bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Knowledge Regarding Alcohol Unit Conversion in Psychiatry Practitioners
Authors: Saima  , Williams Laura Jayne
Published: July 2023

Aims

National health services are facing an increased burden of alcohol-related problems. Between 2019–2020, 280,000 hospital admissions were attributable to alcohol use (1). This was 2% higher than 2018–2019, and 8% higher than 2016–2017. The UK Government has taken some action by recommending a maximum weekly alcohol consumption limit in units; however it is unclear whether psychiatrists are aware of these recommendations. It can often be difficult to calculate accurately the units of alcohol consumed, due to differences in the alcohol concentration of apparently similar drinks (3). The aim of this online survey was to assess junior doctors’ knowledge and their understanding of alcohol unit conversions.

Methods

This was a cross-sectional study, administered via an online questionnaire. We invited junior and middle grade doctors working in Psychiatric Inpatient Units and CMHTs in the North Wales region via e-mail. We have used the same questionnaire that was used in previous studies. The questionnaire captured respondents’ training level, their current alcohol consumption and perception about their knowledge of alcohol unit conversions, as well as assessing their knowledge about alcohol unit conversions using four test scenarios. The data were gathered using the Microsoft office forms (online) and analysed descriptively (i.e., frequency and percentage) using Microsoft Excel.

Results

Twenty-three medical doctors working in Psychiatry completed the online questionnaire, of which the majority were junior doctors (n = 15; 65%). Almost three-quarters of the respondents (n = 17; 74%) reported regular consumption of alcohol. The majority of respondents (n = 20; 86%) reported that they had knowledge of alcohol units.

Nearly half of the respondents were able to calculate correct daily allowance of alcohol in units for males (n = 13; 56%) and for female (n = 12; 52%). Twelve respondents were able to calculate the correct allowance in units for both genders. About one quarter of the respondents (n = 5; 22%) mentioned weekly limits instead of daily limits of alcohol in units.

In response to test scenarios, seven respondents (30%) were able to correctly calculate 9 units of alcohol in a 750ml bottle of 12% wine. Ten respondents (43%) were able to correctly calculate 30 units in the bottle of whiskey. For the lager scenario, the volume was given in pints, and only one respondent was able to calculate 47.6 units correctly. For a wine (36.4 units) and sherry (12 units), only 6 (26%) and 4 (17%) respondents answered correctly, respectively.

Conclusion

We found that medical doctors working in psychiatry do not have adequate knowledge of alcohol unit conversions. To tackle the increasing burden of alcohol-related problems, learning about alcohol unit conversions should be incorporated into teaching programmes for psychiatry practitioners.
Quality Improvement Project: Referral Process for Adults With Suspected ADHD
Authors: Streeter Cassandra , Dankyi Stephanie , Akin-Ojo Isabelle
Published: July 2023

Aims

Twelve GP surgeries refer adults with suspected ADHD to Horsham Assessment and Treatment Service (ATS). Patients are referred by GPs via letter and an adult ADHD self-report scale (ASRS). Letter contents are variable and some referrals are rejected. There is no gold standard or national guideline for what referral information is required. We used a combination of guidelines and advice from The Royal College of Psychiatrists, The National Institute for Health and Care Excellence, and ADHD UK. Aims: to evaluate the current quality of the referrals, to obtain GP’' views on the referral process, to make the process more efficient and clearer, and with that improve patient experience.

Methods

A retrospective data collection method was used. 57 patients were referred between 31st August 2021 and 1st April 2022. We reviewed 54 referral letters (3 were excluded). Main information looked for: presenting difficulties, resultant impairments, confirmation some symptoms present in childhood, past medical history, family history and if an ASRS was attached. We sent a questionnaire to obtain GPs’ opinions on the referral process and how to improve this.

Results

Results of reviewing referral letters:

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89% of referrals explained the current difficulties

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52% described the resultant impairments

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61% of referrals mentioned if symptoms had been present in childhood

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91% of referrals contained past medical history and current medication

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No referrals mentioned family history

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6% of referrals contained some physical health data

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85% of referrals to ATS were accepted; 13% rejected as ASRS not attached.

Results from GP questionnaires: 11 surveys were returned. Most GPs were not confident in making a referral or what information is required, and did not understand the referral process. GPs would like a referral form, a flowchart outlining the referral process and information for patients about ADHD assessment.

Conclusion

89% of referrals explained current difficulties. Just over half described the resultant impairments, and confirmed if there were symptoms in childhood. Most referrals contained past medical history. 6% contained some physical health data. Only 85% of referrals were accepted. GPs would like a referral form, a flowchart and information for patients.

Results were distributed to staff in ATS and we will distribute results to GPs. We have created a referral form and flowchart to make the referral process more efficient and clearer, and to improve patient experience. We will re-evaluate this after a few weeks, so we can compare with previous data collected.
Reducing the Use of Rapid Tranquilisation in Over 65s in a General Hospital
Authors: Chircop Omar , Manning Jane , Heslop Joshua , Dadar-mann Vinita , Jenkinson Josie
Published: July 2023

Aims

A previous audit of use of rapid tranquillisation in older adults conducted in 2019 identified high rates of use of sedation, and poor adherence to local guidelines. Following this audit, a number of quality improvement (QI) initiatives were undertaken in order to try to improve practice, including multiple teaching sessions to a variety of staff. This re-audit was conducted to study whether initiatives had been effective in line with the Plan Do Study Act cycle of Quality Improvement.

Methods

Using the same audit tool developed in 2019, six wards (2 geriatric, 3 medical and 1 surgical) were audited. Patients over 65 given oral or intramuscular sedating medications had their drug charts and notes reviewed. Data were collected on type of sedation, route prescribed, whether it was prescribed regularly or PRN, whether an indication was documented, underlying diagnosis and what monitoring took place post sedation.

Results

297 drug charts were reviewed, and 13 patients were prescribed rapid tranquilisation (RT). The maximum daily dose was included in 63% of prescriptions similar to that of the first audit (58%). The most common route of administration was intramuscular, unlike the previous audit which was oral/intramuscular.

50% of prescriptions documented an indication, of which 25% were illegible. Whilst in the first audit the figure was 33%.

Of all the patients prescribed RT, 77% had a diagnosis of delirium, 77% had a diagnosis of dementia and about 53.8% had both. In both audits 100% of patients had a diagnosis of dementia or delirium. Most prescriptions were for lorazepam (75%). There was no evidence of observations being taken in line with post RT monitoring in the trust policy in both audits

Conclusion

Further work needs to be done to improve practice. Interventions to date have not been effective. Further plans for QI work include updating the RT policy to be more specific and useful for the acute trust, to fit in with a recently introduced electronic records system (ERS) and to include a clear section on older adults with signposting to the delirium and dementia policies. As well as adding prompts and protocols to the ERS to support safe prescribing and dispensing of RT. Teaching will be repeated and a poster has been developed and promoted on all the wards. The project group are planning to join the trust's ‘medication safety huddle’ regularly to include pharmacists in teaching and work. The audit will be repeated in three months time.
WHO AM I? Transcultural Psychiatry in Practice
Authors: Elisha-Aboh Christiana , Tangen Wendy , Dodough Nicholos , Romeu Daniel , Adwok Nyakomi , Nightingale Sharon , Hashmi Nazish
Published: July 2023

Aims

Culture refers to the way of life of a group of people and influences their value system. It affects virtually every area of life, unconsciously shaping one's outlook, behaviours and responses. As the world becomes more multicultural, it is essential that mental health professionals possess the much-needed awareness into the constructs of cultural variation and their impact on the expression of psychopathology and treatment. Black, Asian and Minority groups are a diverse group and make up 16% of the population in England & Wales. They are reported to have a less positive experience of mental health systems compared to white people. The common barriers ethnic minority groups face in accessing mental health care include: cultural barriers, stigma, language barriers, lack of cultural sensitivity from professionals, stereotyping, unconscious bias and so on. The aim of this quality improvement project is to improve the delivery of patient care and professional support to ethnically diverse groups.

Methods

A pre-workshop survey was set up to aid planning. The virtual workshop had over 80 people in attendance and included panel discussions, anchored by four professionals and three patients, all with lived experience. It lasted for 1-hour 15minutes, followed by a debrief. Feedback was obtained through survey monkey and the results were analysed with Microsoft Excel.

Results

The pre-workshop planning survey identified that 91 % of respondents within the Trust (57 individuals) worry about being misunderstood when working with culturally diverse patients. 93 % feel more education on cultural diversity is needed and only 20 % felt they had sufficient knowledge and resources for day-to-day practice with a diverse patient group.The feedback survey results on the day explored five questions which included: awareness of barriers minority groups experience, awareness of available transcultural resources, awareness of transcultural issues, awareness of local protocols and resources, and likelihood to intervene against discrimination showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Using thematic analysis, other areas of interest relating to transcultural psychiatry, at future workshops were considered as; greater awareness, practical approaches, culture/intersectionality, social justice, greater time allocation, spirituality, resources, gender/sexuality and age

Conclusion

Overall, majority of the feedback received was positive. Attendees valued the interactive nature of the panel discussions and choice of topics. Suggested areas of improvement were having more time for discussion and including other relevant topics. Recommendations include repeating workshops and raising local/national awareness.
RANZCP Commitment to People With Intellectual and Developmental Disability
Authors: Moore Elizabeth
Published: July 2023

Aims

To provide an overview of the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) work to improve support for those with an intellectual or developmental disability.

Methods

People with intellectual disability experience significantly higher rates of physical and mental health conditions in comparison to the general population. However, there can be multiple barriers to effective health care including, but not limited to, stigma and discrimination, the training of health professionals and a failure to consider the specific needs of people with intellectual disability in health and disability policy leading to deficits in funding to support generic services or develop specialist service models.

In Australia, a Disability Royal Commission was established in 2019 in response to community concern about reports of violence against, and the neglect, abuse and exploitation of, people with disability. The RANZCP has provided information to the Royal Commission and appeared at a public hearing focused on the education and training of health professionals in relation to people with cognitive disability. In 2022, the RANZCP published new position statements on autism and intellectual disability to address the unmet needs faced by people with autism and intellectual disability and provide a foundation for future College advocacy for improving resourcing and mental health support for these groups.

Results

The new RANZCP position statements on autism and intellectual disability make a number of systemic recommendations to address the mental health needs of autistic people and intellectual disability including:

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providing adequate funding to ensure appropriate policy implementation

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educating and training health providers in the mental health needs of autistic people and people with intellectual disability

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including the voices of autistic people to support a more inclusive approach to policy development and service design

•

collecting data on the needs of people with intellectual disability who are living with mental health conditions to support better service planning and better health outcomes.

•

In response to recommendations from the Disability Royal Commission, the RANZCP is also revising its training syllabus to include additional requirements for cognitive disability and has reviewed its CPD program to determine whether CPD for the provision of health care to people with intellectual disability should be enhanced.

Conclusion

The RANZCP is committed to addressing the unmet mental health needs and significant challenges of people with autism and intellectual disability and advocating for improving resourcing and mental health support for these groups.
An Unusual Case of Neuroleptic Malignant Syndrome on a Stable Dose of Antipsychotic
Authors: Sanger Emily , Rutt Benjamin , Hall David , Foster Harry , Obasohan Owen
Published: July 2023

Aims

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening complication of antipsychotic medication. There are no gold standard tests to diagnose NMS, however various diagnostic criteria have been suggested. NMS is typically reported in patients who have recently commenced an antipsychotic or had a change in dose. This case report describes an elderly female who developed NMS after being treated with the same dose of antipsychotic for 7 years. We aimed to establish whether similar cases are commonly reported, and what the key learning outcomes are.

Methods

This case presents an 82-year-old female taking the same dose of zuclopenthixol for 7 years. She was admitted with increased confusion and was initially prescribed antibiotics for a possible infection. She later became pyrexial and developed hypertonia, at which point NMS was suspected. Her creatinine kinase titre was significantly elevated, and her antipsychotic was discontinued. A potential trigger was a significant rectal bleed occurring a few weeks prior with no other obvious triggers noted. She was switched to quetiapine but developed NMS again when this dose was increased.

Results

There are few reports of NMS occurring in patients taking a long-term and stable antipsychotic dose. One case describes NMS developing after 30 years on Clozapine with no clear trigger. Another reports NMS after 7 years on Olanzapine, however this was triggered by dehydration. This case is an example of NMS in an elderly patient with a complex medical history who was initially misdiagnosed with sepsis before NMS was suspected. This shows the importance of considering NMS not only in those who have recently commenced antipsychotics or recently changed dose, but also those who have been stable on medication for a number of years. In suspected NMS, we should aim to stop relevant medication immediately and commence conservative management. It is important to highlight these atypical presentations so that NMS can be recognised without delaying treatment, thereby reducing mortality and improving patient outcomes

Conclusion

This report highlights the importance of considering NMS in patients who have been prescribed the same dose of antipsychotic for an extended period. Awareness of potential risk factors such as medical comorbidity that may trigger an episode of NMS even in those on established antipsychotic treatment is vital. Symptoms may mimic infection and it is important to raise awareness of atypical presentations to effectively identify, and treat, NMS earlier to improve outcomes.
Evaluation of Psychiatric Intensive Care Unit (PICU) Admissions in Comparison to NAPICU Guidelines on Admissions Criteria
Authors: Felix Francis
Published: July 2023

Aims

Ward 1 at The Newsam Centre, Seacroft Hospital is a 12 bedded PICU facility for the city of Leeds, United Kingdom (UK). Our average length of stay was between 3 and 4 weeks. This project aimed to evaluate our admissions in comparison to the National Association of Psychiatric Intensive Care Unite (NAPICU) guidelines on admission criteria and to describe the characteristics of our patient population. At the time of our evaluation, we operated without a specific admission criteria, and this was hypothesised to be a contributor to longer length of stay.

Methods

297 patients admitted over a period of 2 years were identified and their characteristics including age, sex, ethnicity, housing area, general practitioner (GP) practice, mental health diagnosis, and length of stay tallied. These were compared with NAPICU guidelines on admission criteria and 2 patient groups (NAPICU and Non-NAPICU) were identified, analysed, and compared using Microsoft Excel pivot table. We compared their length of stay corrected for outliers using the z-score calculation. We also looked at significant differences between the groups and looked in greater detail for the profile of the Non-NAPICU group to understand the reasons for their admission, and consider their impact on our length of stay.

Results

We found that our mean length of stay was 25.9 (1 – 215) days. When the NAPICU admission criteria were applied onto the sample, 9 patients were excluded (Non-NAPICU group) resulting in a reduction of our mean length of stay to 20.5 (1 – 83) days. When the Non-NAPICU group were looked at separately, their mean length of stay was 66.22 (7 – 152) days. When the Non-NAPICU group was looked at in greater detail, 2 patients had 2 separate recurrent admissions; one of which had a primary diagnosis of Learning Disability while the other had no clear Psychotic nor Depressive Disorder, and was complicated by Personality Disorder and criminality. 2/9 patients were detained using the forensic section 37/41. In addition, 2/9 patients were from the elderly population and 1/9 was from the younger population. There were no major differences in gender, ethnicity or age distribution.

Conclusion

Our evaluation suggested the potential reduction of our mean length of stay from 25.9 days to 20.5 days when the NAPICU admissions criteria were applied. We recommended a careful implementation of an admissions criteria for Ward 1 at The Newsam Centre PICU.
Electroconvulsive Therapy: Evaluating the Current Practice in Al Ain Hospital, the United Arab Emirates
Authors: Javaid Syed Fahad , Subbarayan Aravinthan , Ahmed Hind Mohd , Ahmed Zahra Yusuf , Alhassani Aysha Darwish , Alkaabi Alyazia Abdulla , Abdulaziz Omar Bin
Published: July 2023

Aims

Electroconvulsive Therapy (ECT) has been used since the 1930s for the treatment of depressive illness, mania and catatonia. This audit aimed to appraise the ECT pathway followed by the Behavioral Sciences Institute at Al Ain Hospital, United Arab Emirates. The authors analysed the pathway's compliance against the standards set out in the local Al Ain Hospital guidelines and The Royal College of Psychiatrists (RCPsych) standards, with a particular focus on capacity and consent issues.

Methods

This audit involved a retrospective review of case notes. After obtaining the relevant ethical approval for the audit, we collected the case notes of all patients who received ECT over a period of three years between May 2019 and June 2022. The audit sample comprised 30 patients, both from the inpatient and outpatient services in Al Ain Hospital. A questionnaire was developed to capture the required information anonymously. Data collection took place between September and November 2022.

Results

Out of the total 30 patients, 21 (70 %) were males. The average age of the sample was 31 years, with a range of 19-71 years. Twelve patients (40%) were Emirati citizens, with Ethiopian nationals (17%) being the second largest ethnic group. A significant majority (90%) of the patients who received ECT were under the inpatient psychiatric services at Al Ain Hospital. The sample studied received, on average, eight sessions of ECT. Major depressive disorder (43% of the sample) was the most common diagnosis, followed by severe mania at 37% and Catatonia at 17%.

Of 30 patients, 16 (53%) had no documentation of their mental capacity to accept ECT on the consent papers. Out of 8 patients deemed lacking capacity, only 4 had proper documentation of the reasons for lacking capacity. Reviewing the consent papers demonstrated that 20 patients (67%) had no documentation of discussing the risk and benefits of the procedure.

Conclusion

This audit has identified areas for improvement in the implementation of Al Ain Hospital's current ECT pathway. The authors have suggested enhanced staff training on consent issues involving ECT, emphasizing better documentation of the decision-making process. Considering the possible medicolegal consequences, a particular area for documenting discussions of the risk and benefits of the procedure should be included in the ECT consent form. We aim to re-audit the practice after one year of implementing the above action plan.

No financial sponsorship has been received for this evaluative exercise.
ID (Intellectual Disability) Crisis Resolution! Novel Approaches in NHS Highland
Authors: Kumar Praveen , Bantwal Ashwin
Published: July 2023

Aims

Like most health and social services, community ID teams are under increasing pressure to manage burgeoning caseloads. This evaluation was for the Red People Meeting video conferencing (VC) from its conception during the pandemic 2020 with particular reference to it's simple format to structure meetings for their effectiveness and promotion of team communication and well-being.

Methods

The Red people meetings is held every Mon – Fri between 11am and 12pm through an invite sent via e-mail or diary invite. A RED STATUS is identified by a support worker who poses:

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Serious risk of harm to self or others

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Serious concerns related to Physical / Health / Perceived challenging behaviours.

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Individual requiring hospitalisation

Meeting Attendees (over TEAMS): Chaired by the Head of Service or Lead ID Nurses. With attendance of ID Consultant Psychiatrist, OT Team, Moving Home Manager, ID Nurse, Social Worker. Attendance depending on individual need include Clinical Psychology, AHPs, Social Work Team Manager, Social Worker, Police, GP, Housing, MHO, District Nurses, etc

Individuals identified as RED and are at risk of admission or an inappropriate alternative solution will likely require significantly longer discussions and a full plan to reduce the risk of harm.

Evaluation data were gathered via qualitative feedback from the multi-disciplinary team (MDT). Number of patients admitted among cases discussed from January 2020 until September 2022 (Total 248) was noted.

Results

The MDT team were generally satisfied with the assistance they received and were able to be provided solution focused remedies with immediate feedback. In particular, they were satisfied with the accessibility in having a collaborated approach with addressing the challenges to request priority of interventions from NHS Highland ID staff and provision of timely advice and guidance to support providers. Out of the 248 People With Intellectual Disability (PWID) discussed from January 2020 to Sept 2022, only two required admission with the rest successfully being managed in the community.

Conclusion

With its easy accessibility and quick response via video conferencing, ‘Red people’ meeting can be used as a platform to discuss PWID and / or autism who have been classified with a RED status identifying the immediate support required, providing expert advice and guidance, enabling a quick prioritised response from professionals and provision of safe and timely discharge from hospital.

It is evident that further research needs to be undertaken into the contemporary and future practice of community ID teams in the management of crisis settings.
Long Waiting Lists and Poor Attendance - How Can Psychiatry Do Better? a Review of Services in North West Edinburgh
Authors: Ali Iqra , Balboa Vito , Datta Sarthak , Dobson Lois , Dubey Devshi , Oguz Alexandra Eylul , Horobin Rachel , Ladha Sophie , Moore Cassie , Tan Louise , Saravanan Pranav Thamarai , Murphy Kenneth , Murdie Douglas
Published: July 2023

Aims

Increasing demand and high rates of non-attendance (DNA) lengthen waiting lists for psychiatric services, a topic of significant public and political interest. NHS Lothian data between 2009/10 and 2018/19 averaged a DNA rate of 19% for new patient appointments. Our aim was to analyse the waiting list and DNA rate for patients referred for a routine Consultant-led General Adult Psychiatry outpatient clinic appointment (OPCA) within the North-West Edinburgh Community Mental Health Team. The goal was to identify lost clinical time and areas for service development.

Methods

We collected data of all patients on the waiting list for a routine OPCA, excluding ‘soon’ or ‘urgent’ appointments and those on the separate Neurodevelopmental Disorder waiting list.

We collected data of all OPCA attendances between 1st of January 2020 and 1st of January 2023.

In line with Royal College of Psychiatrists guidance, we allocated 30 minutes for a return patient and 60 minutes for a new patient to determine lost clinical time due to DNAs.

Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.

Results

221 patients were on the waiting list for an appointment. 52% of patients were female (n = 115). The longest wait was 10 months.

Between the 1st of January 2020 and the 1st of January 2023, 1961 new patient appointments were booked. 263 were cancelled prior to the appointment. Of the appointments remaining, 30% were DNAs (n = 505), resulting in 505 lost clinical hours, an average of 168 hours/year.

9172 return patient appointments were booked. 1189 were cancelled in advance. 22% were DNAs (n = 1812), resulting in 906 hours of lost clinical hours, an average of 302 hours/year.

Conclusion

DNAs have a direct impact on service provision. Were our service to reduce our DNAs to the Lothian average for General Adult Psychiatry new patient OPCA, we would save on average 61 clinical hours/year.

We will disseminate this information to the NHS Lothian Digital Experience Mental Health Team to support the introduction of a text reminder service, before involving the NHS Lothian Quality Improvement team to explore the impact of this intervention on DNAs.

Furthermore, being placed on a waiting list can be an uncertain time for patients. We will create a waiting list pack for patients, including information of local supports and emergency contacts. We will pilot this in our sector before disseminating to other teams in Lothian.
Evaluation of the Quality of the Pre-ARCP (Pre-Annual Review of Competency Progression) Corporate Report for Postgraduate Doctors (Core Trainees) in Relation to Their Postgraduate Teaching Attendance and Audit Involvement
Authors: Muzenda Muredzwa Adelina , Sodiya Olusegun , Sinha Baxi
Published: July 2023

Aims

This evaluation was done with the focus to improve the quality of pre-ARCP corporate report for core-trainees. The pre-ARCP corporate report is a document compiled by the medical education department guided by other departments to capture certain competencies. The area of interest was how the report could be up-to-date and accurate. This would ultimately lead to a fair and objective summation of facts for the Psychiatric and Educational Supervisor report which will be reviewed by the ARCP panel.

Methods

This evaluation included all full-time core trainees within the Northern training scheme of the Trust who have undergone ARCP in January and July 2022. Exclusion criteria included less-than full-time trainees and core trainees who did not take part in an ARCP panel in January and July 2022. The questionnaire was designed by the Project Team and approved by the Trust Audit Team prior to data collection. The data were collected from 11th July to 31st July 2022. Electronic questionnaires were sent out to 33 postgraduate doctors.

Results

A total of 12 postgraduate doctors responded (36%). Out of the 12 doctors that responded, 11 (92%) had taken part in the ARCP panel in July 2022. 11/12 (92%) reported having received their pre-ARCP corporate report prior to the ARCP and in adequate time. Similarly, 11/12 (92%) of postgraduate doctors agreed with the record of both the RCPsych teaching attendance and audit involvement recorded on their pre-ARCP corporate report. In relation to capturing locality teaching attendance, 58% of postgraduate doctors reported the information as accurate. Inaccurate capturing of leaves, on-calls and/or rest days were pointed out by respondents as reasons for the discrepancy in attendance. Of those who contacted medical education, 10/10 (100%) reported that the issue was resolved before the portfolio submission date for ARCP. Of those who did not take action, 50% (1/2) reported the reason as being “I did not see the need to take action”.

Conclusion

We found that core trainees felt that capturing accurate RCPsych teaching attendance as well as accurate audit involvement before ARCP are areas that required improvement. There is room for improvement regarding recording locality teaching attendance and absences due to leaves, on-calls, and compensatory rest. It brings us back to reflect on the time spent by each affected postgraduate doctor to clarify their records when discrepancies are noted. Results were discussed with Medical Education department and suggestions for improvement implemented. A re-evaluation is scheduled to take place in July 2023.
Re-Audit of Blood Monitoring of Lithium in Outpatients of Working Age Under Dudley Mental Health Services
Authors: Bridgewater Peter , Kumar Praveen
Published: July 2023

Aims

Lithium remains the first line mood stabilising therapy recommended by NICE for Bipolar Disorder and an important treatment option for augmentation of the treatment of Depression. Lithium has a strict monitoring requirement due to long term impact on Renal, Thyroid function and risk of toxicity due to a narrow therapeutic range. This Re-Audit aimed to assess improvement in Lithium Blood monitoring in working age adults in Dudley following an initial 2021 audit.

Methods

We used the standards set by NICE CG185- Bipolar Disorder Assessment and Management. We agreed a standard of 3 monthly monitoring of lithium levels due to the number of indications for 3 monthly monitoring to ensure safest practice. We also agreed to standards for 6 monthly monitoring of Urea and Electrolytes (U&Es) and Thyroid Function Tests (TFTs). An additional standard was agreed that at every outpatient review Lithium blood results should be reviewed and documented. A sample of 40 patients was gathered from the 8 outpatient sector teams. We used Rio notes system for demographic, diagnosis and clinical information and blood results systems EMIS and ICE for blood results over a period of November 2021- November 2022.

Results

There was a noted minor improvement to compliance with 3 monthly monitoring, overall increasing from 10% to 17.5%, but this result is still poor. The number of patients who had 4 or more Lithium blood tests over the 12 month period was more of a positive increase, to 32.5% from 17.5% in the previous audit cycle. There was also an improvement in the mean number of lithium blood tests per patient from 2.67 to 3.3. For U&Es 90% of patients were monitored 6 monthly while for TFTs 85% of patients were monitored 6 monthly. There was a slight reduction in documentation of blood results at clinic review, reducing to 62.5% from 67.5% in the initial audit.

Conclusion

While the progress is positive, the results are still far below where the trust would like to be. We considered whether frequency of outpatient review, poor awareness of 3 monthly monitoring standards and a lack of formal system to remind or ensure patients are monitored appropriately. It was agreed that measures to ensure compliance such as a lithium blood monitoring clinic may be useful to improve compliance with monitoring.
Assessing the Number of Patients Receiving 1:1 Sessions and Their Frequency per Week
Authors: Golchinheydari Sirous
Published: July 2023

Aims

The aim of the audit was to assess whether patients on the ward were receiving 1:1 sessions with their named nurse and to assess the frequency of these sessions per week after many patients stated that they were not receiving such sessions. The role of the named nurse is to engage therapeutically with the patient and thus ensure the well-being, safety and satisfaction of the patient while communicating and enforcing the treatment plan. The named nurse answers the patient's questions and helps the patient with tasks such as preparing documentation. The named nurse also acts as an advocate of the patient and communicates the needs and requests of the patient to the team. The recommended frequency of 1:1 sessions is twice a week.

Methods

The electronic records of the patients admitted to a mental health ward were examined to assess whether they were having their documented 1:1 sessions with their named nurse on the 15th of October 2022. This was recorded on an excel sheet anonymously as “complete” and “not complete.” The frequency of these sessions per week was also recorded on the same excel sheet. The audit was repeated on the 15th of January 2023 and the same parameters examined. Improvement was facilitated via speaking to nursing staff, explaining the importance of 1:1 sessions and reminding them of physical health forms in the morning meetings.

Results

The results showed that 4 patients had 1:1 sessions out of 20 admitted patients. 2 out of the 4 patients who had 1:1 sessions had them at least twice a week while the others had them once a week. The repeat audit 3 months later showed 12 out of 20 patients had 1:1 sessions and 5 of those patients had them at least twice a week.

Conclusion

The audit showed some improvement. It is likely that the task can be forgotten on a busy ward and reminding staff regularly is imperative. Further improvement can be managed by using posters in the nursing station to remind staff.
Antipsychotic Dose Reduction for Patients With Behavioural and Psychological Symptoms of Dementia in the Well-being Clinic of a Community Mental Health Team for Older People
Authors: James Timothy Cherian , Mandal Uttara
Published: July 2023

Aims

To evaluate the usefulness of the "Well-being Clinic", a specialized service aimed at reducing the dose of antipsychotic medication prescribed for patients with behavioural and psychological symptoms of dementia (BPSD). The aim of the service was to have a sustained reduction of at least 50% of the antipsychotic dose in at least 50% of the sample size.

Methods

A retrospective quantitative study was performed, looking at the 6 month period between August 2022 and January 2023. Two data parameters were obtained. One, the percentage of reduction of the antipsychotic dose for each patient. Two, the number of reviews done for each patient over the specified time period.

Results

Out of a sample size of 21 patients prescribed antipsychotics for BPSD, only 1 (5%) had a sustained reduction of at least 50% of the antipsychotic dose. 2 (10%) had a dose reduction of less than 50%, 14 (67%) had no change and 4 (19%) had a dose increase.

3 patients (14%) had 3 reviews in the 6 month period, whereas 10 (48%) had 2 reviews, 5 (24%) had 1 review and 3 (14%) had no reviews.

Conclusion

The Well-being Clinic intends to reduce harm to patients by reducing their antipsychotic dose. However, only 5% had a satisfactory dose reduction and 62% were reviewed at least once in 3 months.

Recommended actions include increasing the frequency of reviews to once in 6 weeks (in accordance with national guidelines) and implementing regular monitoring of electrocardiograms (ECGs), vital signs and blood markers to further improve practice.
Evaluating the Impact of COVID-19 on the Transition From CAMHS to AMHS in ABUHB – a Retrospective Study
Authors: Maylor Elise , Pasunuru Kavitha , Todd Andrew
Published: July 2023

Aims

To evaluate the transitions of Aneurin Bevan University Health Board (ABUHB) Child and Adolescent Mental Health Service (CAMHS) patients to Adult Mental Health Services (AMHS) during the COVID-19 pandemic, against regional Health Board policy standards.

Methods

Following a review of the current ABUHB transitions policy and a focused review of the literature, relevant standards were elicited. Retrospective data of transition cases between April 2020 and March 2021 were collected using a standardised data-capture tool from CAMHS records using the EPEX system; cases were anonymised. A questionnaire was constructed and distributed by email to ABUHB CAMHS clinicians to gain further qualitative data.

Results

A total of 34 patients were identified as CAMHS transition cases. 3 were identified as having a transitions co-ordinator, 6 had no record of AMHS having been informed with only 1 case documenting liaison with AMHS at the 6 month mark. 20 cases showed evidence of good patient support before and after transition, and 25 showed young person involvement in decision making. 28/34 cases showed evidence of good coordination of MDTs (multi-disciplinary teams).

There were 16 responses to the staff survey. 93% of respondents were aware of the transition policy, and 68.8% of clinicians strongly agreed/agreed with “I involve young people in their decision making process”. 25% of respondents strongly disagree/disagree when asked whether they work in collaboration with the AMHS. For “I believe my patients are ready to transition at the age of 18” 37.5% remained neutral.

Conclusion

Several of the standards outlined in the ABUHB transition policy are not being met. These include: naming a transition coordinator, informing AMHS 6 months prior to the patient turning 18, and involving the young person in the decision of transfer of care. COVID-19 has evidently impacted the transition process, but more audits must be conducted in order to compare these data to pre-pandemic times.
Assessement of Antipsychotic Side-Effects Monitoring in Learning Disability Patients in a Medium Secure Hospital
Authors: Surendran Indu , Cronje Johannes
Published: July 2023

Aims

Learning Disability population has increased neuroleptic sensitivity which predisposes to development of side-effects at even lower doses of antipsychotics. STOMP practices (Stopping OverMedication of People with a learning disability, autism or both psychotropic medications) advocate regular review of psychotropic medications, providing information about non-pharmacological therapy and involvement of patients and families about medications. Our audit aimed to understand how the side-effects in the Learning Disability patients who are on antipsychotics in a Medium Secure Hospital were being monitored in a 12-month period. The objectives were to assess whether the side-effects were being monitored regularly, whether a scale (Liverpool University Neuroleptic Side-Effect Rating Scale or LUNSERS) was being used or not, the grade of staff conducting the assessment and whether the outcomes being scored and reviewed adequately in Multi-Disciplinary Team meetings or Care Programme Approach meetings.

Methods

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It was a retrospective, cross-sectional audit involving inpatients on the Learning Disability Wards of Rowan View (Medium Secure Hospital under Merseycare) in the time period 01/06/21 to 31/05/22

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No patients were excluded

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Data pertaining to assessment of side-effects to antipsychotics were collected from electronic database PACIS, the computer database used in Rowan View using Microsoft excel tool created by author

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Descriptive statistics were used to analyse data

Results

There were 27 patients included in the study from four different learning disability wards in Rowan View Hospital. In all but one (96.3%), side-effects to antipsychotics were assessed at least once in 12 months, but formal assessment using a rating scale was conducted in only 88.5%. In majority of patients, only one assessment was done in 12 months (43.8%) whilst the maximum was 3 assessments in a year in 34.8%. None of the assessments had the grade of staff noted whilst only 8.7% assessments were scored despite 91.3% being calculated and only 26.1% assessments even reviewed further. All patients reported side-effects to some extent.

Conclusion

The modality and frequency of reviewing side-effects to antipsychotics in this neuro-sensitive patient population was noted to be inadequate. The practice of using LUNSERS appears to be completed only superficially with questionable delivery and review of results. There is no formal guideline available nation-wide for basing this assessment of side-effects despite STOMP actions (other than suggestions) and a real deficit was identified. A creation of a formal guideline for monitoring side-effects in patients with Learning Disability is needed and is currently being addressed by Rowan View Patient Safety Team.
An Audit on the Uptake of Psychosocial Interventions in a Nationally Accredited Memory Service
Authors: Winfield Sarah , Zafar Faria , Williamson Tracey , Cooper-Hunt Michelle
Published: July 2023

Aims

The impaired functioning of patients with dementia has economic, social and quality of life implications for individuals, carers and wider society. We audited the provision & uptake of psychosocial interventions to promote the cognition, independence and well-being of Later life Adults under Macclesfield Memory services, supported by Service and Involvement, Recovery and Wellness Centre at Jocelyn Solly Resource Centre, United Kingdom. Compliance with National guidance on psychosocial care for patients with dementia was assessed: 1. NICE guideline [NG97] “Dementia: assessment, management and support for people living with dementia and their carers.” 2. “Memory Services National Accreditation Programme Standards for Memory Services”

Methods

Electronic patient records were retrospectively reviewed. Clerical staff identified all patients with dementia reviewed at Jocelyn Solly Resource Centre from 1/4/22 – 31/07/22 (n=140) and data of referrals to, and engagement with, the Recovery College collected.

Results

23/140 patients (16.4%) were referred to the Involvement, Recovery and Wellness Centre by a single referrer; 12 booked onto workshops, 4 declined, 1 was unable to attend due to lack of transport & 6 were not successfully contacted. 11.4% (n=16) of clinic letters documented referral and nil stated referral rationale. n=1 patient attended tai-chi and booked workshops included: Cognitive Stimulation Therapy (CST) (n=8), Living well with dementia (n=1), Living well with a long term condition (n=1), Anxiety Management (n=1). Compliance was 100% for: trained staff delivering workshops, patients and carers having access to psychosocial interventions for challenging behaviour and assessment and interventions for the emotional, psychological and social needs of carers. 99.3% of patients (n=139) were offered pharmacological intervention (or the exception documented). There was no access to individual/maintenance CST, art or creative therapies nor input from psychology or occupational therapy due to vacancies. No patients <65 were signposted to work, education or volunteering.

Conclusion

Though the Recovery college adequately trains and supervises staff and documents patient outcomes, there is capacity to improve the quantity of referrers, referrals & attendances to maximize existing resource utilisation. Implementing strategies to reduce access barriers and hiring a psychologist & occupational therapist would improve service quality. Documenting patient-defined goals and using multiple outcome measures would better enable staff to review progress and could heighten patients’ motivation to engage with services.

Recommendations to improve compliance include: amending clinic letter proformas to include patient-defined goals, psychological and social interventions; educating team members about services offered and referring to the Recovery college and implementing multidisciplinary review of recovery college referrals.
Skeletal Muscle Endogenous Estrogen Production Ameliorates the Metabolic Consequences of a High-Fat Diet in Male Mice
Authors: Unger Christian A , Aladhami Ahmed K , Hope Marion C , Cotham William E , Nettles Kendall W , Clegg Deborah J , Velázquez Kandy T , Enos Reilly T
Published: July 2023

Aims

The role of skeletal muscle estrogen and its ability to mitigate the negative impact of a high-fat diet (HFD) on obesity-associated metabolic impairments is unknown. To address this, we developed a novel mouse model to determine the role of endogenous 17β-estradiol (E2) production in males in skeletal muscle via inducible, skeletal muscle–specific aromatase overexpression (SkM-Arom↑).

Methods

Male SkM-Arom↑ mice and littermate controls were fed a HFD for 14 weeks prior to induction of SkM-Arom↑ for a period of 6.5 weeks. Glucose tolerance, insulin action, adipose tissue inflammation, and body composition were assessed. Indirect calorimetry and behavioral phenotyping experiments were performed using metabolic cages. Liquid chromatography mass spectrometry was used to determine circulating and tissue (skeletal muscle, hepatic, and adipose) E2 and testosterone concentrations.

Results

SkM-Arom↑ significantly increased E2 in skeletal muscle, circulation, the liver, and adipose tissue. SkM-Arom↑ ameliorated HFD-induced hyperglycemia, hyperinsulinemia, impaired glucose tolerance, adipose tissue inflammation, and reduced hepatic lipid accumulation while eliciting skeletal muscle hypertrophy.

Conclusion

Enhanced skeletal muscle aromatase activity in male mice induces weight loss, improves metabolic and inflammatory outcomes and mitigates the negative effects of a HFD. Additionally, our data demonstrate for the first time skeletal muscle E2 has anabolic effects on the musculoskeletal system.