bluuebunny/crossref_metadata_2025 huggingface dataset:
A Service Evaluation of Referrals to Sheffield Community Child and Adolescent Mental Health Services (CAMHS) by Ethnicity and Areas of Deprivation
Authors: Arogundade Temitope , Shibib Shatha , Melton William , Younis Ayman
Published: July 2023

Aims

To investigate disparities in the number and outcome of referrals to Sheffield Community Child and Adolescent Mental Health Services from different ethnic groups and areas of deprivation

Methods

The authors reviewed the the 2021 census data for Sheffield and grouped Sheffield into 3 areas of deprivation (low, medium, and high) based on Index of Multiple Deprivation (IMD 2019 Rank).

Reasons and outcome of referrals to Sheffield Community CAMHS for the months of March and April 2022 were analysed by ethnicity and deprivation,

Results

Our study shows that, compared to their white counterpart, Black and Asian children and young people (CYP) were markedly under-represented in CAMHS referrals, whilst CYP of mixed ethnicities were over-represented. Of this group, Asian and mixed ethnicity CYP were less likely to have referrals accepted. Similarly, CYP from areas of high deprivation were also less likely to be accepted into the community CAMHS service. While anxiety was the most common reason for referral, CYP from areas of high deprivation were 3 times more likely to be referred for behavioural difficulties than CYP from areas of low deprivation.

Conclusion

Our study highlighted that black ethnicities are disproportionately underrepresented in CAMHS referrals. Furthermore, children and young people from an Asian background are not only underrepresented in the number of referrals but also in the proportion of referrals accepted. Similarly, it is reported that CYP from deprived backgrounds are more likely to experience barriers to accessibility to mental health services, and this was also evident from our evaluation.

Black and Asian CYP continue to be under-represented in CAMHS services as are CYP from deprived communities. However, these ethnic groups present the highest reported mental health difficulties at adulthood. More research is therefore needed in this area, to identify the specific barriers to accessing mental health care in Sheffield Community CAMHS, so as to allow the provision of culturally appropriate mental health services for the ethnic and high derivation groups.
Service Evaluation of Treatment Response in Adult ADHD Patients With Psychiatric Comorbidities
Authors: Ashraf Afiz , George Sini , Ramaswamy Venkat , Manaswini Namilakonda , Kishore Kondapalakala Kiran
Published: July 2023

Aims

To assess whether psychiatric comorbidities affect response to medications in adulthood ADHD.

Methods

This study included 236 subjects diagnosed with ADHD in adulthood between the ages of 18 and 65 years and receiving pharmacological treatment for the same across community treatment teams in Durham and Darlington.

Patients were identified by going through electronic case notes.

Review of SWMWEBS scores and clinic letters were carried out both prior to and following commencing medication for ADHD to assess response to treatment.

Comorbidities were recorded by reviewing clinic letters.

Results

56% of the study subjects had no psychiatric comorbidity while 44% had at least one comorbid psychiatric diagnosis.

Both groups had a higher prevalence of males in the ratio of 1.9:1(with comorbidities) and 3:1 (without comorbidities).

Depression(56%) was noted to be the most common comorbidity followed by Autism(22%), Emotionally Unstable Personality Disorder(11%) and Bipolar Affective Disorder(10%).

94% patients without comorbidities responded favourably to treatment whereas only 56% of patients with comorbidities improved with treatment.

Conclusion

Having a comorbid psychiatric illness is likely to negatively impact both treatment response and recovery in adults with ADHD.

Both groups(with and without comorbidities) had a male predominance (2.5:1).

Higher number of patients amongst the nil comorbidities group responded favourably to treatment.

Most common psychiatric comorbidity was Depression.

Least favourable response to treatment was found among the groups of Emotionally Unstable Personality Disorder and Bipolar Affective Disorder.

No gender bias in response to treatment across both the groups.
A Descriptive Analysis of the Clinical and Demographic Features of High Intensity Users of Charing Cross Hospital Emergency Department; Utilisation of These Data to Develop Local Services
Authors: Cho Yena , Kydd-Coutts Thomas , Newman Anastasia , Patel Sachin , Schofield Emma
Published: July 2023

Aims

Over recent years, there has been increasing national focus on High Intensity Users (HIU's) of Emergency Department's (ED's) and services designed to case manage and address the unmet needs of these individuals. The descriptive research literature focuses on measurable, demographic identifiers of this group, attendance trends and the presenting complaints driving attendance. There is more variable literature on the clinical profiles of these individuals, with findings describing a highly heterogeneous group. Our inner city service is well-established and staffed by a multidisciplinary team. We provide assessments and interventions to meet the needs of HIU's identified through a referral system which includes electronic flagging of cases. We aim to describe in detail the clinical and demographic features of a cohort of HIU's attending our department and demonstrate the utility of these data.

Methods

All individuals managed by the HIU service in 2022 were identified from our referral database. No individual was excluded. We undertook systematic notes reviews on each case, using medical, psychiatric and primary care records as well as interventional care plans produced by the service. Data were recorded against set domains covering socio-economic factors, demographics and clinical coding.

Results

The analysis included 98 individuals. The majority were male (59%) with 85% in receipt of government benefits and 16% of no fixed abode. A variety of psychiatric diagnoses were present with 12% diagnosed with a psychotic illness, 40% with a mood disorder, 7% with a somatoform condition and 19% with a personality disorder. 83% were diagnosed with a medical long term condition (LTC), with 32% of these being diagnosed with >3 LTC's. 81% suffered from at least 1 LTC and 1 mental disorder in combination. 40% harmfully used or were dependent on alcohol and 21% misused recreational drugs. Known or likely cognitive impairment was seen in 28% of the group and 13% were diagnosed with learning disability.

Conclusion

Our findings demonstrate the complexity of the clinical profiles of HIU's of the ED and supports service models centred on individual case management. There is a high degree of mental and physical morbidity in this group, indicating that specialist assessment and management is required. The range of unmet need covers a breadth of health and social care requiring a multi-disciplinary approach. Homelessness, cognitive impairment and learning disability are particular areas which may benefit from expertise. Our project is limited to one localised system however we recommend ED's undertake similar analyses to better design HIU services.
A Service Evaluation of Workload Monitoring for the Psychiatric Resident On-Call Rota
Authors: O'Neill James , Taylor Anna , Nightingale Sharon
Published: July 2023

Aims

The Psychiatric Resident On-Call (PROC) rota provides medical cover for all inpatients across Leeds and York Partnership NHS Foundation Trust outside normal working hours. With the introduction of a new regional inpatient CAMHS unit in August 2021, a service evaluation project was undertaken to establish if the current medical provision was sufficient to meet the increased demand of expanding services.

Methods

Workload monitoring was undertaken for 28 days during August and September 2022 for all evening, weekend, night and bank holiday shifts. Data collection documents in the form of Microsoft Excel spreadsheets were sent to one doctor to co-ordinate for all PROC doctors on each shift. For each 30-minute period, the number of doctors engaged in clinical activity was documented and the average number working at that time, as well as standard deviation, was calculated.

Results

51 out of 56 on-call shifts were accounted for during the workload monitoring period by returning of a completed data collection document. Workforce demand for the remaining five shifts was estimated from reviewing handover document with listed times of call-out and expected duration for each job.

Data showed that workload was consistent throughout weekend shifts, but slowed around the time of handover. This is likely due to the end of shift being used to complete documentation, and the start of shift being used to assign roles and plan the shift ahead. In addition, lengthy non-urgent tasks may not have been appropriate to undertake if a PROC was due to shortly end their shift.

Patterns of night-shift working suggested a steady demand during the early hours of the shift, but a reduction during early hours of the morning, with trough levels being observed between 04:00 and 05:00 in the morning. No significant differences were observed between evening and night shifts across weekdays or weekends.

Conclusion

Assessing the above data led the authors to conclude two changes to workforce provision which may increase efficiency of workload. The first was to implement a cross-over role which could bridge periods of handover and ensure that a medic is still available to respond to tasks despite the change in workforce around these times. The second was to rebalance allocated provisions so that less medics were on shift during early hours of the morning, when demand was lowest, and re-allocated to evenings or weekends where demand appeared to be greater.
Social Capital for Caregivers of Children With Neurodevelopmental Disorders in Kumasi, Ghana; a Multidisciplinary Approach to Patient and Caregiver Wellness
Authors: Sackey Ruth Charlotte , Adu-Nyako Pearl , Ratner Leah , Osei-Bonsu Angela
Published: July 2023

Aims

To demonstrate the role of psychosocial support groups in providing social capital for caregivers of children with neurodevelopmental disorders as an integral part of service delivery.

Methods

A descriptive prospective pilot study was conducted at the child neuropsychiatric joint clinic of the Komfo Anokye Teaching Hospital. A support group was initiated for caregivers of children attending the clinic, with the support of a multidisciplinary team of two psychiatrists, a paediatric neurologist, nurses, a clinical psychologist, an occupational, art, and speech therapists. Fifty (50) caregivers enrolled in the support group. A total of three face-to-face psychoeducational sessions, monthly Whatsapp discussions on topical issues of interest to caregivers and an outdoor social event were conducted over a period of one year. During sessions, healthcare providers provided psycho-education about illness management and coping skills for caregivers. Caregivers shared their experiences for the purposes of peer-peer learning and peer support. Information was gathered from caregivers on their psychosocial needs through open forum discussions and a questionnaire administered needs assessment. A retrospective evaluation of the support group intervention among caregivers was carried out using a mixed method, after a year's participation in the support group.

Results

From pilot observations of 30 of the caregivers who completed the evaluation, 85% rated the support group as highly beneficial, 10% rated as beneficial, and more than 95% of them will recommend the service to other caregivers. Caregivers perceive support groups as providing a forum to empower providers to educate caregivers about their well-being, de-stigmatize mental health, and strengthen the trust between caregivers and providers. They may also provide increased opportunities for respite and relaxation.

Conclusion

There must be improved social capital for caregivers of patients with chronic illnesses, with emphasis on coping during periods of stress and change. Caregiver and peer support groups are critical to improved psycho-social well-being and smooth service delivery for children with neurodevelopmental disorders and their families.
Knowledge of Service Users’ Voting Rights Amongst Mental Health Professionals in Haringey
Authors: Wright Jessica , Oppenheimer Melina Bergson , Thomas Rhianne
Published: July 2023

Aims

Voting is an intrinsic part of being a member of society and promotes social inclusion. The vast majority of mental health service users have the same right to vote as the general population but are a disenfranchised group and inpatients are half as likely to vote. Service users experience many barriers to voting including knowledge of their eligibility and the accessibility of the registration and voting process. Mental health staff need to understand service users’ voting rights so they can offer appropriate support. This project aimed to explore staff knowledge of service users’ voting rights.

Methods

77 multidisciplinary team members from inpatient and community settings in Haringey were surveyed about voting rights.

Questions focussed on staff knowledge of service users’ right to vote (whether or not subject to various civil or forensic sections), if capacity to vote was required and if those with certain diagnoses were legally disenfranchised.

27 Care Coordinators were asked if they discussed voting with service users and whether support around voting and registration was in care plans.

Results

The response rate was 96%. No respondents answered completely correctly. Staff knowledge was similar across all groups and settings.

The majority of staff believed community service users (89%) and informal inpatients (93%) were able to vote.

63% of respondents knew inpatients on civil sections could vote. 81% knew those on a Community Treatment Order could vote. 40% of responses regarding the forensic sections were correct.

56% believed service users needed to have capacity in order to vote.

Certain diagnoses were believed to legally prevent service users from voting, including dementia (19%) and schizophrenia (13%).

44% of Care Coordinators discussed voting with service users and 26% included voting in care plans.

Conclusion

Despite a national campaign, the level of staff knowledge is disappointingly low throughout all groups and settings, risking service users being given wrong information. This further disenfranchises a group that already experiences significant barriers to vote.

It is of particular concern that a significant minority of staff believed certain diagnoses legally prevent voting.

It was poorly understood that capacity is not relevant to the right to vote.

Voting rights and available support is not widely discussed by care coordinators with service users.

Clearly, education and training on voting rights is necessary for mental health professionals. We are planning staff education sessions and service user workshops as a quality improvement project.
Physical Health Assessment and Monitoring for Adults Receiving Pharmacological Treatment for ADHD in an Adult CMHT:Clinical Audit
Authors: Shankar Nikhil Gauri , Turner Chloe , Klenka Lucie
Published: July 2023

Aims

ADHD diagnoses have skyrocketed in the recent times resulting in a lot of the patients being on stimulant medications. NICE guidelines recommends a baseline review of physical health which should include height, weight ,baseline pulse and blood pressure and a cardiovascular assessment before starting these medications. It also recommends 6 monthly monitoring of weight, blood pressure and pulse. We aimed to assess the current practice of baseline and 6 monthly physical health monitoring against the standards set by NICE guidelines.

Methods

33 random case notes were identified from the adult CMHT who had a diagnosis of ADHD and were receiving stimulant medications. An audit pro-forma was designed to collect data on baseline blood pressure, pulse, weight ,cardiovascular assessment before commencing treatment and 6 monthly monitoring of Blood pressure, Pulse and weight. The data were collected over a period of 3 months between October 2022 and December 2022.The results were presented in the local CMHT meeting and a new proforma was designed for baseline and follow-up physical health assessment which will be incorporated in the case notes. A re-audit is planned in March 2023.

Results

There were 16 females and 17 males in the identified cases.19 patients were on different Methylphenidate formulations,8 patients were on Lisdexamfetamine and 6 were on Atomoxetine.19 patients (57%) had documentation of baseline blood pressure, 13 patients (39%) had documentation of baseline pulse,17 patients (51%) had documentation baseline weight and 2 patients (6%) had documented baseline cardiovascular assessment in the case notes.10 out 33 patients had 6 month follow-up visits and monitoring data were collected from them. None of the patients (0%) had documentation of blood pressure, pulse or weight in the case notes.

Conclusion

The adherence to NICE guidelines was low in physical health monitoring as hypothesized by the team. A new proforma for baseline and 6 monthly physical health monitoring is developed by the audit team which is aimed to increase awareness about the physical health monitoring amongst the clinicians. The need for improving this practice is crucial due to increasing number of patients on these medications and the risk of serious side effects.
Audit on Baseline Physical and Metabolic Investigations Before Prescribing Antipsychotics in Children and Adolescent With Psychosis and Schizophrenia
Authors: Javaid Sadia Tabassum , Latif Lubna
Published: July 2023

Aims

INTRODUCTION: The term ‘psychosis’ is used in NICE guidelines to refer to the group of psychotic disorders that includes schizophrenia, schizoaffective disorder, schizophreniform disorder, and delusional disorder as identified by the International Classification of Diseases – 10th revision (ICD 10; World Health Organization, 1992).BACKGROUND: Children and young people with psychosis and schizophrenia have poorer physical health than the general population as get older. Life expectancy is reduced by 16 to 25 years (Brown et al., 2010; Parks et al 2006).AIMS & OBJECTIVES: To compare the west-midlands child psychiatrist practice with the standard NICE clinical guidelines on baseline physical and metabolic investigations before prescribing antipsychotics in children and adolescents. To compare if fulfilling criteria. Early detection and intervention in order to delay or possibly prevent the onset of psychosis and schizophrenia. To improve the services.

Methods

•

The sample was collected via ‘WEST MIDLANDS CAMHS CONSULTANT SURVEY’.

•

Information collection through the questionnaire.

•

Nine members of the west midlands CAMHS Consultant CLENT group participated in 2019.

Results

•

Indications to use antipsychotics, Record keeping and Assessment of nutritional status & level of physical activity: 100%.

•

Pulse and B.P check: 88.9% yes, 11% not always.

•

Weight and Height plotted on growth chart: 77.8% yes, 22% not always.

•

Antipsychotics (must be initiated by suitably qualified health care professional with expertise in prescribing: 33% consultant, 55% doctor, 11.1% doctor or nurse.

•

Assessment of movement disorders was done by 44.4%always, 11.1% never and 44.4% sometimes.

•

Lipid Profile was checked by 44.4% always, 11.1% never and 44.4% sometimes.

•

Fasting blood Glucose and Hb1ac check: 33.3% yes, 66.7% never and 33.3% sometimes.

Conclusion

Data collected suggest meeting the set standards for indications of antipsychotics, record keeping and physical activity checks but not in other domains.

Recommendations:

•

To create a checklist Performa for physical / metabolic Health Checks for children and adolescent initiated on antipsychotic medications under the care of CAMHS.

•

Clinicians to stay up to date with NICE guidelines.

•

To regularly monitor physical health and blood test before prescribing antipsychotics.

•

To re-audit after introducing Performa in our CAMHS centre, if effective to introduce it in other local CAMHS centres after negotiation with them.
Clozapine: How Well Are We Monitoring Patients?
Authors: Johnson Stephanie , Perera Samantha , Isaac Mokhtar , Heasman Sally-Anne , Payne Laura
Published: July 2023

Aims

Aims and auditable outcomes: We aim to ensure 100% patients on clozapine have annual physical health checks. By ensuring all patients prescribed clozapine therapy receive an annual physical health check and medic review, we aim to improve patient safety and prevent serious harm from occurring in cases that could be avoided.

Methods

All patients aged over 18 years prescribed Clozapine, who were under the assessment and treatment service in Eastbourne, were identified using Carenotes, our electronic patient records system.

Results

78% of patients on clozapine had been reviewed by a doctor in the past 12 months. 32% of patients had attended a physical health review within the past 12 months. One patient had not had a medical review for several years.

Conclusion

Our audit has shown that there are no clear guidelines on the long term monitoring of clozapine in regards to physical health reviews and psychiatric assessment. Using best practice it appears annual review should be the minimal standard, however further evaluation of this is recommended at trust level.

In response to these results and the current guidance, we would like to implement the following:

•

Create a database for all patients on Clozapine under the care of Eastbourne ATS.

•

Create a spreadsheet looked after by one member of admin staff to be updated regularly

•

The physical health lead nurse to be informed of physical health checks due by admin
Prescription of High Dose of Antipsychotics in Two Rehabilitation Wards of Chronically Unwell Patients
Authors: Liolitsa Danae , Khan Azmathulla
Published: July 2023

Aims

The Royal College of Psychiatry (RCPsych) Consensus and the NICE guidelines have set out quality standards for the prescription of antipsychotics. There are concerns, however, regarding the over prescription across different psychiatric units: doses above BNF limits, multiple antipsychotics prescribed, lack of adequate monitoring of physical health and lack of availability of a clear rationale when high dose antipsychotic therapy (HDAT) is used. In the current audit, we sought to review the frequency HDAT is used in a female rehabilitation ward of patients with psychosis and a male rehabilitation ward of patients with dual diagnosis psychosis and/or autism. We also examined whether appropriate considerations are taken prior to prescribing HDAT and if the mandatory monitoring is in place when someone is on HDAT.

Methods

A set of standards was set out and an audit tool was formulated that took the format of a table for data collection. Data were collected and anonymised, by looking at the medication charts and patients’ records, to identify if essential steps prior to/during HDAT prescribing are followed. All service users, 10 in each ward, that were in admission during the period between 7th and 13th November 2022, where included in the study.

Data were compared directly with standards set out based on NICE guidelines and the RCPsych consensus. The data were input into Excel spreadsheet, then analysed and presented in tabular and graphs’ format.

Results

A total of 20 medication charts were reviewed over the five-day period. Only one out of ten individuals with ASD in Springs Centre was treated on HDAT and a clear rationale was documented to justify its use. All patients in both wards had the HDAT form and side effects scale form completed and filed. All patients had documentation of HDAT use on T2/T3 forms.

40% of patients at Kenton Lodge were on HDAT. These patients required use of at least one depot due to lack of compliance. There was four patients overall treated on combination of antipsychotics. One patient did not have physical health monitoring at baseline due to refusing consent.

Conclusion

In a small proportion of cases, HDAT may be justified, as long as the safety implications are considered and monitoring requirements observed.

We recommend that audits of high dose antipsychotic prescribing can be performed periodically as a matter of routine practice. Also, to introduce a formal psychosis assessment scale to identify whether improvement has been accomplished since HDAT initiation.
Audit on the Adherence to Guidelines for the Management of Alcohol Withdrawal Syndrome in a General Hospital
Authors: Simiyon Manjula , Connah Rob , Proffitt Rhian , Downes Sharon , Jarvis Jennifer , Baker Catherine
Published: July 2023

Aims

Problematic drinking of alcohol is a common problem in the United Kingdom. As alcohol is a central nervous system (CNS) suppressant, when a chronic user abruptly stops drinking alcohol, the alcohol-mediated CNS inhibition is withdrawn and the glutamate-mediated CNS excitation is left unchecked leading to a total excitation of the CNS. This results in alcohol withdrawal syndrome (AWS). The aim of this audit was to assess the compliance to the health board's policy for management of AWS available in the intranet as NU16 which was developed based on the NICE guidelines, across the wards in the General hospital. We aimed to assess compliance concerning four aspects:

1.

Initial clinical and laboratory assessment

2.

Prescribing for alcohol detoxification (benzodiazepines and vitamins)

3.

Scoring of and adherence to CIWA-Ar

4.

Specialist advice during the admission

Methods

We requested for the case records of patients admitted to the Wrexham Maelor Hospital during May 2022 with problematic alcohol consumption. We have received 56 case notes from the medical records department among which, 50 fulfilled the inclusion criteria. A case report form was prepared based on the NU16 and anonymized data were collected.

Results

Average age of the participants was 56 years ranging from 21 to 95.There were 29 males and 21 females. Mean days in the hospital was 3.25(+0.88). Only 4% of the records had complete documentation of drinking history, 84% had documentation of physical examination, and 20% had the documentation of signs of Wernicke's encephalopathy. CIWA-Ar was applied in 44% with correct scoring only in 24%. Compliance to laboratory investigations varied from 16% for gamma glutamyl transferase (GGT) to 84% for full blood count. Benzodiazepines were prescribed for 38%, oral thiamine was prescribed for 58%, 42% had two pairs of intravenous pabrinex three times a day and 6% had received 1 pair once a day. Benzodiazepine regimen was completed in 75% and alcohol liaison opinion was obtained only in 16%

Conclusion

We could find that there were omissions in multiple areas of adherence to the guidelines in all the four domains. Alcohol liaison team is conducting special training programs for the management of AWS for all the clinical staff in the general hospital with the aim that compliance should improve in the near future.
Improving Medical Handover in the Tyrone and Fermanagh Psychiatric Inpatient Unit
Authors: Rafferty Mark , Sheridan Aisling , McNamara Laura
Published: July 2023

Aims

This project was undertaken in the Tyrone and Fermanagh Hospital, an inpatient Psychiatric Unit in Omagh, Northern Ireland. It was recognised that the previous method of medical handover via anonymised WhatsApp messages had several issues including patient data on personal phones, over-reliance on phone apps which have the potential to crash and short messages with limited details were included. The aim of our project was to improve patient safety by improving communication between medical staff members.

Methods

The previous method of medical handover was via text message on messaging platform WhatsApp. A message was sent the morning of handover, to the WhatsApp group.

We continued to use a digital platform, but used Microsoft word, and Western Trust email addresses to record and send the handover. At the start of this project, we allowed free space recording, resulting in variation in the handovers.

We agreed a minimum number of details to be included to ensure quality of handover, and audited the word documents, to assess the adherence to this.

This change, still does not require face to face handover. There have been pros and cons to the change, which will be discussed in this presentation.

We reviewed four months’ worth of handovers. They were reviewed for specific elements of essential handover criteria. The areas included Patient Name, H&C, detained or voluntary, admission or review, presenting complaint, patient's history, risks, physical issues, and handover to specific person.

It should be noted that the doctors involved were aware of the changes made, and standards being introduced, and therefore were aware that they would be auditing their own handovers. This might have created bias in the subsequent handovers.

We then analysed each month to see what percentage of handovers had been concordant with the standards. These data were then represented in graphs, as we will show.

Results

We identified areas which were performed well when completing handover. The areas which were consistently 100% included the date of handover and patient name or initials. Outstanding jobs were performed in 97.5% of handovers.

Areas for improvement identified when collecting results were the status of admission (i.e. voluntary or detained), the main patient risks and use of the document password.

100% of the shifts used the new digitalised format for handover using Microsoft word and trust email system.

Conclusion

We reviewed the results of the data, which highlighted areas for improvement

We hope to implement a standard performa for handovers, reducing the chance of key information being missed, thereby improving patient safety. We aim to collect data following this 2nd intervention in the next rotation and continue to examine handover processes using PDSA cycles.
Clinical Audit on the Measurement of Antipsychotic Side Effects Using Rating Scales (GASS, LUNSERS, and SESCAM) in Community Settings
Authors: Sodiya Olusegun , Adegoke Adewole , Ilinoiu Geanina , Morgans Clare
Published: July 2023

Aims

This clinical audit aimed to assess if monitoring of side effect of antipsychotics is adhered to using the Trust and National institute of clinical excellence (NICE) guidelines.One of the determinants of prognosis in schizophrenia is compliance to medications. Hence, the importance to monitor patient's tolerability of side effects when they are on antipsychotic medications. Several patients during episodes of relapse have reported that experience of side effects were their main reasons for defaulting on their medications. This underpins the importance to monitor patients’ tolerability of side effects when prescribed antipsychotics. Recommended monitoring scales are Glasgow antipsychotic scale, Liverpool University neuroleptic side effect rating scale, and Side effects scale for antipsychotic medication.

Methods

The 1st cycle of the audit was conducted from March 30th to April 30th, 2021, and the 2nd cycle was done between 4th October and 28th October 2022. In both cycles random sampling was used to select 50 patients on the caseloads of two community mental health teams. The data were collected with a tool designed using NICE guidelines and the Trust policy on monitoring of psychotropic medications.

Results

For all selected patients in the 1st cycle, no rating scales were used to assess side effects at three months or after one year of commencement of antipsychotics. However, there were random documentation of side effects written as case notes in 96% of patients. Extrapyramidal side effects (EPSE) were the most documented of side effects in the 1st cycle. The re-audit saw an improvement of 24% in the use of an objective rating scale to monitor side effects. Similarly, as in the 1st cycle, EPSE were the most reported side effects in the 2nd cycle.

Conclusion

This audit showed a significant gap in the objective monitoring of side effects of patients on antipsychotics as none of the recommended rating scales were used on the selected patients in the 1st cycle. Although, there was an improvement in the use of rating scales of up to 24% in the re-audit as compared to 0% in the 1st cycle, the uptake was still far from the ideal. There is a need for the Trust and NICE guidelines to be adhered to in the monitoring of side effects of antipsychotics as this is likely to have a positive impact on compliance to medications by patients.
Naloxone Audit
Authors: Venan Paster
Published: July 2023

Aims

The aim of this audit was to look into the services’ fidelity of Naloxone provision and training across the Essex wide area compared with local guidelines as well as national guidelines (UK guidelines on clinical management of drug misuse and dependence, 2017)

Methods

The electronic records database for substance misuse services (THESEUS) was used for extracting the data. A total of 1991 patient records were analysed out of these 885 patient records were excluded, as these patients had never injected heroin. The remaining 1106 patient records were treated as the QUALIFYING POPULATION. A time frame period of 3 years (2019 to 2021) was further applied to the qualifying population, which resulted in 700 patient records being analysed for Naloxone data.

Results

Naloxone provision was recorded under two different headings in the electronic database. The first heading, Naloxone episode – indicated the discussion held by the professional with the patient regarding the use of Naloxone. The second heading, Naloxone event – indicated the actual event of Naloxone being provided to the patient by a professional. There was a lack of clarity on both episode and events data capture regarding previously injected status.

Another important finding was that in the NON-QUALIFYING POPULATION i.e., patients who have never injected heroin in the past were provided with Naloxone for 367 patients, although this is a good practice it comes at the expense of missing out on providing Naloxone to patients who would definitely need it (OUALIFYING POPULATION)

Conclusion

1.

The robustness of the data collection done by the professionals was commendable, but this was let down by the ambiguity and obscurity of the data recorded on two different headings (episode and events)

2.

There was evidence of Naloxone being provided to the patients who have not injected heroin

3.

There was accurate documentation on the type of Naloxone being issued (Injectable vs Nasal)

4.

There was sparse documentation on the Naloxone training provision within the electronic system.
Side-Effect Monitoring for Patients on Depot Antipsychotic Medication Within a Community Treatment Team
Authors: Waterman Harry , Zaborowska Hanna , Taylor Julie
Published: July 2023

Aims

To determine whether the community treatment team (CTT) were meeting the following three trust standards for patients receiving antipsychotic depot medication: 1. 100% of patients should have side effects monitored using a validated scoring system in the form of the Glasgow Antipsychotic Side-effect Scale (GASS) once yearly. 2. 100% of patients should have had a GASS completed ever. 3. 100% of patients with a completed GASS should have this document available in full. Additionally adherence to these measures was compared to the previous year's audit to assess for change following interventions and change in documentation.

Methods

A list of 146 patients receiving antipsychotic depot medication within the CTT was produced and subsequently set up in a Microsoft excel spreadsheet. Exclusion criteria were then applied as follows: any patient no longer under the CTT, any patient no longer on depot antipsychotics and any patient admitted in hospital at the time of audit (to allow for comparison to previous year where this was applied.) Following this 127 patients remained for whom I accessed their online notes and searched for evidence of completed GASS, when this was completed and if the full completed form was available. Once these data were gathered percentage of completion was calculated for each of the three standards outlined above both overall and subsequently broken down by depot administration group. These results were then compared to the results of the previous year's audit.

Results

None of the three standards outlined above were met, however notable improvement was noted when compared to the previous year and are listed below:

1.

In this audit 66% of patients had received a GASS in the previous year compared to 53% previously.

2.

In this audit 97% of patients had a completed GASS ever compared to 95% previously.

3.

In this audit 99% of patients with a completed GASS had the full document available compared to 98% previously.

4.

Additionally significant variation between depot administration groups was identified ranging from 17% completion to 100% completion.

Conclusion

It is clear the standards of 100% completion of GASS yearly are not being met however there was notable improvement following previous intervention suggesting this was beneficial and further interventions have been put in place including, but not limited to, supply of a spreadsheet with up to date list of when patients are due a repeat GASS for future tracking to further improve adherence to standards.
Developing a New Lithium Policy
Authors: Wong Brandon , Baird Kitty , MacLaren Tom
Published: July 2023

Aims

The psychiatry liaison team at Chelsea and Westminster Hospital (C&W) specialises in working together with different healthcare teams to improve patient outcomes. Following feedback received from ward teams who manage the patients that we support on a daily basis, we identified a need for an accessible and user-friendly document that could give some guidance towards safely managing patients on lithium, including lithium toxicity. We do not anticipate medical teams at C&W to initiate lithium therapy without liaison psychiatry input. The most likely scenario where staff will encounter lithium is in patients admitted whilst on established lithium therapy. The aim of the guidance document is to support our medical and surgical colleagues across the hospital site to safely continue to prescribe lithium.

Methods

To create this document, we reviewed joint Lithium Policies across several NHS Trusts in England. This policy has been adapted from Central and North West London's own policy to be more specific in supporting best practice for clinicians in initiating, monitoring and adjusting lithium therapy in a safe and timely way.

Junior doctors in liaison psychiatry wrote policy which was re-drafted with consultant support and input. Additionally, specialist advice was provided by mental health pharmacists for subsequent revisions. At present, the policy is awaiting discussion at a prescribing group meeting prior to starting the implementation process across the trust.

Results

Multidisciplinary feedback from pharmacy has advised that this guidance is particularly useful because lithium patients are so infrequent (approximately 55 patients on lithium at C&W in a 12 month period). Ward teams are therefore unfamiliar with prescribing and managing lithium, and crucially, at recognising signs and symptoms of toxicity. The guidance is not only functional, but is incredibly accessible. It is well laid out and makes use of colour to make it user-friendly. It is an appropriate length and includes a one page overview that is ideal for printing or for quick-reference.

Conclusion

Developing this lithium policy has been a key patient safety project. We hope this document will be a useful and safe tool for ward teams to refer to. Liaison psychiatry continue to have an excellent relationship with our ward colleagues and we hope this policy represents our ongoing dedication towards service development.

During this process, we have been grateful for the expert help from our pharmacy colleagues and have learnt about how liaison psychiatry can support ward teams by creating a robust and easy to follow guideline.
The Impact of Prophylactic Medication Use on the Recurrence of Bipolar Episodes in the BDRN Pregnancy Study
Authors: Dias Marisa Casanova , Perry Amy , Kelson Mark , Gordon-Smith Katherine , Craddock Nick , Jones Lisa , Florio Arianna Di , Jones Ian
Published: July 2023

Aims

Women with bipolar disorder have a high recurrence rate in the perinatal period. However, the use of prophylactic medication can be a concern during pregnancy and breastfeeding. There are few studies looking at the impact of prophylactic medication on the risk of recurrence.The aims of this study are to describe the use of medication in women with bipolar disorder in the perinatal period and the impact of that prophylactic medication on the rate of postnatal recurrence.

Methods

The BDRN (Bipolar Disorder Research Network Study) is the largest individual network of individuals with bipolar disorder and related mood disorders in the world. The BDRN pregnancy study is a prospective observational study which took place in the UK. We collected sociodemographic, clinical and medication data from pregnant women with a diagnosis of bipolar disorder and who were euthymic entering the postpartum period. The clinical data were collected via interviews during pregnancy and the postpartum and access to clinical records where those were available.

Data were analysed for association using χ2 tests and logistic regression.

Results

Our total sample for this analysis comprised of 103 women who met the criteria.

We found that 71 (70%) were taking medication at delivery: 43 (43%) antipsychotics, 9 (9%) antidepressants, 10 (10%) mood stabilisers, (6 lithium, 4 anticonvulsants and 9 multiple medication classes).

Of the total sample, 44 (43%) experienced a postpartum recurrence: 21 (20%) had an episode of postpartum psychosis, 15 (15%) of non-psychotic depression and 8 (8%) of hypomania. Of the postpartum psychotic episodes 11 were of mania with psychosis, 8 of mania without psychosis and 2 of psychotic depression.

There was no significant association between taking medication at delivery and postpartum recurrence χ2 (1)=0.116, p=0.73.

In a multivariable analysis there continued to be no association when adjusted for age, ethnicity, parity, severity (previous admissions, age at impairment, bipolar subtype) and previous psychotic symptoms aOR 1.35 95%CI [0.45; 4.00], p=0.59.

Conclusion

A high number of bipolar women are taking medication at delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high.

Our findings align with recent electronic health records and observational studies, but differ from older clinical cohort and higher Lithium-prescribing sample studies. Limitations include the study design and confounding by indication. Further research in larger populations is necessary to inform clinical decision-making for women and their healthcare providers.
A Peer-Supported, Recovery-Focused Illness Management Programme for People With Early Psychosis
Authors: Chien Wai Tong
Published: July 2023

Aims

To examine the effects of a peer-supported recovery-focused self-management of Psychosis (PRSP) modified from the Crisis-resolution-team Optimisation and RElapse Prevention (CORE) programme (Johnson et al. 2018) for psychotic patients’ recovery, mental state, problem solving ability and other patient outcomes over 18 months follow-up, compared with either a psychoeducation/treatment-as-usual group.

Methods

A assessor-blinded, three-arm multicentre RCT was conducted. A list of 198 Chinese patients with recent-onset psychosis randomly selected from four Community Centers for Mental Wellness in Hong Kong (2021–2022) and randomly assigned into one of the three study groups (PRSP, psychoeducation or treatment-as-usual group) by matching with computerized random numbers. After four-month interventions, the patient outcomes were measured at immediately, 9 months and 18 months post-intervention, and analysed on intention-to-treat basis using Generalised Estimating Equation test.

Results

Significant interaction (Group × Time) treatment effects of the PRSP were found on six outcomes (recovery, psychotic symptoms, functioning, problem-solving, and service satisfaction) between three groups at post-test, Wald χ2 = 7.05–21.87, p = 0.02-0.001, with moderate to large effect sizes (η2) of 0.12–0.24, compared to treatment-as-usual. Level of recovery, problem-solving and service satisfaction of the PRSP were also significantly greater improved than psychoeducation group at 9 and 18 months follow-ups with moderate effect sizes (0.07–0.10).

Conclusion

The findings can provide evidence about the long-term effectiveness of the peer-facilitated, recovery-based self-management programme in early psychosis on improving patients’ recovery and mental condition, functioning, and service satisfaction. Self-learning of illness management through effective problem-solving strategies, together with peer-support, are increasingly useful in recovery-focused intervention for early psychosis in views of inadequate healthcare resources/staffs.
Racial Microaggressions in Healthcare Settings: A Scoping Review
Authors: Khan Nagina , Hafeez Danish , Goolamallee Tayyib , Arora Ananya , Smith Will , Shankar Rohit , Dave Subodh
Published: July 2023

Aims

Racial microaggressions occur when subtle or often automatic exchanges of aversive and covert racism are directed towards people identifying as racialized groups. Consequently, affecting individuals' mental and physical health. Healthcare professionals are a vulnerable group to the effects of racial microaggressions, given the high prevalence of burnout. The aim of the review was to explore healthcare professionals and students' experience of racial microaggressions in healthcare settings

Methods

A PROSPERO registered scoping review was conducted using the PRISMA extension for scoping review guidelines. The literature search was undertaken in August 2020, of five databases, MEDLINE, EMBASE, CINAHL, PsycINFO, EMCARE and we also searched the ‘grey literature.’ Studies featuring primary data on racialized or migrant microaggressions towards professionals or students in healthcare settings were included. We excluded studies that were not in English. QDA Miner was used to analyse the data, using a non-essentialist perspective, which suggests that ‘culture’ is a movable concept used by different people at different times to suit purposes of identity, politics and science.

Results

Our search identified 8 papers (5 qualitative, 2 mixed and 1 quantitative) on the experience of microaggressions towards healthcare professionals and students (n = 602). Almost all (87.5%) were conducted in North America and only one (12.5%) in the UK. The primary themes were as follows:

Intersectionality: Individual and group social categorizations of race, class, and gender were described as interconnected, leading to interdependent systems of discrimination or disadvantage. Healthcare professionals indicated that increasing diversity and racial representation can reduce bias and thus microaggressions among stakeholders in the culture of work.

Workplace culture and lack of senior support: The healthcare curriculum, and the manner of its delivery were found to propagate ideas encouraging racial microaggressions. Seniors behaving as role-models by challenging microaggressions could encourage an open and accountable environment. Supervision was a tool for allyship that reduced the threat of negative race-related incidents.

Intervention: Acknowledging racial microaggressions within healthcare, as well as quantifying their presence with tools, encouraged a stronger and more effective response from institutions. Teaching curriculum also served as a useful platform to teach and address microaggressions.

Conclusion

Racial microaggressions were experienced as having a detrimental impact on healthcare professionals’ well-being and mental health. Consequently, this affected the efficiency, the workplace culture, patient outcomes and job satisfaction. Given the multifaceted nature of racial microaggressions, tackling them requires a complex and wide-ranging response from institutions.