bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the Training Experience of International Medical Graduates (Imgs): A Survey of Psychiatry Trainees in the Yorkshire & Humber Deanery (West/East/North)
Authors: Elisha-Aboh Christiana , Onwuchekwa Ogba , Watts Rahul , Pillai Anilkumar , Davies Sara
Published: June 2022

Aims

There are over 72 000 licensed IMGs in the UK who fill up crucial shortages in the NHS and provide diversity. In 2020 there were more IMGs than local graduates joining the General Medical Council register with over half (54%) identifying as Black and Minority Ethnic doctors. There are ongoing and extensive conversations about the best approach to tackle differential attainment between IMGs and local graduates. The aims were to identify what the perceived differences were between local graduates and IMGs in various domains and recognise what measures could be taken to improve the issues identified.

Methods

This survey utilised the Typeform survey software to ask 23 questions and was left open for 3 months. Participation in the survey was voluntary and anonymized and included feedback from both Core Trainees and Higher Trainees. Initial emails, texts and chats with the survey link and reminders were sent to the Medical Education departments and trainee groups. The qualitative and quantitative data from all 33 respondents were analysed.

Results

90.9% (30) of participants felt there were issues of differential attainment between IMGs and local graduates and felt that the gaps in differential attainment could be addressed by mentoring, networking, IMG lead roles, education of trainers and better support systems. 57.6% (19) of IMGs stated that they had felt bullied, undermined, treated unfairly, or intimidated; with only 29% (9) attempting to challenge this due to the fear of retribution, concerns about accountable, cultural and communication barriers. All respondents felt induction programmes, focusing on IMGs and cultural diversity would be helpful for all trainees, with 93.9% (31) of respondents recommending that more education was needed for trainers. 57.6% (19) stated that they had considered relocating outside the UK after training because they felt they would be better valued elsewhere. 90.9% (30) suggested that a book for IMGs would be a welcomed development. 87.9% (29) recommended that having IMG leads was important for offering well-being support, play a safeguarding role, offer pastoral care, and contribute to induction and education; with 68.8% (22) recommending the person was a College trainer.

Conclusion

These findings highlight several challenges IMGs training in the UK face and must navigate to be successful. A greater awareness of their hurdles is critical to maximising what potentials lie within. As the numbers of IMGs within the system continue to rise, there is an even greater need to support and address the concerns this survey underscores.
A Quality Improvement Project to Evaluate Satisfaction With Alternatives to Face to Face Consultation in a Learning Disability Service
Authors: Elmasry Eslam , Bright Catherine
Published: June 2022

Aims

COVID-19 pandemic has had a great impact on all groups in society. People with intellectual disability (ID)/learning disability (LD) are especially vulnerable. As a result, restrictions were put in place to protect this group, including limiting face to face visits/consultations. Restrictions on usual activities of people with learning disability are likely to induce stress leading to an escalation in challenging behaviors. Regular assessments and follow-ups are essential to evaluate the patients and provide the best care, so virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations

Aim: Evaluation of the service provided during the COVID-19 pandemic including virtual clinics.

Methods

A questionnaire was designed to evaluate the patients and their careers’ satisfaction with the virtual clinics, seeking their feedback about positives and limitations of the service and exploring their preferences for future clinical contact. Data were collected during May 2021. Different professions including (psychiatrists, psychologists, nurses, occupational therapists and speech and language therapists) in community services for adults with learning disabilities in Aneurin Bevan University Health Board have participated in the survey. The questionnaires were filled by service users, their carers or by the service provider.

Numbers of DNA (Did not attend) across the whole service during May 2021 were compared to DNAs in May 2018, 2019 and 2020.

Results

140 surveys were completed. Patients and their carers were happy with many aspects of the service provided through the pandemic. It was reported that virtual clinics are an efficient way to meet with professional carers and families where there are difficulties bringing patients to clinics, however home visits were preferred for assessing patients.

No noticeable change in DNA rates has been identified.

Conclusion

Virtual clinics have been well tolerated by patients and their carers during the pandemic and have provided an extremely efficient tool to overcome the restrictions which were imposed.

Carers and patients expressed satisfaction with clinic appointments provided remotely.
Quality Improvement Project: Monitoring of Intellectual Disability Patients on Anti-Psychotic Medications in Outpatients Clinic, Northern Health & Social Care Trust, Northern Ireland
Authors: Flynn Adam , Ling Patrick
Published: June 2022

Aims

Working as part of a newly-established Community Intellectual Disability Team since April 2020, we set a goal of achieving a target of monitoring 90% of patients who attend outpatient's clinic and who are on antipsychotic medications. This includes both physical observations and blood results, inline with NICE Guidelines. On initial analysis, we were essentially starting from a baseline of zero as patients were often deemed too difficult in primary care for monitoring and this simply wasn't happening as a result.

Methods

Retrospective Analysis of patients who attended Outpatients Clinic between February and August 2021. n = 242. Duplicates and Nursing Home Patients were deemed as exclusion criteria.

Analysis via Paris and Electronic Care Record as to which patients were on Antipsychotic medication. n = 73

Analysis of data regarding physical checks and blood records from September 2020–2021 to capture data in line with NICE guidelines.

Liaising with clinical staff to establish any reasons for exclusions, such as a lack of consent. Follow-up of same.

2x PDSA cycles established. One to capture results, and a second involving acquiring new ECG machine and establishing baseline testing, training and analysis of patients.

Results

91% of patients met target criteria of having antipsychotic bloods monitored. Aim 90%.

97% of patients met target of having physical observations monitored. Aim 90%.

Starting from a baseline of zero, we began to capture ECG monitoring of patients from October 2021 and are currently achieving 42% of patients monitored between October 2021 and January 2022 and aim to achieve over 90% by September 2022.

Conclusion

Working as part of a highly-motivated new community team, we have shown that it is clearly possible to achieve a high level of monitoring of patients with mild to profound intellectual disability who are on antipsychotic medications, in line with NICE guidelines.

This has established a new baseline that is a clear and valid evidenced improvement compared to previous standards.

Future monitoring and PDSA cycles will continue to crystalize this data and establish a high standard of care in the community for this patient cohort improving living standards and avoiding and delaying onset of physical health concerns secondary to the cardio-metabolic effects of antipsychotic medications.
Improving Oncall Handover Through Digitalisation / a QI Project at Newham Centre for Mental Health
Authors: Loveday William , Ratneswaran Kajanesh , Nerantzis Georgios , Haysom Alexia , Hakim Nahid , Dineva Darena , Richards Adam
Published: June 2022

Aims

To improve the information exchange between oncall junior doctors and ward teams between shifts including outstanding tasks, alerts and prompts to update clinical record systems accordingly (Rio). We aimed for the handover to be circulated to the correct recipients in 95% of cases as well as to improve its content. This would minimise loss of information and improve patient safety.

Methods

Handover document set up on MS Teams which is accessed by oncall junior doctors and day teams and can be updated live. Relevant training was offered to trainees during induction. We measured the number of days the document is updated and distributed and also measured the tasks not completed or not documented. We measured doctors' satisfaction via a survey.

Results

We found that on average the handover document is updated and circulated correctly at a rate of 94.8% since the new MS Teams system was implemented. Participating doctors' survey showed that they felt that this system is safe and easy to use as well as reliable and more efficient than the previous system. They also noted that the training they received during induction was helpful and sufficient.

Conclusion

The digitalisation of the handover process using MS Teams, developed and improved through various PDSA cycles, has resulted in a system which the users find efficient, safe and easy to use. This leads to minimisation of information losses and improves patients' safety.
The Impact of Policing on Involuntary Routes of Admission: A QIP on Patient Experiences
Authors: Iftikhar Mashal , Gorny Monika
Published: June 2022

Aims

Patients often have negative experiences of police in their daily lives. Police involvement in mental health services can make an encounter feel disciplinary rather than therapeutic and exacerbate mental distress. People with mental illness, especially of minoritised backgrounds, are more likely to die after police contact, than other groups. Our aims were to: 1) explore patient experiences of being admitted onto the ward under section via the police, 2) explore patient understanding of the role the police play in mental health services 3) Use experiential data towards introducing trauma informed care in an inpatient setting

Methods

A clinician administered questionnaire was conducted on an acute male inpatient ward, with 12 consenting male inpatient participants. All were involuntarily detained, ranging in age from 22 to 56 years; 11 out of 12 were of an ethnic minority background.

The questionnaire consisted of a mixture of open-ended questions and closed Likert scale questions with answers ranging from “strongly agree” to “strongly disagree”. Questions covered themes relating to the experience of admission and the ward environment, personal and communal experiences of policing, views on the role of policing in mental health service provision. Data were collated and presented in a local QIP showcase.

Results

A significant split was identified between answers to open-ended and closed questions. When offering Likert based responses, 66% of participants felt safe with the police and believed that the police had a role in keeping people with mental health problems safe; 50% felt the police role should be greater in the future.

When responding to discussion-based questions, participants were critical of policing in relation to managing mental crises. Participants offered elucidative answers covering themes ranging from feeling a lack of agency, and the traumatic nature of criminalising mental distress, to concerns about abuse of power, the desire to limit the policing role to criminality and lack of trust engendered from experiences of racial injustice.

Conclusion

Our results demonstrate that patient views on policing roles in mental health service provision are complex. The experiences of involuntary admission through the police are often traumatic, rooted in past police involvement in patient's lives. Although it is acknowledged that at times no feasible alternative is available in hostile situations, this QIP opened an important, previously avoided, discussion. This will hopefully lead to introduction of more trauma informed care in an inpatient setting.
Evaluation of a Trauma Pathway Within an Increasing Access to Psychological Therapies (IAPT) Service
Authors: Jell Grace , Kohl Diane , Salvadori Alison , Beasley Annabel , Ting Tai Ken , Collier Henry , Dholakia Shruti , Bushell Verity , Gill Vijay , Beck Katherine
Published: June 2022

Aims

The Enhanced Trauma Pathway (ETP) at Berkshire Healthcare NHS Foundation Trust was established in 2018 to manage high demand on a highly specialist psychology team called the Berkshire Traumatic Stress Service (BTSS). The ETP is used to treat complicated cases of Post-Traumatic Stress Disorder (PTSD) within the IAPT service. However, because of the ETP there is now a cohort of Service Users (SUs) presenting to IAPT with a higher complexity than has been typical, presenting new challenges for the service. We aim to evaluate and redesign the ETP within IAPT to meet the needs of the changing population.

Methods

Clinically Led workforcE and Activity Redesign (CLEAR) is a workforce transformation methodology with four unique stages: i) Clinical Engagement: in-depth qualitative analysis of interview data from staff ii) Data Interrogation: cohort analysis using clinical and workforce data visualisations and analysis, iii) Innovation: developing novel solutions with insights from triangulated qualitative and quantitative data, iv) Recommendations: formulation of new models of care (NMOC) and smaller quick high impact service innovations. Thematic analysis was used for the qualitative data. Quantitative data analysis was conducted using the IAPT dataset.

Results

27 semi-structured interviews were conducted with staff. SUs on the ETP had longer waiting times, their treatment took longer (18 sessions for ETP Vs 12 for core step 3) and they had lower recovery rates: 32.9% for ETP, 49.9% for core step 3 in IAPT and 57.3% for the whole IAPT service. SUs on the ETP presented with increased risk concerns, often not mitigated by stabilisation work offered. Thematic analysis also identified challenges with recruitment, a lack of qualified staff and inefficient use of skills across the pathway. Staff well-being was found to be paramount, however supporting staff was found to be challenging due to national constraints placed upon IAPT and the targets the service is asked to achieve. A series of recommendations were made including three options for a NMOC. The options suggested different ways to redesign the pathway including an option where there would be a trauma only team within IAPT working exclusively on the ETP.

Conclusion

This evaluation highlights the challenges for the ETP and identifies NMOC to reduce their impact on the service. Further work is required to assess the NMOC once it has been implemented and to further evaluate the needs of the SUs presenting to this service.
Service-User Led Recommendations on Improving Medium to Low Secure Unit Transfer Experiences in East London During COVID-19; a Quality Improvement Project
Authors: Kandola Hardeep , Vignali Erin , Bai Xuezi
Published: June 2022

Aims

Forensic service-users (SU) are often transferred between units at short notice, with little information about their new ward and unaddressed concerns. The findings of our first Plan, Do, Study, Act (PDSA) quality improvement project exploring SU's transfer experiences from medium to low secure units during COVID-19 in East London. Whilst unsettling, it may also impact therapeutic progress due to difficulties in developing new relationships with clinicians and ward residents. Our second PDSA cycle explores SU concerns and identifies improvement recommendations.

Methods

Five SUs consented to take part in the experience-based co-design approach. Remote semi-structured interviews explored experiences and suggestions for improvement. Audio transcriptions were thematically analysed to assess information provision, transfer expectations, new ward perceptions, available support and overall reflections.

Results

Recipients of a tour prior to moving felt most informed about the transfer and reported not requiring further information. Without the tour, some SUs were unaware of the name or type of their future ward. Therefore, SUs recommended everyone should have a tour prior to transfer, or where not possible a video tour. Two weeks was felt to be the ideal amount of notice prior to transfer and in the absence of this, weekly updates during ward round. Being able to talk to an SU who had recently moved to the new unit would be ideal, or in lieu of this a pre-recorded question and answer (Q&A) video.

SUs were interested in the new ward policy regarding leave and mobile phone criteria. A recurring issue involved SUs being promised unescorted leave on the new ward, but this not taking place. Importance was also placed on the family being updated during the transfer and moving with a preferred staff member. Many SUs felt the process was smooth yet held concerns about forming new friendships. They felt their psychologist, primary nurse or ward manager were easiest to approach with concerns. On the transfer day, SUs benefitted from the encouragement and congratulations from the old team, however cited feeling rushed when moving.

Conclusion

Implementing a pre-recorded tour with unit facility highlights and a recent SU transfer Q&A video would improve the transfer experience. Having clear policies regarding leave and mobile phone criteria prior to moving improves clarity. Our approach to include SUs in the transfer meeting with both the new and old wards ensures transparent expectations. We continue to monitor the success of these interventions on transfer experience through further PDSA cycles.
Rehabilitation or Stagnation? a Six Month Mirror-Image Study Reviewing the Effectiveness of an Inpatient Rehabilitation Unit
Authors: Kapila Adisha , Whiskey Eromona , Nagpal Mehak , Davey Patrick , King Rebekah
Published: June 2022

Aims

The Tony Hillis Unit (THU) is a locked rehabilitation unit for men aged 18–65 years with Treatment Resistant Psychosis, with or without mild personality disorders; drug and alcohol misuse; and challenging behaviour. The multi-disciplinary team including psychiatrists, psychologists, nurses, occupational therapists and specialist pharmacists offer service-users a holistic, personalised and pragmatic management plan to facilitate an improvement in their level of functioning. This service evaluation aimed to review the effectiveness of our intervention as a unit as defined by functional outcome at six months pre- and post- admission.

Methods

A retrospective, mirror-image study design was used to collect data. Data were obtained from South London & Maudsley's Electronic Patient Journey System (ePJS) records. All patients discharged from THU over a two-year period, from May 2019 to May 2021, were considered in the study (n = 25 patients). Two service users died during the evaluation period and were excluded. A further service user was excluded as he had an admission length less than 28 days. Variables recorded included patient demographics and the presence of biopsychosocial interventions at THU including Clozapine initiation, engagement in weekly 1:1 occupational therapy (OT) and 1:1 psychology sessions. The functional status at six months pre-admission and post-discharge was defined by placement type, graded in terms of level of support; 1 = Psychiatric Intensive Care Unit, 2 = Acute ward, 3 = Rehabilitation service/Prison, 4 = Care home, 5 = Supported accommodation and 6 = Independent living. The change in patient acuity pre- and post- THU was compared using Wilcoxon-signed rank test.

Results

23 service users were included in this evaluation. The average admission length was 365 days, and average age at admission was 38 years. The difference in patient acuity before and after THU intervention was statistically significant (P < 0.005), with an overall reduction in level of placement support required. The most common placement prior to admission was an acute ward, compared to a rehabilitation service six months after discharge. 60% of patients (n = 13) were newly initiated or re-titrated on Clozapine during their admission, with a further 4 patients already on Clozapine. 82% of patients engaged with 1:1 weekly OT and 72% engaged with 1:1 weekly psychology sessions.

Conclusion

This study demonstrates the effectiveness of our role as a locked rehabilitation unit. It outlines some of the key biopsychosocial interventions likely contributing to this, including initiation of Clozapine.
Hertfordshire Partnership NHS Trust - Improving VTE Risk Assessments in an Older Adult Psychiatric Inpatient Unit
Authors: Khanna Bhavna , O'Dowd Christina
Published: June 2022

Aims

VTE-related deaths are a leading cause of preventable mortality amongst all hospital inpatients. Psychiatric inpatients are at greater risk of this, due to administration of antipsychotic medication and longer inpatient stay. This is particularly significant during the COVID-19 pandemic, not least as it is a disease known to cause hypercoagulability, but also due to an increase in mental illness and extended admission, resulting from an overwhelmingly run social service. The objective is to analyse VTE risk assessments performed for the 23 patients at Lambourn Grove, a continuing care unit for old age psychiatric inpatients, diagnosed with dementia. The aims are to assess; the frequency at which VTE risk assessments are performed, the accuracy of each assessment and the subsequent management and appropriateness of preventative measures taken.

Methods

A retrospective study was conducted of 23 service users. Data were collected from the VTE assessment form on the local electronic patient record system, and analysed to assess compliance with local guidance. GP records were consulted to cross check data and ensure accuracy of information inputted. Improvement measures include presenting at the local teaching session and implementing a mandatory monthly review onto the ward round proforma. A second cycle will be carried out to assess the success of these interventions in improving best medical practice.

Results

Of the 23 service users, 20 patients had their VTE risk assessment completed on admission and there was a delay of over a month with the remaining 3 patients. Of significance is that of all initial VTEs, 6 out of 23 contained inaccurate details, such as omission of comorbidities or a subjective assessment of mobility, indicating the need to use a standardized tool which allows for comparison across time. The mean admission duration for all 23 inpatients, as of February 2022 was calculated to be 16.2 months, with a range of 2 and 59 months. 15 patients did not have their VTE risk assessment repeated during admission, and of these 2 did have a change in their risk profile, indicating non-adherence with NICE guidelines.

Conclusion

This study has identified significant areas for improvement, specifically the need for clear timing for repeated VTE assessments, consistent sources of patient's medical history and documentation of mobility status. The project has highlighted the need for a more robust VTE assessment protocol which is currently being developed, to improve patient mortality and outcomes.
Antipsychotic Cardiometabolic Monitoring: Systemic Gaps and Hidden Groups
Authors: Ansari Tanya , Majid Zafrina , Mohamed Ashma , Schmidt Martin
Published: June 2022

Aims

To determine whether there are any gaps in cardiometabolic monitoring within primary or secondary care for people prescribed antipsychotic medication. A well-established system of cardiometabolic monitoring and checks has been implemented for patients with psychosis and bipolar in secondary care. It was unclear whether patients without these diagnoses were receiving the same level of monitoring.

Methods

Data were collected retrospectively from case notes of service users under CMHRS Reigate. We included all patients from three GP practices (100 patients) and identified all who were prescribed antipsychotics and their diagnoses. The GP practices were contacted to determine whether a system was in place to flag physical health monitoring requirements for service users on antipsychotics regardless of diagnosis. The results were used to calculate the potential number of patients across the entire trust who were at risk of not receiving cardiometabolic monitoring.

Results

24/100 patients were prescribed antipsychotics without a diagnosis of psychosis or bipolar. 11/24 had a diagnosis of Emotionally Unstable Personality Disorder. Quetiapine was the commonest antipsychotic. None received routine cardiometabolic monitoring.

The total caseload for all 11 adult community teams in the Trust is 2434. If prescribing and monitoring practices are similar 584 individuals may be affected.

2/3 GP practices responded. Both confirmed that they would only conduct cardiometabolic monitoring when taking over prescribing/on discharge from secondary care if specifically requested to do so.

Conclusion

This service improvement project has identified a significant group of patients who aren't automatically offered cardiometabolic monitoring in secondary care.

Private correspondence from Professor David Taylor confirms that these patients would also benefit from monitoring when prescribed doses that are more likely to cause adverse effects (Quetiapine > 150mg/Olanzapine >5 mg Risperidone >2mg)

Secondary services need to identify these patients and include them in routine cardiometabolic monitoring.

Secondary services need to work closely with primary care to ensure that responsibility for checks is agreed and handed over when necessary.
A Quality Improvement Project to Improve Experiences of Audio Quality for Remote Attendees of a Ward Round at a London Acute Adult Mixed Psychiatric Inpatient Ward
Authors: Morrin Hamilton , Soundararajan Vinitha , Ramesh Rupa , Woollard James
Published: June 2022

Aims

We sought to assess the degree, nature and impact of poor audio quality during ward rounds for individuals attending remotely using Microsoft Teams. We aimed to evaluate attendee experiences of audio quality against our expectation that due to the existing ward microphone system using a cardioid polar pickup pattern that attendees would have difficulty hearing all members of the multidisciplinary team, as well as the patient, gathered in the conference room. We also hypothesised that after switching to an omnidirectional sound recording system, we would observe an improvement in attendee satisfaction with audio quality during ward rounds.

Methods

Individuals who had remotely attended ward rounds at Lesney Ward, Oxleas NHS Trust between 01/11/21 and 01/01/22, mainly patient family members and community care co-ordinators, completed a digital feedback questionnaire regarding audio quality. There was no exclusion criteria. Data from Likert scale questions were analysed with descriptive statistical tests (mode and distribution of responses). As minimal demographic data were obtained, inferential statistical tests were not used. Qualitative data were analysed using thematic sorting based on prevalence of themes in the data.

Results

Feedback was provided by three family members, one ward team member and six members of the community mental health team prior to the intervention. Pre-intervention feedback indicated high levels of dissatisfaction with 6/10 respondents reporting they were “dissatisfied” and 1/10 “very dissatisfied”. Only 3/10 of attendees reported being able to hear and understand all individuals physically present in the room. In addition, respondents agreed that the audio quality was poor (modal response “bad”, 6/10), and that the sound quality impacted upon their experience of the ward round (modal response “yes, greatly”, 6/10).

The three most common main issues reported by respondents were: people speaking too far from the microphone (7/10), voices sounding muffled (6/10), and too much background noise (4/10). Using their own words, respondents described how the ward round sound quality made them feel. Common themes identified through thematic sorting included: distress, difficulty in understanding information / management plan, ward round prolongation and inability to comprehend the patient or staff.

Conclusion

In conclusion, we found that when using an in-built laptop microphone with unidirectional pick-up remote ward round attendee satisfaction was poor, though this improved with the introduction of an omnidirectional system. Key areas for improvement include assessment of optimal positioning for adequate audio pick-up, and the introduction of automatic transcription for individuals with hearing impairments.
Improving the Care of Children and Young People (CYP) Admitted to Adult Mental Health Psychiatric Beds in NHS Tayside Using Quality Improvement Methodology
Authors: Olver Joy
Published: June 2022

Aims

To reduce monthly bed days for children and young people (CYP) aged under 18 years admitted to adult psychiatric beds by 50%

Methods

QI tools used included driver diagram, stakeholder analyses, process mapping, ishikawa diagram, pareto chart and interviews with CYP and carers to gather qualitative data. Monthly data were collected on all admissions of CYP to adult mental health beds. Change ideas/ process changes included:

•

Early senior psychiatric CAMHS review for all CYP admitted to adult psychiatric beds (same or next working day)

•

Increased access to CAMHS medical records for out of hours staff

•

Admission of all appropriate under 16's to paediatric beds instead of adult mental health beds

•

Short test of change of staffing CAMHS specialist nurses over a weekend

•

Develop alternative non-health crisis support/bed for CYP

•

Develop Personality Disorder (PD) pathway

Results

•

Early senior CAMHS psychiatric review was associated with a reduction in CYP admitted to adult mental health beds from a median of 20 days a month to 2 days a month without an associated increase in CAMHS inpatient admissions

•

Pareto chart showed that Personality Disorder (PD) was the commonest diagnosis

•

Access to CAMHS medical records for all out of hours psychiatric medical staff was increased from 13% to 100%

•

Routine admission to paediatrics for all under 16's was agreed with paediatric medical and nursing managers but not sustainably implemented

•

There were no acute referrals to the CAMHS specialist nurses over the single weekend short test of change

•

Development of an alternative non-health crisis support/bed and development of a Personality Disorder (PD) pathway is still in process

Conclusion

The primary outcome measure was successfully met with the median bed days of CYP admitted to adult mental health beds sustainably reduced from a median of 20 days to 2 days. This was associated with the implementation of routine early senior psychiatric CAMHS review and increased access to CAMHS health records for all medical staff providing psychiatric out of hours assessments. The change ideas including development of different admission pathways (paediatrics and non-health crisis bed), weekend CAMHS specialist nurses service and development of a personality disorder pathway were not implemented sustainably. The pathways of care around CYP presenting in crisis are complex. Making sustainable improvements in complex adaptive systems is complex and challenging but not impossible.
A Quality Improvement of the Identification of Obesity in Patients With Mental Health Morbidity and Referral to Weight Management Services
Authors: Patel Anjali , Rasheed Reshma , Shanthakumaran Yathorshan
Published: June 2022

Aims

A quality improvement project was undertaken to counteract obesity in patients with mental health morbidity. The exponential trend of increased antidepressant prescribing (SSRI, SNRI and anti-psychotic medication) has created a trend towards weight gain in patients. An audit of the Serious Mental Illness (SMI) register and depression registers was conducted in a population of 591 patients. Those patients identified as obese were offered referral to the local authority weight management services.

Methods

Patients have a body weight and BMI calculation with their twice yearly mental health and medication review and those whose BMI met the obesity criteria were offered referral to the local authority for 12 weeks weight management services.

Results

Of the SMI and depression register 189 (32%) patients met the criteria for referral to the weight management program. Of these 154 (81%) patients accepted the local NHS weight management program, 35 (18%) of patients declined the NHS weight management program.

Conclusion

Weight gain is a known side effect of antidepressant medication SSRI and SNRIs and Anti psychotic medication resulting in increased risk of obesity and cardiovascular and metabolic disease. The QI program was undertaken to counteract these changes with referral to weight management services to address the weight gain the patients were experiencing.

This quality improvement service was done to help patients across three surgeries lose weight in an effective and educational manner. We found a high rate of acceptability of referral to weight management services when offered as patients themselves were aware of the weight gain. A review of positive changes in the BMI after referral to the weight management program will be undertaken at 6 and 12 months to evaluate its acceptability and effectiveness. We advocate sensitive counselling of the risks of weight gain and regular monitoring of body weight throughout the span of the prescribing of these weight gaining agents.
Clinical Re-Audit of Assessment and Recording of Venous Thromboembolism (VTE) in Patients With Confirmed COVID-19 in Forensic SIS (Secure Inpatient Services)- 2020/2021
Authors: Piparsania Bhavana , Kumar Santosh , Kaur Raminderjit
Published: June 2022

Aims

1. To assess quality of VTE risk assessment and recording; particularly to look at the impact of COVID-19 on VTE (Venous Thrombo-embolism). 2. To ensure VTE criteria have been adhered to from Tees, Esk and Wear Valleys NHS foundation trust 2019 ” Risk assessment for Venous Thromboembolism (VTE) (Ref: CLIN-0085-v 1.2)Specifically, due to additional risks posed by COVID-19 on increase in risk of VTE.

Methods

The Audit was conducted in Secure inpatient service in Teesside, Roseberry Park Hospital, TEWV NHS trust audit team.

This was done on the back of a scheduled Quality improvement reaudit of VTE risk assessment and recording review in Forensic SIS.

Results

One of the main results was that VTE risk assessment and recording, post finding of a COVID-19 positive result was less than 100% in the records we checked. Other results are included in the poster.

Conclusion

The main conclusion is the need for increased vigilance in assessment and recording of (and any actions thereof) in the VTE risks, particularly in those with COVID-19 positive tests.

We propose that this increased vigilance will enhance patient safety and deliver effective and timely care. We highlight some challenges of conducting an Audit and how to embed results and improve practices in a timely manner. This describes how we did both- acted on results and followed process; rather than just one or the other!
Quality Improvement Project to Improve Patient Satisfaction and Opportunity to Attend Clinical Team Meetings
Authors: Rapson Alec , Hynes Fiona , Sharma Aarohi , Malik Talhah , Beech Lesley , Anderson Caitlin , Begum Ruhela , Naik Sima
Published: June 2022

Aims

Clinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.

Methods

The MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.

Results

Early indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.

Conclusion

Patient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.
Improving the Identification, Assessment and Management of Osteoporosis and Fragility Fracture Risk on a Later Life Psychiatry Ward: A Complete Audit Cycle
Authors: Senior Morwenna , Hewson Thomas , Brownless Francesca , Dunne Ross
Published: June 2022

Aims

Osteoporosis is common amongst elderly patient populations and is associated with significant morbidity and mortality. We aimed to assess whether national clinical guidelines regarding the identification, assessment and management of osteoporosis and fragility fracture risk were being adhered to on a female later life psychiatry ward. We then aimed to improve the detection and treatment of osteoporosis amongst this patient cohort and subsequently conducted a re-audit of adherence to relevant clinical guidelines.

Methods

In July 2021, the electronic health records of the 20 most recently discharged patients from a female later life psychiatry ward were reviewed. The proportion of patients who appropriately received FRAX screening, DEXA scanning and pharmacological management of osteoporosis and fragility fracture risk was recorded. The results were compared to standards identified in national clinical guidelines from the National Institute for Health and Care Excellence (NICE) and the National Osteoporosis Guideline Group (NOGG). In addition, the proportion of patients who had FRAX scores communicated to their general practitioners on discharge was recorded. Recommendations were made based on audit findings, and several changes to ward processes were implemented including incorporating fracture risk scoring in a structured ward round template and displaying information posters about osteoporosis in clinical areas. A re-audit was completed in February 2022 using the same methodology as baseline to re-assess adherence to the audit standards.

Results

All included patients were female and aged >65 years, and therefore eligible for consideration of fragility fracture risk according to NICE guidelines. 88% (15/17 patients) of those without pre-existing osteoporosis had FRAX scores calculated during their admission on re-audit compared to 50% (8/16 patients) at baseline. 73% (11/15 patients) had FRAX scores communicated to their GP on discharge at completion of the audit cycle compared to 25% (2/8 patients) at baseline. At completion of the audit cycle 10% (1/10 patients) with intermediate fragility fracture risk received measurement of bone mineral density during admission while 30% (3/10) had this recommended to their GP on discharge. None of the high-risk patients (n = 4) were started on bisphosphonate therapy.

Conclusion

On completion of the audit cycle, we found excellent compliance with national guidelines regarding the identification of osteoporosis and fragility fracture risk, which demonstrates the feasibility of considering this aspect of physical health in the setting of a later-life psychiatry ward. Areas for improvement include the assessment and management of patients identified as having intermediate or high risk of osteoporosis and fragility fractures.
Do Patients on Section 42 Understand Their Section and What Is Involved?
Authors: Alice Lin Chung Mun , Sud Neeti
Published: June 2022

Aims

Mental health disorders, mostly notably paranoid schizophrenia and personality disorders are commonly seen in patients with a forensic background. Section 37/41, within the Mental Health Act 1983, detains patients who are mentally unwell in hospital for treatment, instead of a prison sentence, with the addition of a community restriction order for public safety. Once stable, patients are discharged by the Ministry of Justice (MoJ) on Section 42, otherwise known as a conditional discharge. This means they can live freely in the community but under a set of conditions they must follow in order to obtain absolute discharge. A leaflet on Section 42 was created after a gap in patient knowledge was identified during consultations. Furthermore, a literature review did not retrieve any relevant results on this topic. The aim of this leaflet was to improve both patient and staff knowledge.

Methods

A patient leaflet was created using information from relevant legislation, MoJ official documents, trust resources, the charity MIND UK as well as staff knowledge. A checklist consisting of 12 questions was created to test the patients’ knowledge, with space for additional comments. Care was taken to ensure every question on the checklist had a corresponding answer in the leaflet. Six suitable patients were identified and supported to read the leaflet and a structured interview using the checklist was conducted pre- and post-leaflet. In addition, feedback was sought from staff members of multiple backgrounds. A resource questionnaire was also given to participants to collate feedback. The pre- and post-test answers were compared and given a mark out of 12. A mark was given for answers that were sensible and correct, even if parts were missing for questions that encompassed multiple facts.

Results

All patients were previously on Section 37/41 and now on Section 42. All showed a substantial improvement in knowledge base, with 4/6 patients scoring full marks afterwards. Patient feedback obtained was overall very positive, with many describing it as “useful”, “informative” and “helpful”. Staff feedback was also collated and found to be positive too, with comments including “very informative”, “easy to read” and “clear and precise”.

Conclusion

Our leaflet was well received by both patients and staff. It improved their knowledge base as well as confidence in understanding the medico-legal jargon used in day-to-day practice in the forensic setting. Feedback was overall positive, and the additional patient feedback was encouraging, with many of them wishing for sooner access to similar resources.
Implementation of STOMP (Stopping Over-Medication of People With Learning Disability, Autism or Both With Psychotropic Medications) PLEDGE: A Quality Improvement Project at Bradford District Care Foundation Trust CAMHS Learning Disability Team
Authors: Syed Mahira , Ganguly Sarojit
Published: June 2022

Aims

The project's aim coincides with NHS England STOMP Pledge signed by BDCFT. To maintain up to date records of children and adolescents with learning disabilities eligible for STOMP reviews, implement planned supervised dose reduction, consider alternatives to psychotropics and maintain an up-to-date record of physical health monitoring for patients on antipsychotic medications according to local Trust guidelines.

Methods

The sample consisted of the caseload registered with the CAMHS learning disability Team at BDCFT in December 2021. Each case was reviewed retrospectively through electronic records. Data were collected on a data collection tool designed in Microsoft Excel.

Baseline data about Diagnosis and Psychotropic medications prescribed were recorded. The Antipsychotic prescribing practice was audited against local Trust guidelines as part of the project.

The project was registered and approved by the Trust Audit Team.

Results

The study included 106 cases registered in December 2021.

42 patients (40%) were prescribed psychotropic medication only

10 patients (9%) were prescribed psychotropic medication plus ADHD medication

14 patients (13%) were prescribed ADHD medication only

40 patients (38%) were not prescribed any medication

66 (62%) patients from the sample were prescribed medication.

Medications were divided into, Psychotropics and ADHD medication groups. Each group was assessed against a prescription time standard of either less or more than 12 months.

Antipsychotics were the most frequently prescribed psychotropic medications; 60% of those prescribed psychotropics were on Antipsychotics. A smaller number (31%) on an Anxiolytic, and an even small number (12%) on an Antidepressant. Anticonvulsants were prescribed to 6 in our sample, but all by another service provider (Paediatrics). 20 patients (38%) were on more than one psychotropic medication.

The length of the time was divided into less and more than a year on medication. 20% of patients were on psychotropics for less than 12 months and about 80% for more than 12 months.

As there are local BDCFT guidelines for monitoring patients on Antipsychotics, a summary of compliance against standards was included as an audit in the project.

All 66 patients on medications were deemed eligible for STOMP reviews, and 64 out of them had behavioural support plan in place.

Conclusion

66 patients who had eligibility for STOMP:

1.

35%: Undergoing reduction plan.

2.

35%: Reduction was not deemed suitable.

3.

30%: No review or reduction plan in place

Recommendations are made in the report to achieve full compliance with STOMP objectives and a re-audit in a year to monitor progress.