bluuebunny/crossref_metadata_2025 huggingface dataset:
An evaluation of the Royal College of Psychiatrists' “Psych Star” scheme
Authors: Lunn India , Hyland Declan
Published: June 2021

Aims

In 2019, the Royal College of Psychiatrists (RCPsych) launched the “Psych Star” scheme for medical students with an interest in psychiatry. The one-year scheme provides Psych Stars with a matched mentor, free registration at the RCPsych's International Congress, financial support for psychiatry-related activities, journal subscriptions and access to two online learning platforms. This project aimed to evaluate the effectiveness of the scheme in supporting Psych Stars to explore their interest in psychiatry and in promoting psychiatry as a career choice, through use of a survey for both Psych Stars and mentors.

Method

Surveys were sent to all Psych Stars and mentors from the first cohort of the scheme. The mentor and student surveys contained a mixture of ranking, multiple choice, closed-ended and open-ended questions. Questions examined: clarity of the scheme's aims and objectives; benefits of each aspect of the scheme; impact of the scheme on application to Core Training; benefits and barriers to successful mentorship; adequacy of mentor support from the RCPsych and suggestions to improve the scheme.

Result

Six Psych Stars and nine mentors completed the respective surveys. All Psych Stars stated the scheme was enjoyable. Five Psych Stars were more likely to apply for Core Training because of the scheme. All Psych Stars identified the most beneficial aspect of the scheme being the funded place at the RCPsych International Congress. Other aspects highly ranked included: funding to explore areas of psychiatry of interest and the opportunity to be an ambassador for psychiatry. All Psych Stars found the mentorship useful.

Mentors supported Psych Stars by providing career advice, suggesting relevant conferences to attend and assisting Psych Stars make decisions on how to use their allocated funding. Barriers to mentorship that were identified included: geographical separation, limitations related to the COVID-19 pandemic and lack of time. For mentors, areas for improvement included clearer aims and objectives and more support from the RCPsych.

Both mentors and Psych Stars suggested forming a network of Psych Stars and mentors would be useful to share ideas and experiences.

Conclusion

This evaluation shows that the Psych Star scheme successfully supports Psych Stars to explore their interest in psychiatry, and promotes psychiatry as a career choice. This survey has been helpful in identifying what aspects of the scheme are particularly attractive, and also, importantly, how the Psych Stars scheme can be improved for future cohorts. The survey will be delivered to all future annual cohorts of Psych Stars and mentors.
Physical Health Simulation Based Education (SBE) for psychiatrists in the first COVID-19 wave: improving the competence and confidence of the medical workforce
Authors: McEwan Craig , Kerslake Richard , Hobkirk Michael
Published: June 2021

Aims

At the start of the COVID-19 pandemic there was significant uncertainty for the NHS and it's workforce. Within psychiatry, there was an expectation that junior doctors would be redeployed, with senior psychiatrists stepping down to cover physical health and on-call duties.

Senior leadership in mental health trusts were also preparing for COVID-19 outbreaks on psychiatric wards and were developing strategies for managing a novel illness with a poorly understood clinical course. Many psychiatrist expressed anxieties around their competency in assessing and managing acutely physically unwell patients in a mental health setting.

This project aimed to improve confidence of psychiatrists in core physical health competencies through devising and delivering an evolving SBE package.

Method

Sussex Partnership Foundation Trust redeployed two higher trainees from their simulation faculty to work full time on developing a SBE package. This was requested by senior leadership to deliver training about assessing and managing physically unwell patients in the context of COVID-19. This training was devised as a 90 minute didactic lecture following by 90 minutes of SBE.

This was delivered at 6 sites through 10 opt-in sessions available to all doctors in the trust over 4 weeks. Pre and post-course questionnaires were given to all participants to measure the effect.

Result

102 medical staff attended the SBE workshops. Feedback was completed by 93 (91%) doctors prior to the course and 97 (95%) post. Before the workshop, 33% did not feel they had a structured approach for assessing an acutely unwell patient, which reduced to 0% after completing the course.

On a 5-point Likert scale, confidence in managing COVID-19 symptoms increased from 2.54/5 to 4.07/5 overall with 89% of doctors feeling “confident” or “very confident”. There were similar increases in confidence in managing critically unwell patients (2.7/5 pre; 3.95/5 post) and in identifying alternative causes for acutely unwell patients (2.63/5 pre; 4.02/5 post).

Conclusion

This project demonstrates that SBE is an effective way to rapidly develop effective interventions for the medical workforce, increasing confidence in the face of significant uncertainty and reducing anxiety within the system to meet the learning needs identified by medical leadership.

As part of this project Sussex Partnership Medical Education freely shared the workshop materials, which were later adopted and used by psychiatry departments internationally.
Demystifying the pathway of assessment and treatment for bipolar disorder – utilising co-production and algorithms to personalise the approach
Authors: Nicholls-Mindlin Jessica , Quested Digby , Taylor Matthew , Fuzi Lauren , Gee David
Published: June 2021

Aims

To develop an evidence based, patient centred treatment pathway for people experiencing symptoms of bipolar disorder (BD), modifiable to include local resources.

Method

This project was developed in line with current approaches to service development such as coproduction, with patient and public involvement (PPI) and enhancing personalisation of treatment in medicine. As part of a local initiative, a multi-disciplinary team was brought together to understand and analyse the current local pathway for those affected by BD. It was found that the approach to assessment and management was not consistent between locality teams. Two experts by experience who have a diagnosis of BD were invited to become involved with the development of the pathway. Meetings were set up to enable coproduction and elicit information from those with the diagnosis. The responses provided insight into the effectiveness of different approaches used nationally to inform the methods and resources that are most helpful and appropriate to comprehensively support those with the illness.

NICE guideline evidence was used to create two algorithms to streamline the care of those with BD in both primary and secondary care. These algorithms include pharmacological, psychological and social approaches. It also considers the junctions at which referrals should be made and the criteria on which decisions are based.

Result

One algorithm was designed for use in primary care and will be distributed to local GPs to clarify the initial steps for assessment and management of BD and the criteria for referral. A second decision tree will be made available to all doctors working in mental health services with detailed medication options, when they are appropriate and whether additional psychological intervention should be considered e.g. post-discharge groups. Other specialist options such as Early Intervention for Psychosis and Perinatal Mental Health Services were also included. An information pack was created to be offered to all those with a diagnosis or possible diagnosis of BD. This contains useful resources such as skills and exercises that patients may find of benefit, external resources and websites regarding additional support and further information on BD, its nature and management.

Conclusion

The approach and resources collated here will help to streamline the management of those with bipolar disorder whilst also ensuring a more consistent approach. The involvement of experts by experience and the incorporation of NICE guidelines ensures a well-rounded and comprehensive set of documents that will be helpful to both clinicians and patients.
A national CASC course
Authors: Ramesh Yathooshan , Stock Lisanne
Published: June 2021

Aims

There was understandable anxiety from trainees about the transition to the online format of the CASC due to the pandemic. There is also significant variability between trusts in the availability of lectures tailored specifically to the CASC exam. Having recent experience of the CASC exam, including the online format, we developed a free online lecture series. We aimed to address common questions relating to the exam, and selected topics that trainees may find daunting or had less experience with through clinical care. The topics covered were: An Introduction to the CASC, Mental State Examinations, Psychological Therapies, Pharmacology and a Q&A Session.

Method

The course was designed to tackle areas that trainees often find difficult based on our own experiences as well as surveying course attendees. Prior to the course, we liaised with consultant site tutors & junior doctor representatives to integrate the course into the local academic programme, and to facilitate promotion of the session to trainees across sites. We subsequently offered registration to trainees nationally. The course was planned and delivered by the organisers through interactive lecture-based presentations with handouts, ahead of the January 2021 examinations. Content was based on national guidelines and published research. 5 sessions were delivered with the final session including guest consultant panellists to answer trainee questions. Quantitative and qualitative feedback was collected from the attendees.

Result

172 doctors registered onto the course, with 44 NHS trusts represented. Doctors from a variety of grades attended, with 55% CT3s, 17% Specialty Doctors, 16% CT2s, 8% CT1s, 4% in other roles. 100% of attendees stated that they would recommend the course to any doctor sitting the CASC. 97% of attendees rated the course as either ‘Excellent’ or ‘Good’. Qualitative feedback was positive and 3 themes were identified- communication, content and the online format.

Conclusion

The CASC course provided an opportunity to deliver national teaching to trainees based on national guidelines and peer-reviewed research, with a focus on addressing areas that trainees may feel less confident with. The course received significant positive feedback from attendees. The significant number of pre-CT3 trainees attending the course suggests that there may be an interest from this group for further support in developing the complex communication skills that ultimately are assessed by the CASC exam.
An innovative CASC training redesign – ‘experience of virtual mock CASC exam’
Authors: Rankin Jennifer , Foster Jessica , Minhas Omer
Published: June 2021

Aims

Cardiff CASC Training (CCT) has provided structured and formal training for the CASC exam for Wales trainees since 2012, in conjunction with Wales Deanery. For the past 8 years CCT has delivered face-to-face mock CASC exams and received excellent feedback from candidates and examiners, in addition to an extremely positive outcome of improvement in CASC pass rate for candidates.

Due to the current COVID-19 pandemic restrictions delivery of the mock CASC examination had to be adapted with the aim of running it remotely via an online platform.

Method

The examinations were run online via Zoom due to its ease of use, including the ability to screen share candidate instructions and assign participants in to breakout rooms. One lead exam coordinator manually rotated candidates around the circuit of 16 stations.

Result

A total of 16 candidates sat the mock exam over two separate sittings. Written feedback was obtained from candidates and examiners. Limitations identified during the initial sitting included high logistical workload for the lead exam co-ordinator and Zoom not being supported by all hospital computer internet browsers, these issues were addressed prior to the second sitting. Feedback from candidates regarding the overall experience of the online exams ranged from 'extremely effective’ to ‘very effective’, this is in line with feedback obtained following previous face-to-face mock exam events CCT has run.

Conclusion

Although online learning may feel very different to the face-to-face interactions we are all used to we are in an era where adaption is necessary. These online mock CASC examinations have been a success and are also in keeping with how the real CASC examination is currently being run by the Royal College of Psychiatrists. CCT are running a further online mock examination to support the next cohort of candidates through their CASC exam in this particularly challenging time.
Immersive psychiatry simulation: a novel course for medical student training
Authors: Ruddock Kenneth , Herbert Kim , Neil Catriona , Gajree Neera , Dempsey Karli
Published: June 2021

Aims

Over the last decade, there have been significant developments in the use of simulation for undergraduate medical education. Despite simulation's diverse applications across the medical school curriculum, it has thus far been underutilised within psychiatry teaching. Psychiatric simulation can support students to develop strategies to elicit psychopathology, de-escalate an aggressive patient or perform a risk assessment. Such experiences can be difficult to encounter during clinical placements and may expose a student or patient to an unacceptable level of risk. We have therefore developed an immersive simulation course that aims to enhance undergraduate psychiatry training.

Method

Our course was developed by medical education faculty and psychiatry staff. The course handbook includes storyboards, patient scripts and debrief guidelines. Clinical scenarios are mapped to university intended learning outcomes and include; conducting a risk assessment for a patient with emotionally unstable personality disorder and comorbid depression, managing a manic patient in the Emergency Department and assessing a patient with obsessive-compulsive disorder who has developed skin damage due to hand washing.

The one-day course is delivered to groups of 4-8 students from the Universities of Glasgow and Edinburgh during their placements in NHS Lanarkshire. The course takes place in a simulation suite and is facilitated by psychiatrists and medical education faculty. Students each take the lead role during a clinical scenario in which they will encounter a simulated patient. Live video from the simulation is broadcast to other candidates. Scenarios last 10-15 minutes with a 20-30 minute group debrief immediately afterwards. The debrief utilises the PEARLS framework (Promoting Excellence and Reflective Learning in Simulation) and provides the opportunity for peer and facilitator feedback, as well as discussions regarding mental state examination, diagnosis and management.

Result

Qualitative and quantitative feedback has been collected via an anonymous electronic post-course questionnaire. To date, the course has received universally positive feedback. 93% of candidates rated the overall quality of the course as a learning experience as ‘excellent’. Students reported that the course helped them develop communication skills which they could apply to future clinical situations. In addition, candidates felt participation had increased their confidence in taking a psychiatric history and performing a risk assessment.

Conclusion

Immersive simulation is an underutilised tool in psychiatry education. Our course complements the existing educational programme of lectures and ward-based teaching and has been positively received. It provides the opportunity for students to develop interview techniques and communication skills in a safe, controlled environment.
Is it possible to use research to learn psychiatry from scratch: a reflective self-study of a pre-clinical year medical student
Authors: Selvakumar Jashan , Loo Jiann Lin , Ohn May Honey , Kelly Gabby
Published: June 2021

Aims

Despite the abundance of opportunities available for medical students to explore the field of psychiatry, active immersion through experiential learning has proven to be difficult for pre-clinical year students as a result of a busy time table and the need to wait for psychiatry postings during the clinical years. Hence, the question of “how to implement experiential learning of psychiatry in pre-clinical years” arises. This study is aimed to elucidate the attempts that have been made to use research as a proximate approach to learn psychiatry experientially, focusing specifically on the challenges faced and lessons learned by a pre-clinical medical student.

Method

This self-study outlined the informal three-months learning-by-doing journey of a year-one medical student, supervised by a psychiatrist registrar. Employing research as a proximate approach of experiential learning for psychiatry was explored based on reflection from discussion during supervision meetings and messages exchange. The agreed learning method was an active involvement in research projects on psychiatry topics, with the learning outcome of producing publications.

Result

The challenges faced included: 1) the difficulty associated with striking a balance between an ambitious project with high impact versus a feasible smaller project to keep both parties motivated through the means of short-term accomplishment; 2) the ongoing requirement for learning process adjustment to build the foundational knowledge essential for progress. Through active and deliberate effort, every step in the process was found to be an opportunity for active learning. Literature review, for example, was used to build the understanding of psychiatry topics and practise critical appraisal skills, while allowing for the recognition of knowledge gaps, which ultimately encouraged future research idea synthesis. The process of writing and submitting a manuscript was used to learn publication-relevant skills including: journal impact calculation, referencing, indexing and abstracting services, and publication ethics. Certain future proof skills were also developed, including literacy in information and communication technology which improved efficiency of research, problem solving and decision making. This was done using pros and cons whenever difficulties were faced.

Conclusion

Although research is not a comprehensive substitute for clinical posting in the process of learning psychiatry, the lessons learned from psychiatry research can potentially serve as an initial exploration tool for preclinical-year medical students interested in the field. The stimulating process has found to be effective in stimulating further interest in psychiatry but maintaining it will be the next challenge.
Developing a virtual mock casc for trainees
Authors: Somerville Laura , McMurray Peter , Sing Vivian , Campbell Stephanie , McGee Meta
Published: June 2021

Aims

The restrictions experienced due to the COVID-19 pandemic had impacts on how clinical teaching and assessment is conducted. The Royal College of Psychiatrists decided to run the final part of the membership exam, the Clinical Assessment of Skills and Competencies (CASC) online for the first time in September 2020. We aimed to prepare candidates in the Northern Ireland deanery for this by developing a virtual mock examination using the Zoom platform.

Method

In previous years, higher psychiatry trainees in the Northern Ireland deanery have run successful face to face mock examinations to help pre-membership trainees prepare for the CASC. We adapted some of this material to our virtual examination. 16 stations were run in total, in two circuits of eight. These stations were mapped to the Royal College CASC blueprint. Higher trainees were recruited to act as examiners, with core trainees acting as simulated patients. The mock examination was advertised through the local deanery and all candidates sitting in September availed of the opportunity (a total of 8 trainees).

Zoom was used as the platform due to ease of use, familiarity and breakout room function. Each station formed one breakout room, and a facilitator moved candidates between rooms and provided timing prompts. Instructions were emailed to candidates in advance.

A comfort break was provided between circuits. At the end of the mock examination, everyone was returned to the main room and examiners gave general feedback and tips. Individual feedback was provided by collating mark schemes for each candidate, which included free text feedback, and sending these via email.

Result

Despite the evident challenges involved, the mock CASC ran smoothly. There was one minor delay of approximately 3 minutes due to technical difficulties, which was easily recouped. We obtained qualitative feedback from candidates which was positive, with trainees commenting that they felt “more at ease … less worried” about a digital exam, and that it was “efficient and effective”.

All candidates who sat the mock examination were successful in the face to face CASC sitting which followed in September.

Conclusion

We were able to successfully adapt what was previously an in-person mock CASC exam to the new digital format in a way that reflected how the actual CASC exam will run, and it was considered beneficial preparation by the candidates who sat this mock. This has improved trainee experience at a time when many teaching opportunities have been suspended.
The use of drama and theatre in enhancing communication skills of psychiatry trainees: a pilot study
Authors: Stevenson Laura , Khan Farooq , Bharmal Qusai , Odejimi Opeyemi , Samnani Sheliza , Wright Polly
Published: June 2021

Aims

Various methods have been employed in the development of communication skills. This pilot study was designed to assess the acceptability, feasibility and cost-effectiveness of a specially designed workshop exploring the use of drama and theatre in enhancing the self-reported communication skills of psychiatry trainees. As a secondary aim, it assessed if the value of the improvements translated both into clinical practice and to training situations, including success in the Royal College of Psychiatrists (RCPsych) Clinical Assessment of Skills and Competencies (CASC) examination.

Method

A three-day drama and theatre workshop was organised in the West Midlands Deanery in conjunction with specialist instructors from performing arts at the Hearth Centre, Birmingham. The Tension State technique developed by Jacques Lecoq and Forum Theatre approach, were some of the methods employed to enable participants to develop the softer, but essential communication skills required for effective practice. Work was also undertaken focussing on self-regulation. Fourteen trainees completed the first day of the workshop. This pilot study utilised a mixed methodology to evaluate participants’ views of the perceived impact of using drama and theatre to enhance their communication skills. Feedback was obtained from organisers and facilitators specifically relating to feasibility and cost effectiveness. Data were collected from participants using pre and post-workshop questionnaires and focus groups.

Result

All participants reported a positive and enjoyable experience, indicating that the approach was acceptable to those involved. The facilitators deemed this more novel approach to enhancing communication skills feasible, and cost effective and concluded that there was scope to incorporate it into routine psychiatry training in the area. It was however identified that the content of the workshop could be condensed, reducing the length therefore to two days. There was a notable increase in participants’ self-reported confidence in their communication skills post compared to pre-workshop. Trainees reported utilising the techniques in day-to-day practice. All of those participants who undertook the CASC examination during the workshop were successful, although it would be too presumptive to assume a causative effect. The workshop was completed without any adverse events and there were no concerns from a safety perspective.

Conclusion

Drama and theatre, as a novel approach, appears to have noticeable benefits in enhancing the communication skills of psychiatry trainees. The success of this pilot study in demonstrating acceptability, feasibility and cost effectiveness, suggests that drama and theatre techniques could be easily incorporated into psychiatry training and potentially other medical education programmes.
Mind and body: physical health monitoring in clozapine treatment
Authors: Abdelreheem Moataz , Connell Olivia , McNally Daniel , Ayeni Itunuayo Veronica , Smith Clare
Published: June 2021

Aims

To evaluate physical health monitoring standards in patients on Clozapine in the community.

Standards

NICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.

Background

In the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.

Method

This audit is a retrospective study of patients known to South Kensington & Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.

Result

Of the 48 patients, one was transferred to a different service so was excluded (n = 47 total).

All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).

Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).

Conclusion

Following review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.

In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.
Using an electronic discharge notification system reduces the time delay between discharge and a summary being sent to the GP
Authors: Adams Alex , Ymisson Bodvar , Davies Virginia
Published: June 2021

Aims

All patients discharged from our Paediatric Liaison Team will have an electronic discharge summary sent to their GP within 24 hours by January 2020.

Background

Writing a GP discharge summary is an essential part of patient care and is a patient safety issue if not completed on time. The NHS England Standard Contract states discharge summaries should be completed and sent to a GP within 24 hours of discharge. Baseline data showed our median time between discharge and a GP summary being sent off as 3 days and a baseline survey of staff in our team rated our discharge summary process as inefficient and time consuming. At baseline our discharge summary was typed on a word document which was then emailed to admin staff who would print and post to the GP. Our electronic patient record had an inbuilt discharge notification function that generates and sends summaries via email to the GP that other teams in the trust were already using.

Method

We utilised the Model for Improvement Quality Improvement methodology. Initially we created a driver diagram breaking the process of discharge summary writing into its constituent components to generate change ideas. We then tested out these out in plan, do, study, act (PDSA) cycles whilst continually collecting data using a shared team spreadsheet to monitor for change.

Result

We found that switching to electronically sent discharge notifications improved our time from discharge to a summary being sent to the GP from a median of 3 days to 1 day. We noticed that alongside a shared team spreadsheet monitoring when summaries were written we also reduced variation of time between discharge and a summary from a range of 0-27 days (with an outlier of 161) to 0-9 days.

Conclusion

On average the time from discharge to a summary being written met the standard and we reduced the variability of time delay by using an electronic notification. However only 56% of summaries were sent within the 24 hour limit. Key factors for continued variability identified during regular team meetings included overall caseload of patients, amount of staff on shift and technical issues with the form. Our plan for sustainability is to discuss monthly in the team meeting any discharges that took longer than 1 day and target further PDSA cycles to these issues.
An analysis of outcome measures in a specialist inpatient eating disorders unit in Aberdeen: changes since 2015 and response to the COVID-19 lockdown
Authors: Cross Emma , Morris Jane
Published: June 2021

Aims

Identify differences in outcome measures between inpatient cohorts during the first year of the pandemic compared with preceding years.

Identify key elements in the treatment provided by identifying any trends in the outcome measures between 2015 and 2021.

Background

The Eden Unit at the Royal Cornhill Hospital (RCH) in Aberdeen is a ten-bed specialist centre for the inpatient treatment of eating disorders (ED). Strict measures to control the spread of COVID-19 have meant that important aspects of therapy in the Eden Unit are no longer permissible. It is not known whether handicaps to providing the previous service are reflected in recent outcomes.

Method

Values for age, length of stay (LOS), BMI, HbA1c (diabetic patients) and responses to three questionnaires: Eating Disorder Evaluation Questionnaire (EDE-Q); Depression Anxiety Stress Scale (DASS)-21; and Clinical Outcomes in Routine Evaluation (CORE). This data were collected for April 2020 to February 2021 (Pandemic) and compared with five preceding years, April 2015 to March 2020 (Pre-COVID). The project was registered with NHS Grampian Quality Assurance Team and approved by the MCN Quality Assurance subgroup. Ethical approval was not required. A data collection sheet allowed anonymised data to be entered into a Microsoft Excel TM Spreadsheet for analysis of baseline demographics.

Result

Average age of patients remained similar across the six years. Length of stay in the first year of the pandemic was significantly shortened. BMI on discharge in 2020/21 remained similar to preceding years. If relevant, HbA1c was measured throughout admission and comparison with BMI change reflected a focus on treating both diabetes and ED concurrently. Comparison of admission and discharge questionnaires to determine outcome measures proved difficult due to the small number of responses to both.

Conclusion

Shorter LOS during the pandemic was a significant finding. Despite this, BMI on discharge remained similar, suggesting a shift to weight restoration due to lack of opportunities for an holistic approach due to restrictions. Key elements of treatment include careful monitoring of HbA1c and concurrent management of Type I Diabetes for those patients. The low response rate to questionnaires raises concern regarding their use, in their current format, as effective tools to measure outcomes. Though low numbers of questionnaire responses prevent firm conclusion, it appears that the reduced opportunities for elements of treatment to be undertaken in the community may have contributed to increased anxiety levels on discharge.
Improving the management of menopause in women with serious mental illness
Authors: Lorenzo Maria-Elena Di , Reilly Thomas , Walker-Tilley Tom , Mace Shubhra
Published: June 2021

Aims

To improve the diagnosis and management of menopause in women with a serious mental illness in psychiatric services. This will be achieved by developing a questionnaire to systematically assess symptoms related to the menopause, based on NICE guidelines. Women will be offered information and advice, according to these guidelines. Barriers to the assessment or management of the menopause will be identified by piloting the questionnaire on an inpatient female ward.

Method

Women aged 40 years and over, admitted to an acute female in-patient ward in South London and Maudsley NHS Foundation Trust, were interviewed using a structured questionnaire.

Result

In total, 23 eligible women were approached of whom 17 (74%) agreed to take part with mean age 53 years (range 40–67 years). Nine women reported that they had undergone the menopause and four women reported experiencing perimenopausal symptoms. Fifteen women had not previously received information about the menopause. Of the 13 women who had undergone the menopause or were experiencing irregular periods, 7 reported experiencing hot flushes, night sweats and a general change in physical and mental health and four reported a change in mood. Seven women reported that the changes noted may have been related to the menopause over the previous 12 months. Eight women requested further information either in written format or in the form of an information group about the menopause.

Conclusion

We identified women who were admitted to a psychiatric ward who had experienced symptoms related to the menopause that had impacted on their mental and physical health. It was evident that the majority of these women with severe mental illness had not had the opportunity to discuss their symptoms with a healthcare professional in the past and a significant proportion welcomed further information to help make sense of their symptoms. We intend to implement the questionnaire trust-wide with the eventual aim of developing a local guideline to inform the assessment and management of the menopause within our services.
“The path is smooth that leadeth on to danger”: caffeine and psychosis
Authors: Ganhao Isabel , Marinho Goncalo , Paixa Afonso , Trigo Miguel
Published: June 2021

Aims

To review literature on the importance of caffeine intake with regard to psychosis. The need for intervention with regard to caffeine intake hinges on effectively recognizing potential risks.

Background

Caffeine is the most widely consumed psychoactive substance worldwide and as such is generally considered acceptable but as a competitive adenosine antagonist, it affects dopamine transmission. Patients with serious mental illness are known to have higher caffeine intakes than the general population. The hierarchy of needs for this patient population is complex, frequently leaving the intake of caffeine under the radar of clinical priorities.

Method

PubMed and Google Scholar search for caffeine/coffee and psychosis/schizophrenia

Result

Of the 43 articles that were considered relevant for clinical practice, caffeine consumption was associated with 1) appearance of psychotic symptoms and episodes (caffeine-induced psychosis) and chronic psychosis in high intake 2) exacerbation of psychosis in schizophrenic patients even in lower intakes, 3) treatment resistance possibly due to interference with antipsychotics (ex. clozapine), 4) abuse and addiction, 5) comorbidity with tobacco smoking and other addictions. Caffeine in low doses was associated with ameliorating cognitive and extrapyramidal side-effects of medication and as a potential treatment strategy for treatment-resistant schizophrenia.

Conclusion

Caffeine consumption may have a greater impact on psychotic symptoms and episodes than is recognized with negative effects outweighing any potential benefits. Greater awareness of the necessity to quantify caffeine intake and implementation of interventions to curb intake may contribute to better quality of care of serious mental illness. Further research is warranted.
Audit on nursing notes in a psychiatry in-patient setting
Authors: Gunathillaka Kavinda , Timbo Mariam , Ginn Stephen
Published: June 2021

Aims

We aimed to assess the accessibility and informativeness of the content of daily nursing notes through an audit, and improve deficiencies identified.

Background

Nursing notes are an important source of observation findings, of in-ward psychiatry patients.

There can be variations in the quality of the notes as well as information contained within.

A basic level of clarity and information within all notes will be helpful in using these to inform the management of patients.

Method

An audit was carried-out in a ward treating working-age patients for psychiatric illnesses.

Setting standards - standard required of a daily progress note was decided after discussion in multi-disciplinary team meeting (MDT). Clear language and information on; mental-state, medication, meals, physical health, personal care, activities, risks and use of leave, were identified as requirements.

Retrospective audit - First audit cycle was carried-out by assessing the notes two weeks retrospectively. The assessment instrument used a qualitative measurement of the readability of the notes as well as quantitative assessment of the contents.

Intervention - The standards set during the MDT, as well as a suggested format for recording notes, were communicated to the staff through email. Follow-up meetings with individual staff members and MDT, to evaluate staff satisfaction and new suggestions to improve the format were held. Difficulties staff encountered when implementing the format were discussed and resolved.

Second audit cycle - Following implementation of the intervention, the notes were again assessed using the same instrument.

Conclusion

Difficulty in accessing information from the notes was noted in the first audit cycle. The average score for accessibility of information when scored on Likert scale + 3 to -3, was 1. Use of language scored 2 on average. On the second audit cycle, accessibility had increased to 3 on average while language score remained 2.

Quantitative measurement was done for presence of information on; mental state, medication, meals, physical health, personal care, activities, risks and use of time away from ward. All of these parameters showed an increase in the post-intervention second audit cycle. Information on taking meals, medication, and physical health was present 100% of the time in the second cycle. Most improvement was in information on personal care which showed a five-fold increase, from 17% to 89%

In conclusion, standard for nursing notes arrived via discussion and consensus in MDT, has been successful in improving the accessibility and information within nursing notes.
Investigating sleep quality on an inpatient psychiatry ward
Authors: Hughes Joshua , Thomas Rhianne , Macklin Jonathan , Owen Jonathan
Published: June 2021

Aims

Sleep is essential for optimal physiological functioning, but often interrupted in hospital settings. Disturbed sleep is associated with relapse of mood disorders and multiple comorbidities including impaired immunological function and increased cardiovascular risk. There are unique environmental challenges on psychiatry wards, such as overnight monitoring. Recent studies highlight the importance of evaluating and managing inpatient sleep disturbance. Aims include exploring the extent to which patients’ sleep is impacted by inpatient admission, elucidating causes of sleep disturbance and determining ways to improve sleep during admission.

Method

Patients aged 18–65 years, who consented and were expected to be inpatients for a week, were approached after 72 hours of admission (n = 35). Quantitative and qualitative data, including on pre-hospital and hospital sleep quantity and quality, were gathered, as part of a cohort characterisation. Questionnaires using Pittsburgh Sleep Quality Index elements were used to gather data. Offering earplugs as a sleep-aid intervention was implemented, with sleep quantity and quality reassessed 72 hours post-intervention. In response to feedback, sound monitoring at regular intervals overnight was undertaken using a decibel-metre to determine noise baseline and variation.

Result

All patients approached agreed to participate. Pre-hospital average sleep quantity was 5.2 hours, with restedness score of 4.3, and 71% patients rating their sleep as ‘bad’. After 72 hours post-admission, average sleep length was 6.5 hours and restedness 5.3. Of patients who accepted earplugs (59%), there were improvements to mean sleep quality and quantity (7.6 hours), with 86% patients rating earplugs helpful. All patients surveyed thought that earplugs should be offered routinely on admission. 70% of patients were prescribed benzodiazepines or z-drugs as required. Self-reported factors affecting sleep included noise, psychiatric symptoms and medication side effects, with 13 patients mentioning the former. Sound monitoring recorded an average decibel level with a range of 35–75 dB, with peaks reaching 95 dB.

Conclusion

Poor sleep in hospital is widespread. There is a need to understand and address modifiable environmental and ward factors implicated in sleep disturbance within inpatient settings. Pharmacological options for sedation are common, but it is important to focus on alternative options of low-cost, non-pharmacological interventions which promote sleep optimisation and enhance inpatient care.
Hyperprolactinaemia: audit of practice and new guidance
Authors: Janaway Benjamin , Anwar Lubna
Published: June 2021

Aims

Hyperprolactinaemia is a problem secondary to antipsychotic use. Current management guidelines are heterogeneous and impractical. We aimed to assess coherence to common themes monitoring and intervention, reasons for failure, and to design new guidance for both general use Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and beyond.

We hypothesised that performance would be poor and new guidance warranted.

Background

Hyperprolactinaemia is defined as blood prolactin of >530 miu/L in females and >424 miu/L in males, with 49.9% is due to medication. Several agents are deemed higher risk Symptom profiles and risk are idiosyncratic and there are adverse long-term outcomes. Treatment is based on symptom profile and severity and cause. Current guidance is trust specific or advised through The Maudlsey Prescribing Guidelines.

Comprehensive and practical guidance reflecting front-line limitations is lacking. There is no clear delineation of a risk stratified pathway.

Method

We wished to ascertain data on surveillance, aetiology and signpost opportunities for service improvement. We also designed ‘risk strata’ to guide intervention.

A random sample (n30) was selected from Enfield South Locality Team and data captured using local records. No ethical considerations were raised.

A number of audit standards (95%) were developed based on previous guidance and agreed within the team and included frequency of monitoring, time to review and need for further referral.

New guidance was developed based on results, MDT agreement and consultation with medical specialities.

Result

Data (n 30) showed predominant male bias to sample (66%) and average age of 48.87 yrs. Predominant diagnoses were Paranoid Schizophrenia (53.33%) and Schizoaffective disorder (33.33%.) Only 7/30 (23.33%) had undergone testing within the last year.

Of those sampled, 2 (6.667%) had a new diagnoses of Hyperprolactinaemia, one on routine monitoring, one incidentally on admission to hospital. Both were on high risk agents. Both were reviewed and treated within one month. No audit standards were met, but no further referrals were required.

Reasons for failure varied, but included loss to follow-up, no test requested or appointments missed.

Conclusion

Based on these data it was noted that monitoring was poor and reasons for failure varied. New Guidance was developed in response. The scope and validity of this guidance was agreed by MDT and awaits formal ratification.

Re-audit will occur in 2020, and if successful the guidance submitted to other Trusts and RCPSYCH for national use.

No financial interests to declare.
Quality improvement project: improving the confidence of junior doctors to manage emergencies; Drs abc in an acute psychiatric setting
Authors: Jayakumar Ahrane , Erin-Jones Wren , Edwards Simon
Published: June 2021

Aims

To improve the confidence and preparedness of junior doctors in managing medical or psychiatric emergencies when on call at an inpatient psychiatric unit.

Background

Facilities for emergency care differ between acute medical and psychiatric units. Protocols for managing acutely deteriorating patients and those requiring immediate resuscitation differ across these organisations.

Managing medical emergencies can be stressful for all involved. Junior doctors rotate between services where the level of support varies depending on specialty and setting. For doctors who have worked in a setting where the minimum emergency response includes a Resuscitation team, moving to an environment with less support available is a challenge.

In our unit, the protocol following an urgent call is for the on-call doctor (who has access to basic resuscitation equipment) to attend and assess the need for paramedics and transfer to local hospital. Stress can be worsened by change of environment, change of expectation and concern about best management in new settings.

Method

A cohort of junior doctors were recruited. Baseline assessment included rating their confidence level (scale 1- 10), listing common medical and psychiatric scenarios they had experienced and those they felt least confident managing. Over a period of 10 weeks, follow-up data was obtained. Interventions to improve confidence were assessed during this period, including a handbook and a teaching session on emergency medications. At the end of the project a wordcloud was created in response to the request to “choose 5 words to describe your feelings when called to an emergency”. Identified themes have been fed back to relevant senior staff and will form the basis of future projects.

Result

The initial average confidence score improved from 4.9 to 9.2 and was sustained out to 14 weeks. According the word cloud the most commonly used words were “morale” and “education”.

Conclusion

Prior to the study, confidence levels amongst the Junior Doctors was low. Introduction of the handbook and teaching session led to an improvement which was sustained. Key themes identified using a word cloud were “morale” and “education”.

For junior doctors moving from between services, different expectations and protocol for management of emergencies can influence confidence levels. Psychiatric units should be cognisant of these concerns and implement evidence-based intervention to support junior doctor confidence and improve quality of working experience.