bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of New Maternal Mental Health Service ‘Thrive’ in the Treatment of PTSD Symptoms Arising From Birth Trauma and Perinatal Loss
Authors: Crook Helen , Duffy Athena , Nair Bosky , Waters Rose
Published: June 2022

Aims

The NHS Long-Term Plan includes the perinatal mental health objective: by 2023/24 ‘Maternal Mental Health Services’ will be available across the country to provide psychological therapy for those who experience mental health difficulties directly arising from birth trauma and or/perinatal loss. We achieved early implementer status via application to NHS England and, using transformation funding received, ‘Thrive’ was piloted in East Kent. A gap in service provision was identified: some existing primary care services provide intervention for this cohort, however some people remain in psychological distress but do not meet the criteria for specialist perinatal mental health secondary care services; these secondary care services are not commissioned to support those who have experienced perinatal loss. Thrive is co-delivered by a mental health trust and acute healthcare trust; NICE recommended psychological interventions are provided by Psychological Therapists, Specialist Mental Health Midwives and a Peer Support Worker. The aim of this project was to evaluate the effectiveness of the Thrive pilot in reducing PTSD symptomology whilst also collating feedback from patients, their families and healthcare staff across the maternity system, in order to adapt the service offer for full county rollout.

Methods

40 people who received care from Thrive from 11th January 2021 to 31st December 2021 were included in this evaluation.

Data were collected retrospectively at the end of each period of care via:

Clinical outcomes measures (quantitative):

•

PCL-5: a 20-item self-report measure assessing the 20 DSM-5 symptoms of PTSD.

•

CORE-34: a universal method of establishing well-being and risk.

•

HoNOS (Health of the Nation Outcomes Scales): a measure of the health and social functioning of people with severe mental illness.

Patient Satisfaction Survey (qualitative).

Results

•

100% of patients improved following Thrive intervention: PCL-5 (significant change = a reduction in score by 10–20 points has been met) / CORE-34 (clinically significant change =score above 10 initially and below 10 after intervention).

•

Clinical improvement: HoNOS = 100% of patients improved following Thrive intervention.

Conclusion

Evaluation has evidenced the effectiveness of Thrive in successfully treating those with PTSD symptomology arising from their maternity experience. Post-treatment measures indicate that the level of trauma symptomology and the impact of psychological distress on the functioning of patients who have received intervention from Thrive has reduced to a sub-clinical level in all cases.
Understanding and Overcoming COVID-19 Vaccine Hesitancy & Anti-Vaccine Beliefs Within the High Secure Forensic Services
Authors: Giles Karla , Soni Anju , Head Marc , Gewanter William , Kalovidouri Christina , Tyszuk-smith Tomasz
Published: June 2022

Aims

This is a cross-sectional service evaluation study of the vaccination programme within the high secure setting of Broadmoor hospital with a view of improving the quality of it's delivery. We aimed to establish patients views about COVID-19 vaccinations particularly if there are any themes as to why the patients choose/did not choose to receive the vaccine. This information will be used to help us understand how to overcome vaccine hesitancy and anti-vaccine beliefs.

Methods

Patients across Eight wards were asked to participate in the study. 56 patients agreed to be administered the following semi-structured questionnaire by the doctors.

1.

Have you had a COVID-19 vaccine?

2.

Do you think there any advantages to taking a COVID-19 vaccine? Yes/No. If you think there are any advantages, please write these

3.

Do you have any fears or worries about the COVID-19 vaccine? Yes/No. If you do have any fears or worries, please write these.

The results of this were reviewed and put into the categories that are cited below.

Results

14 patients had no vaccination, 2 had one, 38 had two or more.

34 patients said there were advantages, 13 said no advantages and 9 did not know. The themes of the advantages were established: Protects you from bad infection and symptoms (48), stops you from passing it on to others (3), blank (13), others (13) which included “Important to follow government guidelines, proven through history to work, it was offered, I'm more concerned with hepatitis, The doctor would have my best interests.”

30 patients stated that they did have fears and 26 did not. Common themes established were; side effects (17), Not tested correctly/given too quickly (5), Blood clots (2), positive comments (2), blank (22), others (10), which included, “Interaction with medications, more fear about face masks, injecting humanity with something could kill them, infertile generation, Control the public, don't like injections and alter the DNA genome.” The common side effects of concern were “painful arm, fever and headache.”

Conclusion

68% of patients had 2 or more vaccinations across the 8 wards studied. The commonest advantages cited by 86% of patients was to protect themselves from serious illness. The commonest fears or worries were of side-effects that result from the vaccine, although 46% patients had no worries and 39% gave no explanation for fears or worries. The fears and worries appeared mainly related to vaccine hesitancy rather than fixed generalised anti- vaccine views.
Detentions in BSMHFT (Birmingham and Solihull Mental Health Foundation NHS Trust) - Covering the Birmingham and Solihull Geographical Area Under the Mental Health Act Between 2018 to 2021
Authors: Maganty Dinesh , Harsh Rajendra , Cleverley Tom
Published: June 2022

Aims

To continue to monitor trends in detentions under the Mental Health Act based on race, age, gender, and sexuality during the COVID-19 Pandemic to consider if there were any specific areas that would need to be addressed.

Methods

We investigated available mental health detention documents stored in mental health legislative office, Birmingham and Solihull mental health foundation NHS Trust.

Results

We found that detentions under Section 3 of the Mental Health Act have increased very gradually over the last three years (2018 to2021). However, there has been gradual reduction in detentions under Section 3 within the white population beginning in 2019 and continuing with a marked acceleration in reduction during the two peaks of the pandemic. This is marked in the 66yrs plus age group. As the pandemic has eased this reduction has stopped and reversed with increased section 3 admissions in last few months in this population. The detentions in the black and Asian population have followed a reverse pattern, with marked increase during the pandemic peaks in 2020/2021 and a marked fall as the pandemic has eased.

Conclusion

1.

Mental health act detention data during the Pandemic shows that the pandemic has disproportionality impacted black and Asian population of all ages and Elderly white population.

2.

During the pandemic there has been a marked increase in detentions under Section 3 of the Mental Health Act (for treatment) in the Black and Asian population with a marked reduction in the white population. This difference is stark in the working age population.

3.

This highlights:

a.

The need for a well-functioning community based health and social care offer to reduce detentions in the black and Asian population.

b.

Return of admissions under the mental health act of white elderly post vaccination (which are vast majority white) shows a reversal of the trend of this group not accessing inpatient treatment fully during the pandemic.

4.

Community Treatment Order (CTO) detentions in the Black and Asian population continue to increase through the pandemic disproportionately

5.

There is no material change during the pandemic, in short term detentions (section 2, 5(2)) or other inpatient detentions under the Mental health act

6.

There are no significant trend changes noted based on gender or sexuality or age during the pandemic in BSMHFT (Birmingham and Solihull mental health foundation NHS Trust).
An Evaluation of the Prescribing of High Dose Antipsychotic Therapy and Combination Antipsychotic Therapy to Inpatients on the General Adult Wards of Mersey Care NHS Foundation Trust
Authors: Campbell Louise , Holmes Harry , Hyland Declan
Published: June 2022

Aims

High dose antipsychotic therapy (HDAT) is defined as “a total daily dose of a single antipsychotic which exceeds the upper limit stated in the SPC or BNF or a total daily dose of two or more antipsychotics exceeding the SPC or BNF maximum using the percentage method. Previous audits have looked at HDAT on both a national level (the Prescribing Observatory for Mental Health) and within Mersey Care NHS Foundation Trust. This audit aimed to identify the proportion of patients subject to HDAT and review combination antipsychotic strategies and consideration of Clozapine in patients subject to HDAT.

Methods

In August 2021, data were collected from the eight inpatient wards in Mersey Care NHS Foundation Trust. This involved using the Electronic Prescription and Administration system to identify those prescribed antipsychotics. Following this, the patient's electronic record was scrutinised for documentation of the rationale for HDAT, combination antipsychotics and consideration of Clozapine.

Results

129 inpatients were identified as being prescribed antipsychotic medication. 21 (16.3%) patients were prescribed combination antipsychotic therapy, with four of these patients (3.1%) being prescribed HDAT. For these four HDAT patients, there was no recorded documentation of discussion of the option of Clozapine. The most common antipsychotic combination was Paliperidone depot with oral Risperidone. 38 out of 129 (29.5%) patients had been considered for Clozapine. Reasons for Clozapine being refused included the patient declining, concerns about non-concordance with oral medication, patients having had a neutropenia on an FBC, the patient being reluctant to have regular blood tests and a patient's comorbidities.

Conclusion

When comparing the proportion of patients subject to HDAT (3.1%) to the previous Trust audit in December 2020 (9.1%), there is a recurrent theme that antipsychotic prescribing practice in Mersey Care is safe, with minimal HDAT. Of note, the figure is significantly lower than the proportion of HDAT patients identified in the 2012 national study (28%). In this audit, none of the patients on HDAT had documented consideration of Clozapine. Three of the four patients were soon to be no longer subject to HDAT which may explain this result. Compared to the Trust's HDAT audit in 2020, the percentage of patients on combination antipsychotic therapy has stayed largely the same - 16.3% compared to 17.4%. The Trust needs to strive to continue minimal HDAT prescriptions and ensure that, in those patients subject to HDAT, there is consideration of and documentation of Clozapine being considered.
Evaluation of Early Neuro-Imaging Requests for Dementia Diagnosis in Wolverhampton Memory Assessment Service (MAS)
Authors: Prasanna Aparna , Mandair Kuljit , Ling Clare
Published: June 2022

Aims

The Wolverhampton Memory Assessment Service (MAS) is nurse led and accepts referrals from primary and secondary care settings. There has been a rapid rise in the number of referrals as well as an increase in demand to provide a timely diagnosis. This poses a challenge to meet the national aspiration of referral to diagnosis in 6 weeks. The aim is to improve access to neuroimaging in order to avoid delays to diagnosis and management.

Methods

In January 2022, a retrospective sample of three groups of newly referred patients to MAS between 1st June-31st October 2021 was selected, each group consisting of 15 patients.

A dedicated tool was used to collect data. MAS follows NICE standards for neuroimaging in dementia guidance.

In Group 1 scans were not requested at referral but were requested after initial nursing assessment, in Group 2 scans were available at initial referral and in Group 3 scans were requested by the MAS Consultant Psychiatrist upon receipt of referral.

Results

In group 1; 47% of patients have still not had a scan (with a waiting time of approximately 6 months) and 73% have not been given a diagnosis. Three patients were given a diagnosis due to exceptional circumstances and therefore the results of these patients can be disregarded.

In group 2, all (100%) patients had a scan either prior to the referral (73%) or requested by GPs at the time of referral (27%). 80% of patients have been given a diagnosis. The average days from referral to diagnosis was 82 days. Patients not given a diagnosis yet was due to cancellation/awaiting appointments.

In group 3, all (100%) patients have had a scan and 67% of patients have been given a diagnosis. The average days from referral to diagnosis was 102 days. Patients not given a diagnosis yet was due to cancellation/awaiting appointments.

Conclusion

Implementing a pathway whereby clinicians can either have access to prior neuroimaging or refer appropriate patients for scans at the point of referral, significantly reduces waiting times to diagnosis and management within a timely manner.

This reduces carer burden and provides increased support from appropriate services as well as reducing the chances of patients ending up on crisis pathways.

There is a need to implement an integrated care pathway that is responsive and accessible to all patients.
Implementation of an App Based Communication Platform, “Consultant Connect", to Improve Physical Health Outcomes for Patients at a UK Mental Health Trust
Authors: McMullen Isabel , McGrath Raymond , Ang Karen , Fairbairn Elli , Williams Julie , Reddy Prashanth , Sevdalis Nick , Gaughran Fiona
Published: June 2022

Aims

Patients with mental health disorders are known to have worse physical health outcomes. ‘Consultant Connect’ (CC) is an app-based communication platform which aims to improve patient outcomes and experience, by offering clinicians direct access to consultants working in a partnership acute Trust, so they can seek advice and guidance for their patients’ physical health problems. This creates whole system efficiencies by avoiding unnecessary referrals to an Emergency Department or outpatient clinics. This poster describes the implementation of CC in a large UK Mental Health Trust. Initially designed for GPs, this is the first time a UK Mental Health Trust has used CC.

Methods

Consultant Connect was launched in the Mental Health Trust's inpatient services in June 2020 as part of a Trust-wide programme of work aiming to improve the physical healthcare of mental health patients. In July 2021 it was rolled out across all services, including all community services. All platform activity was monitored and the implementation team collected data to determine: a) origin of call, b) which specialty was required, c) numbers of calls successfully connected, and in a subset of calls d) outcome of call. In addition, 183 call recordings were analysed, to identify clinical training needs and inform further development of the platform.

Results

In the period June 2020 – December 2021, there were 1422 use episodes of the CC platform by Mental Health Trust clinicians. There were 401 Trust registered downloads of the CC App by the Trust clinicians. 53 different clinical specialties were contacted, with cardiology (414 calls), diabetes and endocrinology (243 calls), and haematology (124 calls) the most frequently called. 68% of queries received a response. 48% of calls had an outcome recorded, with 70% of these resulting in the physical healthcare being delivered by the mental health team, following the advice received (i.e. referral or admission avoided, or the patient treated out of hospital).

Conclusion

CC is being progressively embedded into clinical practice and has become a well-used pathway for mental health clinicians seeking immediate clinical advice from acute hospital Consultant colleagues. Further qualitative and quantitative work is planned with mental health clinicians, patients and carers to better understand their experience and determine if it improves care from both the clinicians’ and patients’ perspective.
Evaluating a Pilot Group Based Mental Health Promotion Programme Adapted for Young People With Intellectual Disabilities: The “Healthy Me” Programme
Authors: McDermott Emma , Jenkins Naomi , Hanna Heather , Morgan Tammy
Published: June 2022

Aims

A mental health promotion programme called ‘Healthy Me’, was a collaboration between Action Mental Health (AMH) MensSana, Child and Adolescent Mental Health Services (CAMHS) in the Southern Health and Social Care Trust and the Royal College of Psychiatry (RCPsych) in Northern Ireland in 2014. Adapting ‘Healthy Me’ for delivery in special schools was recommended in evaluation of this pilot programme. A co-produced pilot adapted ‘healthy me’ programme, for young people with ID was taken forward by Action Mental Health (AMH) MensSana and Intellectual Disability Child and Adolescent Mental Health Service (ID CAMHS) in the Southern Health and Social Care Trust (SHSCT). To determine the feasibility of adaptation and delivery of the programme for the needs of the ID population. To inform changes to be made before wider roll-out. To promote children's social and emotional well-being and emotional literacy through the teaching of problem-solving, coping skills, conflict management and managing feelings. To evaluate the effectiveness of this intervention with children being able to retain learning, information and ideas.

Methods

Evaluation

•

Pre programme quiz July 2021 (young people)

•

Post session 1–5 quizzes (young people)

•

Post programme quiz October 2021 (young people)

•

Simple visual blob tree (young people)

Outcome Measures

•

Pre programme initial outcome measure (parent) The Mood, Interest and Pleasure Questionnaire-short form (MIPQ-S) July 2021

•

Pre programme initial outcome measure (parent) non standardised, based on the strength and difficulties questionnaire (SDQ) and the Child and Youth Resilience Measure-Revised Person Most Knowledgeable version (PMK-CYRM-R) July 2021

•

Post programme repeated outcome measure (parent) MIPQ-S October 2021

•

Post programme repeated outcome measure (parent) Based on SDQ & PMK-CYRM-R October 2021

Results

Six participants identified at outset and four attended and engaged consistently, young people aged between 14 and 17 years. Participants were supported 1:1 to fill in a simple evaluation forms after sessions rating their enjoyment and what they had learnt. Repeating the MIPQ-S with parents highlighted some improved scores indicating positive affect and elevated interest and pleasure.

Conclusion

The programme will be offered to in the next stage of the pilot to Special Schools in NI. It is hoped to show that similar positive gains can be made in the school settings for children and young people with intellectual disability in terms of promoting positive mental health and social and emotional well-being.
Rapid Tranquilisation Use in Working-Age Adult Inpatients
Authors: O'Neill James
Published: June 2022

Aims

This study aimed to review if clinicians varied significantly in choosing rapid tranquillisation agents when using consistent clinical guidelines, analysing the rationale behind decision-making. It also aimed to assess confidence across varying grades and clinical experience, and to evaluate efficacy of current trust guidelines. We hypothesized that less experienced clinicians would be less willing to prescribe antipsychotics for rapid tranquillisation, and that current guidelines did not allow for consistent and uniform prescribing.

Methods

A qualitative survey was distributed to 165 clinicians within one mental health trust, including core psychiatry trainees, trust-grade doctors, higher trainees, staff-grade doctors & working-age adult consultants. This survey included a fictional but commonly occurring scenario which clinicians responded to with the aid of current trust guidance. Respondents were then asked to justify their choice and to rank their confidence in prescribing rapid tranquillisation, along with rating how useful the guideline was in aiding their decision. Thirty-six participants responded to this survey, with a response rate of around 22%. There was even representation across clinical grades.

Results

Clinicians of all grades were equally willing to prescribe antipsychotic agents for rapid tranquillisation. Higher psychiatric trainees reported greatest self-confidence when prescribing tranquillisation, with consultants surprisingly lower in confidence. Intramuscular olanzapine was most favourable, but significant variability was observed in suggested management between clinicians. Main themes for suggested amendments to the guideline included clarity, when to use the various options, further specification on dosage ranges and options for specific instances, such as if a patient is antipsychotic naïve or there is minimal physical health information.

There was marked variability in choice of agent. The majority of clinicians felt that early commencement of antipsychotic was beneficial in acutely unwell patients, although the merits of initially assessing medication-free were also raised. Key themes for tranquillisation choice included a need for a prior electrocardiogram to prescribe intramuscular haloperidol, the potential lack of efficacy with aripiprazole, the risk of respiratory depression with concurrent olanzapine and lorazepam, and a surprisingly high proportion of respondents opting for combined use of haloperidol plus a further sedative.

Conclusion

Less experienced clinicians were not found to lack confidence to prescribe antipsychotics for rapid tranquillisation. However, clinicians responding to the same clinical scenario using the same guideline resulted in marked variability in choosing rapid tranquillisation agents. This highlights a need for clearer guidelines and education on this matter to ensure a consistent treatment approach to tranquillising medication.
What Is the Future of Primary Mental Health Care?: A Post COVID-19 Service Evaluation
Authors: Zarif Ahmad , Nazir Imaduldin , Mahmod Azad , Bibi Hajira , Rasheed Reshma , Patel Anjali , Shanthakumaran Yathorshan
Published: June 2022

Aims

During the COVID-19 pandemic, many service lines needed to be transformed to enable more telemedicine and virtual consultations. This enabled seamless care across many service boundaries as all services adapted to operate virtually. During COVID-19, the mental health of many patients deteriorated. With easing of restrictions, we wanted the patient voice to be heard and to ensure our service was patient-centred. We undertook a service evaluation to understand our patients preferences. Our cross-sectional study evaluated patient preferences for their care which we felt was important as earlier during pandemic, patients did not have the choice to choose between virtual vs face-to-face consultations. We felt this was important to our patients so they could exercise choice of consultation and this would enable the patient voice to be heard.

Methods

591 patients across three practices in primary care were identified from the Serious Mental Illness (SMI) and on the depression register. They were asked about their preference of care: telemedicine vs face-to-face consultations. Using a simple questionnaire, in order to record their preference on the patient screen. Of these a total of 495 patients (83%) participated in the study.

Results

Of the 495 respondents, 308 (52%) declined virtual telemedicine consultations and 175 (29%) patients were content with virtual consultations. Of the 175 patients who wanted telemedicine were 20 to 40 years of age. Reasons given included convenience (allows family and work commitment) and overall time management (reluctancy to travel). The 308 patients (52%) wanted face-to-face consultations because they wanted human contact, validation of their mental health problems, reassurance and were uncomfortable about discussions on the phone. They also had poor mobility especially the elderly who chose traditional models of care.

Conclusion

As services are restored to the new norm of patient care, patient choice should remain paramount if services are to remain patient centric. During the COVID-19 pandemic, many services transformed to virtual consultation of necessity without recognising the impact on patients themselves. Patients with serious mental health and depression are inherently vulnerable and our evaluation goes to show that despite the popularity of telemedicine. Patient choice should enable patients to access face-to-face care for greater patient satisfaction.
Audit on the Quality of Outpatient Letters From Cherrywood Clinic
Authors: Akhtar Armaan , Badshah Faisal
Published: June 2022

Aims

Letters between secondary and primary care are an integral part of continuity of patient care. It is crucial letters are comprehensible, focused and useful. The quality of letters can be of a variable standard, we aim to see if the letters sent from Cherrywood clinic are in line with the Royal College guidance.

Methods

Data were collected manually by 2 doctors using dictated clinic letters and patient notes, from the 3 community teams. 20 outpatient letters were sequentially selected from each team from the 1st to 31st of March 2017; 60 letters in total. The letters were divided equally between consultants and junior doctors. In the team where there were 2 Consultants; 5 letters of each were taken, and in the team where there was a junior doctor and a specialist registrar, 5 letters from each were taken. The data were collated onto an Excel spread sheet and analysed.

1.

Demographic Details including Name, Date of Birth, Address and the Date of Appointment

2.

Who was the patient been seen by; Consultant or Junior doctor (FY/GPST/CT/SPR)

3.

Current diagnosis

4.

Current medication including doses

5.

Mental State Examination (MSE) findings

6.

An update of the current problem(s)

7.

Current/relevant Risks

8.

Plan/recommendations

9.

Follow-up plans

Results

Of the Consultant letters the diagnosis, medication and dosage was mentioned in 93%, 93% and 90% respectively. Mental state was found in 66%, risks in 83% and follow-up plans in 96%.

Most of the content derived from the registrar letters were unremarkable; with 80% in MSE in the 5 audited letters.

In the Junior doctor letters; the diagnosis was mentioned in 88% of letters, medication and dosage 76%, mental state 100%, risks 80%, follow-up 100%.

Conclusion

Our letters are largely meeting the Royal College standards, more than 85% of the data were up to the standard. The main area's to improve are;

–

Documentation of the MSE.

–

The medication and the dosages.

–

Diagnosis.

–

Risks should always be present.

The areas which require improvement are the areas which are essential for GPs to safely manage psychiatric patients in the community.
The Impact of COVID-19 on Physical Health Monitoring of Community Rehabilitation Team Patients in NHS Borders
Authors: Ball Rachel , Bredski Joanna
Published: June 2022

Aims

People with schizophrenia have a life expectancy that is 10–20 years shorter than the general population. The high incidence of metabolic syndrome, cardiovascular disease and diabetes mellitus in this patient group are thought to be major – and potentially modifiable – factors contributing to this premature mortality. Therefore, annual monitoring of physical health parameters is recommended by organisations including the Scottish Intercollegiate Guidelines Network (SIGN). The SIGN guideline on schizophrenia advises that the following parameters are checked annually for patients with schizophrenia who are on anti-psychotics: ECG, blood glucose, lipid profile, prolactin, BMI/weight, smoking status and blood pressure. Traditionally, this monitoring is overseen in the community by general practitioners. This audit aimed to capture how the COVID-19 pandemic impacted on the annual physical health monitoring of patients under the care of NHS Borders Community Rehabilitation Team.

Methods

A retrospective audit was performed by reviewing notes of the 100 patients on the NHS Borders Community Rehabilitation team caseload. Notes from the years of 2019, 2020 and 2021 of all 100 patients on the caseload were reviewed, for documentation of the following seven parameters as recommended by SIGN: ECG, blood glucose, lipid profile, prolactin, BMI/weight, smoking status and blood pressure. Results were then entered manually into a secure spreadsheet. Permission for this audit was granted by NHS Borders.

Results

Initial results for the parameters of: ECG, blood glucose, lipid profile and prolactin levels demonstrate that routine monitoring of all four domains has decreased since the start of the COVID-19 pandemic. In 2019 the following numbers of patients had monitoring in these domains: ECG 56 (56%); blood glucose 84 (84%); lipid profile 74 (74%) and prolactin levels 62 (62%).

During 2020, the number of patients having monitoring in all four domains fell: ECG 31 (31%); blood glucose (72%); lipid profile 64 (64%) and prolactin levels 48 (48%). During 2021, monitoring levels remained low: ECG 30 (30%); blood glucose 71 (71%); lipid profile 62 (62%) and prolactin levels 43 (43%).

Data collection for the parameters of blood pressure, BMI/weight and smoking status is ongoing.

Conclusion

Initial results indicate that the COVID-19 pandemic has negatively impacted on the routine physical health monitoring of patients under the care of the community rehabilitation team in NHS Borders. These results imply opportunities to treat and prevent conditions such as diabetes mellitus and hypercholesterolemia are being missed, further perpetuating an existing health inequality for patients with severe and enduring mental illness.
Reviewing Interventions to Ensure Management of Cholesterol Levels in Psychiatry Inpatients
Authors: Chatterjee Indrajit , Cordiner Matthew , Booker Naomi
Published: June 2022

Aims

Studies have been done to suggest an increased risk of mortality in patients with mental illness, from cardiovascular diseases. This may be a result of factors ranging from lifestyle choices in the patient group, access to health-care facilities, side-effects of antipsychotic use etc. As a suitable predictor of cardiovascular risk, this audit reviews and attempts to improve the management of cholesterol levels in this patient group based on local trust guidelines.

Methods

116 and 120 patients from general adult psychiatry wards were included in two cycles of the audit respectively. Blood results, discharge letters were obtained from the Clinical portal database; drug prescriptions from the ‘Hospital Electronic Prescribing and Medicines Administration (HEPMA)’ database. As per local trust guidelines, it was verified if ‘ASSIGN’ (indicator of cardiovascular risk developed in Scotland) scores were calculated and a statin was prescribed accordingly, lifestyle modification advice provided or blood results communicated to GP in the discharge letter. An email with a flyer was distributed among doctors with trust guidelines, as intervention after the first cycle of the audit, and the results were presented in internal teaching. This was followed by a reaudit in a few months.

Results

In the first cycle, 85 out of 116 patients had a lipid profile done on admission out of which 29 had abnormal levels without a prescription of statin. 6 patients had their abnormal lipid results mentioned in their discharge letter in the absence of an ASSIGN score calculation or lifestyle modification advice. In the second cycle, it was noted that only 35 patients out of 120 had a lipid profile done on admission and a total of 12 patients had abnormal lipid results without a statin prescription. Only 1 patient had their ASSIGN score calculated and 7 patients had their abnormal lipid results documented to the GP.

Conclusion

Unfortunately, considering both cycles of the audit, only a minority of patients had been managed in accordance with trust guidelines and no significant improvement was noted in the results of the reaudit. The importance of efficient management of cholesterol can be highlighted in a relevant forum and any barriers to change in practice may be explored. QRISK3, an alternative to ASSIGN may be suggested, which includes factors like severe mental illness and atypical antipsychotic use.
Audit Cycle on Medical Reviews of Seclusion in Medium and Low Secure Learning Disability Units
Authors: Iyer Sruthi Easwaran , Williamson Abigail
Published: June 2022

Aims

Seclusion is defined as “the supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving, where it is of immediate necessity for the purpose of the containment of severe behavioural disturbance which is likely to cause harm to others”. Patients in seclusion require reviews at the frequency set out in the Mersey Care NHS Foundation Trust policy, “The use of seclusion and long-term segregation” (SD28). This is based on the requirements set out in the Chapter 26 of the Mental Health Act 1983 Code of Practice (2015).This audit will look at whether medical reviews for secluded patients in the secure learning disability wards meet with the expectations set out in the Trust Policy. In doing so, the audit will establish whether medical reviews of seclusion meet and uphold the guiding principles of the Mental Health Act Code of Practice as highlighted in Chapter 26.110.

Methods

Retrospective audit that collected data from inpatients on secure learning disability wards in Mersey Care. After reviewing data, we actioned plans which involved educating colleagues working in secure services. This was re audited after three months. One month of seclusion reviews was audited in each cycle, which equated to 39 reviews in the first cycle and 100 reviews in the second.

Results

The re-audit data showed an improvement in most parameters.

Re-audit showed that 66% (34%) of the seclusion reviews had an initial medical review within the first hour. The on call consultant was informed in 60% (50%) of the situations and 4 hourly reviews took place in 66% (50%) of scenarios. All MDT reviews took place within 24 hours, Responsible Clinician was present in 100% (67%) of reviews.

34% (33%) of MDT reviews had only 2 MDT members.

There was 100% compliance with reviewing physical health in both audits. 100% (90%) of the reviews commented on mental health, 72% (20%) commented on medications used, 51% (39%) of reviews commented on level of observations and 89% (48%) included risk assessment. 95% (92%) of reviews assessed need for continuing seclusion. 84% (59%) of reviews commented on reducing restriction in seclusion.

Conclusion

This audit cycle has focused on the quality of medical reviews and not just the frequency. The improvement in practice will strengthen the safeguard provided by these reviews.
An Audit to Assess the Level Pregnancy Screening Conducted on Admission for Female Inpatients on an Acute Psychiatric Ward
Authors: Handa Nikhita , Quinlan Jessica , Mohammed Mariam
Published: June 2022

Aims

Currently, practice is that if patients of childbearing age provide a urine sample on admission they will also be consented to test for pregnancy. As many new patients may refuse to provide a urine sample often due to their mental state or concerns about drug testing this results in some patients not being tested for pregnancy during admission unless required for medication or at patient request. Given the high level of vulnerability and the medication implications for pregnant patients, ascertaining pregnancy status early on in admission is beneficial to patients found to be pregnant. Therefore, we aimed to audit how pregnancy status is assessed and documented on admission and aim to improve the practice where areas for development are identified.

Methods

Over the 6 month period July-December 2021 there were 105 inpatient admissions on an acute female psychiatry ward. Using a random number generator 15 patients from this cohort were selected and their notes audited as to whether a urine pregnancy test or bHCG serum pregnancy test was completed on admission. If not, we searched the admission notes for documentation of ‘pregnancy, last menstrual period (LMP), sexually active status, contraceptive use’.

Results

Of the 15 patients audited, 7 had a documented urine pregnancy test on admission (47%). Of the 8 patients that had not had testing only 1 patient had documentation of contraceptive use prior to admission, the other 7 non-tested patients had no notes regarding their LMP/contraception. 2 patients who did not have a pregnancy test had in fact had a urinary drug screen on admission, this coincided with a time of approximately 1 month when there were no urine pregnancy test strips available on the ward. At this time serum bHCG or LMP were not routinely used. One of these patients was found one month later to be pregnant.

Conclusion

We propose based on our findings that a more robust enquiry as to the risk of pregnancy should be conducted on admission for female acute inpatients. We have made recommendations that this should be in the form of a checklist to be conducted as part of the nursing admissions assessment such that if a urine sample is refused then a form detailing LMP, contraceptive use and any recent unprotected sexual activity will be completed. This can then be reviewed by the medical team prior to commencing medications. The use of this checklist will be reaudited between January-June 2022.
Lithium Counselling in Women of Childbearing Age
Authors: Jeyaprakash Sarah , Yin Kyla Ng , Broughton Isabella
Published: June 2022

Aims

Lithium is a commonly prescribed mood stabiliser given to women of childbearing age. There are risks of teratogenicity in first trimester of pregnancy, most notably cardiac abnormalities. It is not clear whether this is highlighted to patients. Our aim was to evaluate whether women were being counselled according to NICE and BNF guidelines.

Methods

We analysed records for 25 female inpatients who were commenced on lithium in Goodmayes Hospital from August to September 2021 to see if lithium counselling was done and documented on Rio. This was corroborated with e-prescribing records on ePMA.

Results

Data were collected from 26 patients; 1 was post-menopausal (excluded), final sample size n = 25. 16% were given a lithium leaflet, 92% had trialled alternative antipsychotics, 8% were asked if planning pregnancy, 4% had the risks of lithium in pregnancy explained and 12% were offered contraception.

Conclusion

Lithium counselling needs to improve. We should give patients information via lithium leaflets and explain the risks when they improve in mental state. We should arrange contraception referrals if desired and signpost perinatal psychiatry team if planning a pregnancy.
Looking at Current Practices Regarding Implementation of Covert Administration of Medication Policy
Authors: Kauser Rehana , Saeed Mahmoud , Marson Edward , Asad Saman , Mohamed Amoune , Knowles Georgina
Published: June 2022

Aims

The aims of the audit was to find out current practices regarding implementation of covert administration policy guidance. The Covert Medication Administration policy was introduced during the past two years, but due to ongoing pandemic, awareness of it was low. Guidelines for when making a decision to administer medication covertly were clear in the policy. Covert medication administration is a very restrictive practice, albeit clearly in a patient's best interests. Instances were found when medication for physical health was administered covertly and there isn't authority to do so under the Mental Health Act as noted in Care Quality Commissioning inspections.

Methods

The sample selection was obtained by Incident Reporting forms for covert medication prescription from which 10 patients were identified from a four month retrospective sample of geriatric psychiatric inpatient admissions at the Juniper Centre at Moseley Hall Hospital, Birmingham from April to August 2021.

Results

Covert medications administered were used to treat physical and mental health conditions. The physical health medication given was not for side-effects of mental health medication. Of the 22 medications and 10 patients there were no instances where the covert medication checklist had been completed. 9 of 22 medications (41%) (across 7 patients (70%)) had neither a best interest meeting nor a separate discussion held with the patient's family, friend, carer or advocate documented on the electronic record. Of the 22 medications, 7 medications (32%) belonging to 3 different patients had documentation of pharmacist involvement in the decision of covert medication administration whereas 15 medications belonging to 8 different patients did not.

Conclusion

Our findings conclude inadequate following of the standards protocol of the covert medication administration policy. Despite 77% of medications being prescribed with a completed multi-disciplinary covert care plan and 95% of medications having had completed Incident Reporting forms, the rest of the standards were notably missed.
How Are We Prescribing? a Re-Audit of Prescribing Practices for People With Personality Disorder Presented at the Local Personality Disorder Forums
Authors: Khan Maham , Reddi Neelima
Published: June 2022

Aims

NICE recommends that drug treatments shouldn't be used specifically for the treatment of individual symptoms or behaviours associated with Borderline Personality Disorder but may be considered for the overall treatment of comorbid conditions. National audits have been completed by Prescribing Observatory for Mental Health UK (POMH-UK) in 2012 and 2014, with a local Trust audit in 2017. Subsequently, ‘Guidance for Prescribing in Personality Disorder’ was published and circulated across the Trust in Dec 2020.This audit aims to establish whether there has been a change in the prescribing trends in the Trust since the last audit in 2017.

Methods

Electronic records of patients identified and presented at Personality Disorder forums throughout the Trust between June-December 2021 were reviewed.

Two audit standards and four treatment targets derived from the POMH-UK audit were used.

Results

24 electronic patient records were reviewed.

79% patients had a documented crisis plan, fewer than the 87% in 2017.

The proportion on antipsychotics with documented clinical reasons for prescribing was 69%, compared to 43% in 2017.

For those on antipsychotics in the absence of a comorbid psychotic illness, 91% were on them for >4 weeks, compared to 86% in 2017.

Z-hypnotics were prescribed for >4weeks in 37.5%, significantly more than the 13% in 2017. Benzodiazepines were prescribed for >4 weeks in 38% of patients, with 28% recorded in 2017.

100% of patients eligible for medication reviews had had them, an improvement from 90%in 2017.

Conclusion

Compared to the previous audit, fewer patients had crisis plan documentation, but more patients had a clinical indication for antipsychotics recorded.

Rates of prescribing Z-hypnotics, benzodiazepines and antipsychotics for >4 weeks seems to have risen, demonstrating a lower compliance with the treatment targets.

The proportion of patients having medication reviews has improved, however, the quality of these reviews remains similar to the 2017 audit.

The findings will be presented within the Trust with the re-emphasis on guidelines.

Prescribing in people with personality disorders can be revisited in 2 years.
Monitoring of ADHD Medication: Are We in Line With NICE Guidelines? a Closed Loop Audit
Authors: Langan Clare
Published: June 2022

Aims

Attention Deficit Hyperactivity Disorder (ADHD) in adults is a growing clinical problem and its prevalence among patients being referred to the General Adult Psychiatry clinic is rapidly increasing. The treatment of ADHD involves the use of medications such as methylphenidate, atomoxetine and lisdexamfetamine. These medications can cause significant adverse effects including arrhythmias, hypertension and appetite suppression. NICE guidelines stipulate that individuals on such medications should have weight, blood pressure and heart rate monitored every 6 months. The aim of this closed-loop audit was to assess if weight, heart rate and blood pressure are being monitored in line with current NICE guidelines in those who are on medication to treat ADHD in a Community Mental Health Team in Glasgow.

Methods

Patients with an ADHD diagnosis were identified through a search of electronic case records. Electronic records were reviewed for each patient identified to assess if weight, heart rate and blood pressure had been recorded in the last 6 months. The results of the first cycle of this audit was presented at a local meeting in May 2021 with relevant clinicians present. The patient cohort identified was subsequently re-audited in December 2021 to assess if there had been an improvement in the monitoring of these medications.

Results

30 patients were identified who had an ADHD diagnosis. 15 male and 15 female patients were identified. Patient age ranged from 18–50. 10 patients did not engage with services and were so subsequently excluded from our analyses. There was a substantial improvement in the monitoring of weight, heart rate and blood pressure in the second cycle compared with the first cycle of this audit. 45% of patients had their weight recorded (previously 15%), 40% had their heart rate recorded (previously 8%) and 50% had their blood pressure monitored (previously 19%).

Conclusion

There has been a significant improvement in monitoring heart rate, blood pressure and weight every 6 months in line with NICE guidelines in the second cycle compared with the first cycle of this audit. However, we are still not currently meeting NICE guidelines. This is of particular clinical significance given the increasing prevalence of patients with an ADHD diagnosis and subsequent increase in the use of these medications. The COVID-19 pandemic and the reduction in face-to-face reviews has likely had an impact on our ability to monitor these medications.