bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Capacity and Consent to Treatment Recording, Park House Hospital
Authors: McKnight Rebecca , Fu Rachel
Published: June 2022

Aims

Re-audit for adherence of all inpatient wards at Park House Hospital to Trust Consent to Treatment policy. Improve hospital compliance to Trust Consent to Treatment policy. Reduce prescribing errors. Improve trainee confidence and knowledge of Consent to Treatment

Methods

•

Cross sectional audit.

•

Data collected between 8th and 12th November 2021

•

All wards in Park House Hospital

•

5 patient records and medication charts reviewed per ward.

•

Proforma used.

•

Data analysed using Excel.

•

Interactive teaching on Consent to Treatment delivered by Dr McKnight to Core Psychiatry Trainees on 3rd July 2020.

•

Dr McKnight presented the original audit data and consulted the Pharmacists and Consultants to assess and improve ward systems for recording Consent to Treatment. (26th May and 30th April 2021).

•

Dr McKnight presented to Greater Manchester Mental Health, Mental Health Act and Mental Capacity Act Quality Improvement Group (30th June 2020).

Results

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No wards had 100% capacity forms documented, kept in medication charts and uploaded to Paris.

•

7/9 wards had 100% compliance for completing T2/3/S62 forms.

•

6/9 wards had 100% compliance rate for retaining the T2/3/S62 forms in the medication charts.

•

78% T2/3/S62 forms were uploaded to PARIS.

•

80% medication charts matched T2/3 forms.

When Dr McKnight asked trainees, “Do you feel confident with your knowledge of consent to treatment” only 24% answered yes, 35% answered no and 41% a little.

When asked, “Do you check Consent to treatment forms before prescribing?” 32% answered yes, 24% no, 34% sometimes and 10% that they didn't know what they were.

During the post-teaching quiz, trainees were asked, “Has this teaching session improved your knowledge and confidence regarding Consent to Treatment?” 91% answered yes, 0% answered no and 9% answered a little.

Discussion with Consultants and Pharmacists concluded that it may be beneficial for wards to include Capacity to Consent and Consent to Treatment within ward round proformas

Conclusion

•

The two main concerns of the initial audit and re-audit, relate to Treatment Capacity and Consent forms compliance and prescribing.

•

New trainees rotate into the Trust every 6 months and levels of knowledge surrounding Consent to Treatment varies depending on trainee experience. Trainees require teaching on Consent to Treatment as part of their induction and teaching programme.

•

Based on the multidisciplinary nature of ensuring compliance to Consent to Treatment the authors propose monthly ward auditing of Consent to Treatment, which they believe will lead to better compliance rates across the hospital.
Patients With Psychotic Disorders Are More Likely to Refuse Vaccination: An Audit of Vaccine Acceptability on Acute Adult Psychiatric Wards
Authors: Miles-Marsh Rupert , Diamantis Elias , Duan George , Suarez Lori Edwards , Lankappa Sudheer
Published: June 2022

Aims

This audit is looking at COVID-19 vaccine uptake in an acute adult psychiatric setting as part of the national drive to minimize COVID-19 infection. The aims of this audit are to identify: the number of patients that have been offered vaccination in a ward setting; the acceptability of the vaccination and the reasons for non-acceptance of vaccine.

Methods

A total of 339 patients were admitted to acute adult psychiatric wards (Male, Female, PICU) at Highbury Hospital, Nottingham between February to August 2021. Data on the following parameters: demographics (age, sex, ethnicity), section status, HoNOS cluster, admission length and vaccine data (offered, accepted, received) using the RIO system and Health Informatics.

Results

Out of 339 patients, 31% (n = 105) had received or planned to receive the first dose of vaccine prior to admission. 43% (n = 100) of 234 patients who hadn't received vaccine were offered. Out of the patients who were offered vaccine, 59% (n = 59) accepted. 92% (n = 55) of patients who accepted vaccine, received vaccine. Those offered vaccination had an average length of stay of 117 days whilst those not offered had a shorter average length of stay of 81 days.

For patients who were offered vaccine, those who were sectioned and in psychotic clusters refused vaccine compared to non-psychotic and informal patients. Deprivation, gender, age, admission length had no statistical significance in vaccine uptake for patients who were offered.

Patients listed the following reasons for refusing the vaccine: media distrust; vaccine not effective; already had COVID-19; doesn't want it; believes vaccine made by consultant; doesn't want bad reaction; “Scientists and politicians are liars”; “I am fine and don't need it"; “Don't trust it and don't like needles”; “Don't want to be part of the game”; “Have had covid twice and, if I get it, I'd prefer my body to fight it”.

Conclusion

Our current vaccine acceptance rate of 59% is lower than those found nationally (80%) and in a medium secure psychiatric hospital (77%). The trust policy recommends all eligible patients should be offered the vaccine; our offer rate is lower than this standard. The low offer rate may be explained by vaccines being offered in rounds leading to patients possibly being missed. Our acceptance rate could be enhanced by improving our vaccination care plans for formally admitted psychotic patients.
Antipsychotic Prescribing Practice in Adults With a First Presentation of Psychosis Amongst Bolton's Early Intervention Team and Inpatient Mental Health Services: An Audit
Authors: Morrison Eve , Cappleman Hannah
Published: June 2022

Aims

In Bolton Early Intervention Team (EIT) it was noticed that patients prescribed antipsychotics frequently required a change in medication due to side effects. Similar issues had been identified in Avon and Wiltshire NHS Foundation Trust where a prescribing guideline was developed which won the NICE Shared Learning Award in 2020. This recommends prescribing Aripiprazole first line and cautions using Olanzapine or typical antipsychotics first due to their side effects. The aim of this project was to identify which antipsychotic drugs are currently prescribed in first episode of psychosis (FEP) in Bolton EIT patients and to audit adherence to National Institute of Clinical Excellence antipsychotic prescribing guideline CG178.

Methods

The sample included all adults with FEP accepted by Bolton EIT across a four-month period from 01/12/20 until 31/03/21. Fifty-two people were identified.

Measured standards were documentation of prescribing rationale, discussion regarding medication side effects and weekly weight monitoring for six weeks following initiation. Antipsychotic choice and need for a change within six months of initiation was recorded. Data were collected retrospectively from patients’ electronic records.

Results

Thirty-eight patients had been prescribed an antipsychotic – fifteen as inpatients, seventeen by Bolton EIT and six by the Home Treatment Team.

Of the fifteen inpatients Olanzapine (8) and Zuclopenthixol (3) were the most common choice. 5/15 had a documented rationale, and side effects were discussed with 3/15 patients. Weekly weight monitoring was performed in 7/15.

Of the 17 people who started antipsychotic medication once under Bolton EIT Quetiapine (6), Olanzapine (6) and Aripiprazole (5) were the most common choices. 12/17 had a documented rationale and 13/17 were consulted regarding side effects. Weekly weight monitoring was not performed for any of these patients.

Within six months, sixteen antipsychotic prescriptions (42%) were changed due to side effects (9), inefficacy (6) and non-compliance (1). The drugs changed were Olanzapine (6) Quetiapine (6) Zuclopenthixol (2) Aripiprazole (1) and Chlorpromazine (1).

Conclusion

Those initiated on antipsychotics as inpatients need better involvement in decision-making and consultation about side effects. A community initiative should be introduced to offer weekly weight monitoring. Further work is required to understand the rationale for frequently prescribing Olanzapine and Zuclopenthixol in inpatient services, and to consider why Aripiprazole is infrequently used first line.
Audit Against DVLA Guidance for New Psychiatric Patient Referrals at the Early Intervention for Psychosis Team (EIP)
Authors: Radhakrishnan Tharun Krishnan , Lathif Nismen
Published: June 2022

Aims

To assess the compliance of the clinicians in EIP team with DVLA guidelines. Objectives: To assess if there was documented evidence of: 1)Patient's diagnosis, 2)Patients’ driving status, 3)Type of vehicle driven, 4)Informing the patient that their condition may affect their ability to drive, 5)Advice regarding driving restrictions where applicable, 6)Informing the patient that they have a legal duty to inform the DVLA about their condition

Methods

We selected two-thirds of the patients(n = 40) enrolled in the EIP service in the last year by consecutive sampling. We collected the data retrospectively from the clinical documentation and analysed it using excel sheets.

Results

The mean age of the study sample was 34 years. 95%(n = 38) had a documented diagnosis, 67.5%(n = 27) had a documented driving status. The documentation of driving status was completed by doctors in 52%(n = 14), nurses in 26%(n = 7) and by both in 22% (n = 6). The type of vehicle driven was documented for only 33%(5) of the drivers. Among the drivers identified 33%(n = 5) had been informed that their condition might affect their driving, 67%(n = 10) had received information on driving restrictions and 47%(n = 7) had received information that they have a legal duty to inform the DVLA.

Discussion:

One of the reasons for the low compliance may be because another team might have documented the information at the time of referral. It is possible that the professional involved did elicit the information but didn't document the same. Healthcare professionals(HCP) have to identify, discuss and document driving-related information as advised by the DVLA. In cases where the patients’ don't follow the advice, the HCP must notify the DVLA.

Conclusion

Assessment of driving history and the risks associated are critical. Awareness should be raised among the clinicians (through training and team meetings). This practice should be made an integral part of the structured initial assessments. Patients can be offered information leaflets. If successfully implemented, it will prevent unsafe driving and minimise the risk of harm for the patient and other road users.
Changes in Crisis Resolution Home Treatment Team Referral Numbers and Patient Caseload During COVID-19 Pandemic in First Lockdown
Authors: Raza Awon , Pillai Sujith
Published: June 2022

Aims

The COVID-19 Pandemic has had an impact on most aspects of functioning on the world in general. We wanted to see what impact of COVID-19 Pandemic has had on a Crisis Resolution Home Treatment Team North Peterborough. The main objectives of this audit were to see changes in Crisis Resolution Home Treatment Team North number and source of referrals, average length of stay, total number of patients Home Treated during this period (Pre and during COVID-19 pandemic) and to also identify whether patients with a certain diagnosis deteriorated or presented more to services compared to others.

Methods

We retrospectively reviewed case-notes and data were collected from RiO Electronic Patient Records (EPR) covering all the factors we wanted to analyse. Data collection periods were pre-COVID-19 between 1st April 2019 and 30th September 2019 and COVID-19 pandemic (1st Lockdown) between 1st April 2020 and 30th September 2020. Total number of referrals received between April and September 2019 pre-pandemic were 844 and total number of referrals received during COVID-19 pandemic between April and September 2020 were 660. Data were exported from the electronic patient record into Microsoft Excel and quantitative analysis was performed using Microsoft Excel.

Results

The results showed 21.8% drop in total number referrals from 844 to 660 and there were 20.89% (79) less patients Home Treated from April and September 2020 during first lockdown compared to the similar period in 2019. Significant increase observed in patients with bipolar affect illness by 32% (from 86 to 128 patients), acute stress reaction and adjustment disorder by 15% (from 68 to 80 patients) and psychotic disorder by 11.5% (from 245 to 277patients) in 1st lockdown period compared to 2019 similar period. Declining trend observed in intentional self-harm by various means by 20.75% and 4% drop in personality disorder patients. Anxiety and depression patients number remained same in both periods.

Conclusion

Although referral numbers dropped significantly and Crisis Resolution and Home Treatment Team caseload decreased during the COVID-19 pandemic first lockdown, the number of patients with serious mental illness presented to services increased remarkably (bipolar and psychotic illness). Overall, no major change in length of stay of patients with Crisis Team was observed when compared both periods and referral numbers remained low from all sources during COVID-19 pandemic.
Assessing the Impact of COVID-19 on Overdose Presentations Through the Emergency Department in a Large Tertiary Hospital
Authors: Saleh Raneem , Kutubi Abdubadie , Shobowale Zainab , Saleh Renad , Guerandel Allys , Moore Susan
Published: June 2022

Aims

The outbreak of COVID-19, lockdown and self-isolation has created a lot of additional pressure on the society as a whole. We aim to audit the number of patients presenting to SVUH ED since March 27th 2020 (the date at which the government imposed a stay-at-home order) with an overdose.

Methods

The cohort of cases analysed was identified using ED MAXIMS under the subheading of ‘overdose and poisoning’ presentations. Data were collected using MAXIMS and clinical portal and stored on the SVUH system and analysed using Microsoft Excel and SPSS.

Results

There were a total of 713 cases in both years (from 27th of March – 31st December), with 353 (49.5%) admitted in 2019 and 360 (50.5%) admitted in 2020. Out of those admitted, 423 patients were females (196 and 227 in 2019 and 2020 respectively). There was a significant increase in the number of female presentations in 2020, with a p value of 0.041.

When stratifying patients based on age, the mean ages were 37.22 (SD 17.04) and 34.18 (SD17.32) in 2019 and 2020 respectively (p = 0.076). When dividing age groups in three categories (under 18, over 65 and 19–64), our data showed significant differences. There was a significant increase in numbers in the ≤18 yr and 19–64 age groups in 2020 compared with 2019. In the under 18 groups, there was an increase in numbers by 7.9% in 2020 (11.6% compared with 19.5%). When comparing numbers between Months per year, overall, there were no changes in presentations. Interestingly March 2020 had no presentations compared with March 2019, coinciding with the beginning of the pandemic in Ireland. May showed more than 50% decrease in presentations in 2020. Similar numbers were seen in the rest of the months of both years.

Conclusion

Between 2019 and 2020, there was a 1.9% increase of ED presentations with overdoses, which did not show any significance in increase of numbers or in age demographics. There were three main findings from our analysis:

1. A significant difference between the two years in a rise in female patients admitted with overdose (p = 0.041)

2. An increase in presentations in the age groups of under 18 and 19–64. This may allude to increase strain in the younger population with loss of jobs, financial burdens etc.

3. There were no presentations in March 2020, coinciding with the beginning of the pandemic in Ireland.
An Audit to Assess the Quality of Ward Referrals Sent to City Hospital Liaison Psychiatry Team From Inpatients Wards D15, D17and D27, Between July 2021 to September 2021
Authors: Setlhare Kesegofetse , Woodman Hannah , Pahal Amandeep , Hickmott James
Published: June 2022

Aims

Liaison psychiatry provides psychiatric care to medical patients. Patients include those attending emergency departments, general hospital inpatients and outpatients. Liaison teams work hand in hand with several general hospital teams to offer advice, review and manage these patients. Over the last few months, the Liaison service in City Hospital have been receiving many inappropriate referrals. Inappropriate referrals are defined as patients who are referred to services, with one of the following reasons:

1.

Insufficient presenting complaint

2.

No documented Past psychiatric history

3.

Insufficient Mental state Examination (MSE)

4.

No risk assessment

5.

No documented Drug/alcohol history

6.

Patients having not consented to referral.

7.

If one or more of the above criteria is not met

Our aim was to evaluate the appropriateness of the referrals received from D15, D17, D27 inpatients wards in City Hospital over a 3-month period from July to September 2021. These wards were chosen as they commonly refer patients to liaison services.

Methods

We collated data retrospectively on the nature of all referrals from D15, D17 and D27 ward over a 3-month period. The patient referral portal was used, and referral content of each patient was analysed. An audit tool was devised to assess whether the referrals followed the liaison referral pathway and guidelines set by NHS England for referral structure to liaison services.

Results

18 patients were referred to the Liaison psychiatry from the three wards over the three-month period. We observed 77.8% (n = 14) of the referrals having insufficient information for the presenting complaints, whilst 22.2% (n = 4) of them did not state past psychiatric history. Approximately 94.4%(n = 17) did not state sufficient details of MSE. In 83.3% (n = 15) of referrals appropriate detailed risk assessment was not done, 27.8% (n = 5) of them did not have alcohol/ drug use stated and 22.2% (n = 4) of patients referred did not consent to the referral being made.

Conclusion

The results demonstrated that ward referrals lack quality and contain inadequate information to allow for safe screening of patients and for the implementation of appropriate actions by the liaison team. A possible reason for inappropriate referrals may be due an existing knowledge gap and lack of confidence taking detailed psychiatric histories, assessing risk, and performing MSE in non-psychiatric trainees making referrals to liaison services.
Audit & Reaudit of Assessments Regarding Substance Misuse in Patients Referred to Liaison Psychiatry Service
Authors: Shittu Oriyomi , Mushtaq Samlan , Maria Dervis
Published: June 2022

Aims

1- What percentages of people presenting to general hospital that are referred to Liaison Psychiatry service have Substance misuse problems? 2- Are the assessments by Liaison Psychiatry services identifying substance misuse problems? 3- If substance misuse problem is identified then are we offering any advice/intervention/referral

Methods

To look at 100 consecutive assessments by using an audit proforma to capture information required to answer above questions.

Results

In 78% of cases there was evidence documented that the patient was asked about alcohol use. In 22% - no evidence patient was asked about alcohol use.

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77% documentation about drug use. 23% no evidence documented that the patient was asked.

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Of those asked about their alcohol use (n = 62), a misuse problem was identified by clinicians making the assessment in 6 cases (10% of those asked).

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Of those asked about their drug use (n = 61), a misuse problem was identified by clinicians making the assessment in 8 of cases (13% of those asked).

Of those with a substance misuse problem identified (n = 15), 20% identified misuse of both alcohol and drugs, 40% identified misuse of alcohol only, and 40% identified misuse of drugs only.

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Of those with a substance misuse problem identified (n = 15), 73% were offered advice or an intervention, and 27% had no intervention documented.

Conclusion

Just over a fifth of patients assessed were not asked about alcohol or drug use. This has improved since August 2020 when nearly half of the patients assessed were not asked about alcohol or drug use.

–

Since audit in August 2020, there has been a 21% increase in documentation of advice or intervention being offered to patients identified to have a substance misuse problem.
Audit to Assess Melatonin Prescribing in Community CAMHS
Authors: Shroff Chirag
Published: June 2022

Aims

Disordered sleep is common, affecting 20–30%of children aged 1–5 years and often continues later into childhood. Neurodevelopmental disorders and psychiatric comorbidities pose a greater risk. The audit aimed to determine whether clinical prescribing practice of melatonin in Burlington House, Sefton CAMHS reflected current NICE recommendations. NICE suggest that first-line treatments for children with sleep problems include good sleep hygiene and behavioural therapy (including sleep diary).

Methods

Nice guideline CG170 provides guidance on Autism management. BNFC states that melatonin therapy should be reviewed every 6 months. Records of children currently prescribed modified release melatonin were checked to see if they met the inclusion criteria. Data were collected retrospectively from clinical case files and pharmacy records (December 2020- February 2021).

Results

The results showed 18 young persons received melatonin for insomnia with ASD, 26 for insomnia without ASD, 3 for likely ASD and none for Smith Magenis syndrome. 36 received Specialist CAMHS review, 9 received Community Pediatrics review and 2 GP review. All patients received melatonin as per dose recommendations with 6 monthly reviews. Documentation on sleep hygiene was unclear.

Conclusion

We concluded that Melatonin prescribing in community CAMHS tends to be high and discussion on sleep hygiene measures must be given importance.
An Audit on the Adherence to Antipsychotic Prescription Policy for the Management of Delirium in the Medical Wards
Authors: Simiyon Manjula , Loo Jiann , Baker Catherine , Lepping Peter , Jones Steven
Published: June 2022

Aims

This audit aimed to assess the adherence to the anti-psychotic policy for delirium in the medical wards. It aimed to assess compliance with each of the guidelines mentioned in the health board's policy which is based on the National Institute for Health and Cares Excellence (NICE) guidelines.

Methods

After registering the audit, the Acute medical ward was approached for the hospital numbers of all the patients admitted in the months between January and March 2021, and 70 case records were screened. Case notes of patients above 18 years who were diagnosed with delirium including those after managing alcohol withdrawal were included. Those who were admitted only with alcohol withdrawal delirium were excluded. 47 case records were selected for data collection. A proforma was prepared based on the policy available in the intranet and data were entered.

Results

Retrospective data of 47 patients who had delirium were analysed which included 18 males and 29 females. The mean age of the participants was 80.7 years (range 40–101; SD + 30). The mean days of referral after admission were 28(+7.07). 34%were diagnosed to have delirium by the treating team,8.5% were diagnosed by the Emergency Department (ED) team and 57.4% were diagnosed by the liaison psychiatric team. 57% had another psychiatric diagnosis. The cause for delirium was mentioned in 55% of the records and the most common cause was urinary tract infection (31%) followed by multifactorial delirium (27%). Antipsychotics were prescribed for 57% and among those who received 74% received risperidone, 15% received olanzapine, and 11% haloperidol. Compliance was 100% in prescribing appropriate antipsychotics, maximum dose, investigations (expect x-ray chest and CT scan), only 54% compliance was observed with regards to stopping the antipsychotic before discharge and in 23% it was mentioned to be monitored by the GP and another 23% by the treating team.

Conclusion

This audit has displayed the lacuna in the prescription of antipsychotics for patients diagnosed with delirium. Periodic programs will be planned and executed for training the liaison practitioners and the staff in the medical wards regarding the diagnosis and management of delirium especially the prescription of antipsychotics. A re-audit will be conducted after 6 months.
An Audit of Compliance With NICE Guideline: Obesity: Identification, Assessment and Intervention by the Forensic Community Mental Health Team Based at a Supported Accommodation
Authors: Lin Chung Mun Alice , Sud Neeti
Published: June 2022

Aims

In England, 64.8% of adults are currently classified as overweight or obese, with rates even higher in the North East at 68.6%, especially in adults with severe mental health illnesses. This additional body weight has the potential to increase the risk of developing a number of serious health conditions including diabetes, heart disease and even cancer. Studies have shown that patients with schizophrenia have a 2.8–3.5 increased likelihood of significant weight gain and reduction in life expectancy of 15–20 years, mainly due to preventable physical illness. Monitoring of risk factors for this, particularly weight gain, is therefore crucial. The NICE Guideline (2014) recommends that patients are routinely categorised into BMI categories to assist with obesity identification, management, and monitoring. A waist measurement is also advised to help with risk stratification. Patients with psychosis or schizophrenia, especially those taking anti-psychotics are also recommended to be offered a combined healthy eating and physical activity programme by their mental healthcare provider. Finally, patients with rapid or excessive weight gain, abnormal lipid levels or problems with blood glucose management should be offered appropriate interventions. Our main objective was to identify whether the obesity assessment, monitoring and intervention care delivered by our community team is in line with current guidance.

Methods

A total of 12 residents living in community forensic supported accommodation and currently taking antipsychotic medications were included. Data reviewed were from September 2020 to September 2021. Data audited were from electronic medical records.

Results

This audit found that 10 out of 12 patients (83%) fell into either the overweight or obese BMI categories (seven obese and three overweight). Only four patients had agreed to have their waist circumference measured, which meant only four patients were able to be appropriately risk stratified. One patient was identified as pre-diabetic and another diabetic. All patients identified to be overweight or obese received appropriate lifestyle advice. Qrisk scores, to assess cardiovascular risk, were calculated for the majority of eligible patients, except for two.

Conclusion

This audit highlights that patients who are on regular antipsychotic treatment and living in the community are at high risk of obesity and its associated complications. It is important to perform regular health checks in this cohort due to this risk, both to improve their quality of life and prevent significant morbidity and mortality. Waist circumference measurements should be encouraged to enable risk stratification and accurate documentation will enable timely treatment intensification.
A DVLA Notification Audit in Forensic Supported Accommodation
Authors: Lin Chung Mun Alice , Lim Nicole , Sud Neeti
Published: June 2022

Aims

The Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver. The driver is legally responsible for telling the DVLA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Patients with acute schizophrenia or an acute psychotic disorder must not drive and must notify the DVLA. In alliance with the above, the GMC advises that clinicians have a responsibility to explain the above information to the patient and inform them that they have a legal duty to inform the DVLA. Doctors should also inform patients that relevant medical information may need disclosing about them to the DVLA if they continue to drive against advice, and any advice given should be documented. The main objective of this audit is to identify if notification of DVLA for forensic patients living in supported accommodation, is in accordance with the DVLA guidelines.

Methods

A total of 12 residents living in community forensic supported accommodation who have a notifiable diagnosis were included. Data collection took place in September 2021, looking through all previous records relating to the search words “DVLA”, “drive”, “driving” and “license”. Data audited were from the trust's electronic patient records.

Results

Diagnoses included paranoid schizophrenia, delusional disorder and personality disorder. Antipsychotic medications included Olanzapine (oral and IM), Clozapine and Zuclopenthixol +/- antidepressants. Legal status included community treatment orders (civil section), voluntary community patients and those on a conditionally discharged restriction under secretary of State supervision. Two patients held full driving licences and a further two held provisional licences, with DVLA documented discussions and notification compliance at 100%. The remaining eight patients had no documentation regarding driving nor DVLA discussions or notification.

Conclusion

This audit found that DVLA discussions are not currently well documented, with only four patient records that have this recorded. Although it is the clinical team's responsibility to advise the patient to notify the DVLA, it is ultimately the patient's responsibility to notify the DVLA themselves. DVLA discussions need to be had regardless of driving status and documentation should reflect this.
Audit: Do Electronic Mental Health Records Match General Practice Shared Records of Medications and Allergies for Patients Residing at a Community Forensic Supported Accommodation?
Authors: Bernard Kate , Sud Neeti
Published: June 2022

Aims

Medicine reconciliation in community teams is guided by trust guidance, which emphasises that for all new patients accepted into a community team, staff should be aware of all current medication (both psychotropic medication and those prescribed for physical health needs). This information needs to be considered at each review to inform safe prescribing. Upon this background, concordance between electronic mental health records and general practice shared records of medications and allergy status for patients residing at a community forensic supported accommodation was audited in order to identify areas for improvement in practice.

Methods

Data were collected from mental health electronic records (Rio) and general practice records (Health Information Exchange). All patients residing full-time at a community forensic supported accommodation in Cumbria Northumberland Tyne and Wear NHS Foundation Trust during January 2022 were included. Concordance between the records in medication and allergy status was assessed. Initial assessment was performed by one reviewer and 100% of included records were then cross checked by a second reviewer. Data collection was intended to pick up any mismatch in the records. Standards were set at 100% concordance.

Results

Eight patients were included. For allergy status, in two patients’ (25%) records showed allergies which were present in electronic mental health records were not present in general practice records. The reasons as to lack of documentation of allergy status in general practice records were unclear. Cross check of the discharge summaries to primary care from the wards where allergies were originally identified indicates that allergies were clearly documented.

For medication, discrepancies between records were found in two patients (25%). In these patients, medications present on general practice records were not present on mental health records. These were both physical health medications (vitamin D supplements) which were being prescribed regularly by primary care and had been omitted during transcription onto electronic mental health records.

Conclusion

1) Currently, standard practice is for updates of medication on mental health records to take place every four months as part of quarterly care coordination reviews. Electronic mental health records should not be relied upon solely to check patients’ medication: while they provide a snapshot, cross checking with primary care records and pharmacy remains a must. This is current practice and ensures patient safety.

2) Primary care to be made aware of the omissions and requested to update their records as per the discharge summaries.

3) Continue regular re-audits every four months
Buckinghamshire Early Intervention Service’ (BEIS) Compliance With the National Institute for Health and Care Excellence (NICE) Antipsychotic Monitoring Guidelines: Practical Challenges, Including Those Posed by the Pandemic, in an Outpatient Setting
Authors: Tan Shinn , Butt Harun , Pike Grace , Williams Busayo , Breton Alexandre , Reid Alaistair
Published: June 2022

Aims

Antipsychotic use is associated with cardiovascular and metabolic side-effects, which may contribute to increase mortality and morbidity in this patient group. This highlights the importance of physical health monitoring. We aimed to assess our compliance with the more stringent NICE guidelines, updated in September 2021.

Methods

Half of BEIS team's caseload was audited (n = 67) during October 2021 for compliance with NICE's monitoring guidelines for patients initiated on antipsychotic medication. These included initial and, if indicated, repeat monitoring of body mass index (BMI), pulse, blood pressure (BP), blood results, electrocardiogram, and adverse effects. Patients who were not on antipsychotics were excluded. 61% of patients were initiated on antipsychotics as inpatients, and 39% were outpatients. These patients have been started on antipsychotics within the last three years. Data were collected via electronic record systems. 80% compliance was set as the standard, in line with National Clinical Audit of Psychosis standards.

Results

In the first three months of antipsychotic initiation (61% as inpatients, 39% in the community) six out of nine parameters met standards (ranging from 2% to 100%), with BMI measurement (weekly), pulse and BP measurements and one month repeat haemoglobin A1C (HbA1c) failing. When only accounting for patients who were started on antipsychotics in outpatient settings (BEIS or crisis team), compliance was only met on two parameters.

Three months post initiation, when patients were mainly monitored in the community, only three of the nine parameters met compliance (lipids, HBA1c, and side-effects).

Conclusion

Adherence to the NICE standards for physical health monitoring in the community poses significant challenges. Possible barriers include reduced patient contact during the pandemic, lack of awareness of monitoring requirements, poor documentation (particularly of declined screening) and a lack of time and resources. There is also a possibility of unnecessarily stringent and impractical guidelines which are difficult to achieve in outpatient settings – such as weekly BMI. We plan to implement interventions including providing a checklist for medical and nursing staff and encouraging patients to monitor their own blood pressure and weight at home. We will reaudit the same parameters in 6 months’ time.
Availability and Functionality of Physical Health and Resuscitation Equipment in an Inpatient Setting: A Closed Loop Audit Cycle
Authors: Tang Song Ling , Fadlalla Ikhlas
Published: June 2022

Aims

To ensure physical health and resuscitation equipment on all wards in a mental health hospital fulfil relevant standards. A closed-loop audit of this was performed on four acute adult inpatient wards after implementing interventions.

Methods

Data were collected from treatment rooms on each ward, with standards based on Physical Health in Mental Health; Final Report of a Scoping Group (Royal College of Psychiatrists) and Mental Health Inpatient Care Equipment and Drug Lists (Resuscitation Council UK) – parallel to the trust approved standards.

Percentage of availability and functionality against audit standards were tabulated and interventions were carried out, including:

1.

Awareness presentations at trust clinical governance meetings.

2.

Each ward to have own complete sets of physical health and resuscitation equipment.

3.

Policy for wards to register their physical health equipment and service details on the trust maintenance services database. The medical device engineering team to complete maintenance and repair as needed.

4.

Resuscitation equipment on each ward being checked weekly and replaced as needed (monthly before).

A re-audit was performed one year post intervention on four acute adult inpatient wards in the mental health hospital using similar parameters.

Results

1.

In general, 90.0% of the standards are met (out of 160 pieces of equipment, 144 are in stock and functional), similar to that of previous year (90.0%).

2.

Decrease in overall available and functional physical health equipment: 76.6% (49/64) compared to 83.8% last year.

3.

Increase in overall in overall available and functional resuscitation equipment: 99.2% (95/96) compared to 94.2% last year.

Conclusion

There is a significant decrease in percentage of overall available and functional physical health equipment; while that of resuscitation equipment has significantly improved when checked and corrected weekly using the trust Resuscitation Check Form.

Action plan:

1.

All unavailable/ inadequate equipment to be reordered or sent for maintenance immediately.

2.

Discussion in the upcoming trust Physical Health Nurses Forum and Medical Devices Standards Group on audit recommendations below:

. Allocation of named permanent staff member to check presence and functionality of medical equipment regularly.

a. Creating a checklist similar to the Resuscitation Check Form for physical health equipment.

3.

Discussion in the trust Resus Standards Group on ‘My Kit Check’ (MKC), a centrally monitored electronic checking platform with alerts automatically sent for incomplete checks or expired resuscitation items (e.g., AED batteries, anaphylaxis kit) that are not replaced. A funding request has been submitted for this.
Audit on Smoking Cessation in a Community Secondary Mental Health Service
Authors: Tu Hanna , Campion Jonathan
Published: June 2022

Aims

Smoking is the single largest cause of preventable death. Smoking prevalence is higher in people with mental disorders and impacts on physical health, mental health and bioavailability of psychotropic medications. Evidence-based interventions exist to support smoking cessation (SC)/reduction in people with mental disorders, although evidence suggests less provision compared to the general population. We aim to determine the unmet SC needs and associated causes in a community secondary mental health service, in order to advise appropriate service response. This audit will inform relevant work of the RCPsych Public Mental Health Implementation Centre as a case example.

Methods

From the caseload of 364 patients, a sample of 91 case records was randomly selected for recording of smoking and provision of treatment. A survey of 31 smokers and 12 ex-smokers identified patient attitude and barriers in SC. Information on availability and nature of other SC provision in the community was gathered from staff and relevant services.

Results

A sample of case records found 44% (n = 40) of patients were smokers compared to 13,5% in the general UK population. 31 patients were offered SC advice of whom 2 were recorded as wanting to quit. Nicotine Replacement Therapy (NRT) was offered to 13 patients and 5 were referred to SC services (SCS). Aside from smoking status, limited information on smoking was recorded.

The survey revealed that 20/31 smokers wanted to reduce or quit smoking, of whom 10 used NRT. Six were referred to SCS which helped 3 reduce. Four ex-smokers used SCS, which helped 3 to quit. Most frequently reported barriers in SC were habit, social isolation, availability of tobacco, and stress. Frequently reported enhancers in SC were NRT, allocated support with follow-up, social interventions and family support.

Regarding current service provision, we identified that local GP's did not prescribe NRT. Targeted SCS exist exclusively for inpatients and the only community SCS available offered 12 SC sessions without targeting needs of people with mental disorder.

Conclusion

Despite high smoking prevalence in our caseload, there is an implementation gap in providing and recording SC advice and treatment, both in our service as in local primary care and community services. Provision of evidence-based interventions and coordination with GP's and SCS could prove useful in narrowing this gap. Results from this local project could be explored on a larger scale to address the implementation gap in SC in this population at high risk of smoking associated harm.
An Audit of the DNACPR Policy at Malta's Mount Carmel Hospital
Authors: Warwicker Sean , Bellizzi Annalise
Published: June 2022

Aims

A consideration for patient dignity in end-of-life care dictates that good clinical judgment should be exercised in advance resuscitation decisions. The COVID-19 pandemic, and its inherent risks to caregivers, only adds to this importance. Our aim was to audit the standards for the DNACPR policy at Mount Carmel Hospital (MCH), which is Malta's major inpatient psychiatric hospital, against those at Saint Vincent De Paule Residence (SVPR), which is a long-term care facility where DNACPR decisions are taken by geriatricians as opposed to psychiatrists.

Methods

Resuscitation status designation and rates of form completion were measured in the five chronic psychiatric inpatient wards at MCH. This 98-patient population was compared against an age-matched cohort from SVPR to evaluate differences in decision-making.

Medical comorbidities and frailty scores (measured using the Clinical Frailty Scale) were compared between the two groups. As far as age-groups would allow, as many patients with a psychiatric comorbidity as possible were included from SVPR (36).

Z-score testing for two population proportions was used to evaluate the differences in resuscitation status designation. The Independent Sample T-Test was used to compare means in medical comorbidity and frailty. A p-value of <0.05 was used to assume statistical significance.

Results

Rates of resuscitation form completion were 73.47% and 94.90% in MCH and SVPR, respectively. In those patients with completed documentation, 9.72% of patients were designated as “Not for CPR” in MCH, compared to 61.29% in SVPR.

Between these two age-matched cohorts, the mean frailty score was slightly greater in SVPR, which was not statistically significant (5.83 vs 5.48, p = 0.1456). The mean number of medical comorbidities was significantly greater in the SVPR cohort (3.50 vs 2.47, p = 0.0002).

Conclusion

This striking difference in DNACPR designation suggests that geriatricians have a higher threshold for determining whether a patient would benefit from CPR compared to psychiatrists. Furthermore, rates of resuscitation form completion at MCH were disappointing. The greater likelihood for chronic psychiatric inpatients to be designated “For CPR” may be due to the perception that this entails a higher level care. In reality, in older, frailer patients, CPR may only prolong suffering, while a “Not for CPR” decision does not necessarily imply an omission of care.

In Malta, we've tailored resuscitation training to the inpatient psychiatry setting, which includes stations on decision-making and COVID-19.
Improving the Use of the Mental Health Risk Assessment (MHRA)
Authors: Sampey Libby , Walzl Dennis , Wee Colette , Clafferty Robert
Published: June 2022

Aims

The MHRA is a comprehensive form on our electronic patient records system. It includes 11 sections assessing different risk categories, with tick boxes to evidence input from various members of the MDT. Anecdotal experience suggested that these forms were sometimes incomplete and often lacked input from MDT members other than nursing staff. We aimed to increase the completion rate and multidisciplinary team (MDT) involvement, particularly doctor involvement, in the electronic MHRA documentation on an acute inpatient psychiatric assessment ward at the Royal Edinburgh Hospital.

Methods

•

Baseline survey (November cohort of 12 patients): data collection on number of sections completed (total number = 11) and whether the ‘psychiatrist’ box was ticked, indicating medical input.

•

Intervention: doctors on the ward reviewed all inpatient MHRAs, added additional assessments if appropriate, and ticked ‘psychiatrist’ involvement in the MHRA.

•

Repeat survey (February cohort of 11 patients): data collection as before and review of findings.

Results

In our baseline survey (November 2021), 75% (9/12) of patients had all sections of the MHRA completed. 33% (4/12) had the ‘psychiatrist’ box ticked. In our repeat survey (February 2022), 91% (10/11) of patients had all sections of the MHRA completed. 100% (11/11) had the ‘psychiatrist’ box ticked.

Conclusion

Accurate assessment and management of risk is an important factor in the safety of patients and staff on acute psychiatric wards. Our baseline data showed that risk assessments had limited medical input and at times had sections which were not filled in at all. Review of the MHRA by medical staff improved this, and in some cases found and added relevant information which had been missed. As a person dependent intervention, this may not be a sustainable change. As a first step to introduce a sustainable system change, a visual prompt has been introduced, in the form of a blue triangle icon in the duty room whiteboard to highlight whether each patient has a complete and up to date MHRA. Further interventions could include integrating a review of the MHRA in weekly ward rounds. This audit also raised the issue of some relevant information having been missed from risk assessments and showed that further audit of the quality of risk assessments is indicated.