encompass.

Method

We audited initial PLT assessments and the resulting documentation to determine if these met the 7 standards set by NCEPOD. Baseline audit undertaken from 21-27/09/2020 encompassing 130 patient referrals to PLT.

A period of time was allotted to implement robust changes to improve the service. This included a streamlined e-template that automatically populates in the acute hospital eRecord system which prompts clinicians to document according to the NCEPOD standards, structured clinician training and education, and the nomination of “Treat as One Guardians” in the team to ensure that acute trust documentations are present during daily multidisciplinary meetings.

The cycle was then completed on 22-28/02/2021 with a re-audit capturing 55 referrals.

Result

Implementation of our recommended changes saw an increase from 58% of documentations with ≥50% NCEPOD elements to 98% in the re-audit.

We also saw an increase in number of the NCEPOD 7 elements included following intervention: formulation (0% to 8%), legal status and capacity (47% to 79%), risk assessment (2% to 28%), risk management (18% to 53%), and discharge plan (2% to 29%).

Completion rate of acute trust documentation increased from 74% to 96%.

Our interventions also led to more contemporaneous communication, significantly reducing mean time from assessment to documentation in both acute trust and mental health records from 6.02 to 3.53 hours, (p = 0.04) and 6.12 to 3.50 hours, (p = 0.05) respectively.

Conclusion

Following our interventions, the results showed improving trends in the frequency and quality of our documentation with secondary outcomes showing increased documenting efficiency. Our current practice is not yet optimal and retains potential to adversely affect our patients. We propose further investigating barriers to change using the quality improvement PDSA (Plan, Do, Study, Act) methodology to continue innovating.
Improving cardiometabolic health assessments and interventions at St Charles Hospital, London
Authors: Rahman Mehtab , Julien Vernanda
Published: June 2021

Aims

St Charles is one of the largest inpatient mental health units in London with 8 wards and covers the boroughs of Kensington & Chelsea and Westminster. This project aimed was set up so that 95% of patients in St Charles Mental Health Centre would have a complete cardiometabolic health assessment by December 2020. This would include Weight, Smoking, Alcohol, Substance Use, Hypertension, Cholesterol and Diabetes assessments with necessary interventions recorded. The outcome of the intervention would improve overall physical health and life expectancy.

Method

People with serious mental illness experience significantly worse physical health and shorter life expectancy of up to 10 to 15 years than the general population. CNWL is making Physical Health of patients in Mental Health Services a priority. Performance in this area has been challenging across the Trust because of:

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Buy in from clinicians.

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Staff did not feel empowered to discuss interventions with patients.

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High sickness and absence as a result of COVID was found to directly correlate with reduced physical health monitoring/recording.

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Lack of training in completing the SystmOne physical health template

The following cardiometabolic risk monitoring interventions were recorded on SystemOne (electronic documentation platform) and performance reviewed using Tableau : Weight, Smoking, Alcohol, Substance Use, Hypertension, Cholesterol and Diabetes assessments with necessary interventions recorded.

Result

Prior to the commencement of this project, the wards in St Charles Mental Health Centre completed physical health assessments on roughly 8% of the patients in February 2020. The QI project was implemented in June 2020. By September 2020, physical health recording across 8 wards across St Charles had increased to 89% following successful implementation of the interventions.

Conclusion

The following interventions resulted in a significant improvement in physical health cardiometabolic risk monitoring at a busy inpatient mental health setting:

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Monthly physical heath meetings to enable shared learning with ward doctors, nurses and healthcare assistants.

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Ongoing one-to-one and group support to train staff with completing and recording physical health assessments.

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Tableau Physical Health Report regularly reviewed with MDT during ward round meetings.

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Physical health leads given supernumerary days to run physical health clinics on the wards.

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Fortnightly Physical health monitoring meetings with the Director of Nursing and Head of Governance.
PLAN standards and writing to patients: quality improvement by audit
Authors: Shaw Edie , Adams Catherine , Maclaren Thomas , Brown Fergus
Published: June 2021

Aims

This quality improvement project aimed to assess the adherence of a hospital psychiatric liaison team's documentation of assessments to the Psychiatric Liaison Accreditation Network (PLAN) standards framework; to identify areas of improvement; to identify barriers to and improve adherence.

Method

Data were extracted from 27 randomly selected patient assessments from 01/07/2020 to 31/08/2020 and then 27 assessments from 01/10/2020 to 30/11/2020 for re-audit.

Quantitative data was collected by calculating the percentage of assessments which documented each specific aspect of PLAN standards.

Qualitative data including attitudes specifically towards writing to patients was gathered from 1:1 discussions with members of staff.

Interventions between rounds of audit:

Presentation of results of 1st data collection to team in November 2020 followed by discussion

Emailed instructions to create a template based on PLAN standards for assessments to staff

Lobbied for Cerner access at liaison team office to facilitate use of above

Result

Quantitative – overall improvements were seen in adherence to all aspects of documentation of assessments including collateral history (from 23% to 67%) past medical history (30% to 70%) and acknowledging the patient/carer perspective (46% to 74%). Some improvement was seen in offering written correspondence to patients (0% to 20%).

Qualitative – the majority of comments regarding writing to patients were positive, with no staff members opposing the standard (“it is best practice”, “should become a habit”). However, some barriers were identified including increased workload (“requires more editing”, “could take a lot more time”).

Conclusion

Team adherence to PLAN standards for documentation of assessments was improved through low intensity interventions. Overall adherence was high, however certain areas leave space for improvement. The audit facilitated conversations around writing to patients on discharge, both in the form of formal gathering of qualitative data and informal discussions between staff. Attitudes towards writing these letters were positive and some improvement was seen between audits. Ongoing audit activity aims to further improve adherence and monitor improvements.
Quality improvement project: to improve adherence to DVLA (driving and vehicle liscensing agency) guidance in the tyrone & fermanagh hospital acute inpatients ward
Authors: Sing Vivian , Ballantine Chad , Hackett Peter
Published: June 2021

Aims

To reach 80% adherence to DVANI (Driving and Vehicle Agency Northern Ireland) guidance in acute inpatients ward, T&F Hospital

Background

This is a scale-up of a previous successful QI project on driving and Attention Deficit Hyperactivity Disorder in Belfast Trust. According DVLA's guidance for medical practitioners on the current medical standards of fitness to drive, patients with certain mental health diagnosis are required to inform DVLA of their diagnoses and refrain from driving. Different factors are considered in order to determine patients’ fitness to drive. According to DVLA and GMC, it is medical professionals’ responsibility to advise patients to inform DVLA/DVANI of their mental health diagnosis. It is the patient's legal duty to notify DVLA/DVANI of their diagnosis. Patients can be fined up to £1000 if they failed to inform DVANI of their medical condition.

Method

Outcome: Completeness of driving advice given to consecutive patients discharged from T&F hospital from April 2019 to early August 2019 in %

Process: Document clearly in electronic and written notes on following - (1) has driving status been asked (2) has patient been advised to inform DVA if required (3) has patient been advised likely how long he/she is to refrain from driving for

Balancing: increased the time of reviews, increased numbers of consultant reports requested from DVA

Result

4 cycles have been completed. Cycle 1 – baseline and review guidance; Cycle 2 – medical staff education and developed driving advice pathway and patient leaflet; Cycle 3 – admin staff was involved for putting driving advice pathway in admission pack; Cycle 4 – medical staff was educated again regarding importance of documenting electronically. Clear changes were seen after cycle 3 showing an increase of mean of 25% completeness of driving advice to over 90%.

Conclusion

It is the legal duty of patients to notify DVANI of mental health diagnosis, however it is the responsibility of medical professionals to advise patients to do so. This QI project has shown improvement in the completeness of driving advice given. Further cycles are to be completed to obtain patient feedback.