bluuebunny/crossref_metadata_2025 huggingface dataset:
A closed audit reviewing the electrocardiograms of patients presenting to the memory assessment team
Authors: Heath Joseph , Anderson Maroulla , Miles-Stokes Jonathan
Published: June 2021

Aims

To review the ECGs of all patients referred to MAT services over the preceding 5 year period.

Background

Neurodegenerative conditions such as Alzheimer's Disease can be treated with Acetylcholinesterase Inhibitors (AChEI) to slow down cognitive decline. Side effects of AChEIs include bradycardia, syncope and cardiac conduction disorders. An electrocardiograms (ECG) is completed prior to memory assessment team (MAT) medical assessments to screen for those who may be at risk of the cardiac side effects of AChEIs. ECGs may be included in the initial referral to the service or completed by the MAT. Given the predominantly elderly population referred to the MATs service, other incidental abnormalities are to be expected. Not all MAT referrals that are screened by memory nurses reach the threshold to be reviewed by the medical team and therefore not all ECGs are routinely reviewed, potentially missing clinically significant abnormalities.

Result

A total of 1795 patients were identified as being referred to a single mental health unit in the North West on England over a five-year period. 781 (44%) of the patients had an ECG completed by the MAT, of which 452 (58%) showed an abnormality. Significant abnormalities that were previously unknown to the patients’ primary care provider include eight cases of Atrial Fibrillation (AF), four cases of Trifasciular Block, and 19 cases of Left Ventricular Hypertrophy (LVH). 64 (8%) of patients who had an ECG by the MAT had a bradycardia.

Conclusion

In addition to identifying abnormalities that could interfere with memory medication, this audit showed that over half of the ECGs completed by the MAT had an atypical trace. Cardiology was consulted to identify which abnormalities were considered clinically significant and if not already known, the general practitioner (GP) was informed. A change in the local service means that all ECGs completed by the MAT are now screened at point of filling into the notes, so any future abnormalities are identified and followed up immediately.
Obsessive compulsive disorder in treatment seeking children & adolescents during the COVID-19 pandemic
Authors: Henein Anthony , Pascual-Sanchez Ana , Corciova Suzana , Hodes Matthew
Published: June 2021

Aims

Few studies have investigated the COVID-19 pandemic's effect on children and adolescents with obsessive compulsive disorder (OCD), who are thought to be particularly vulnerable. This study aims to investigate whether the COVID-19 pandemic is associated with increased referral of young people with OCD in one area of London and determine if COVID-19 has been associated with change in symptom severity and treatment offered in recent years.

Method

A retrospective study was conducted using clinical service data investigating 58 young people (8–17 years) referred and assessed in CNWL NHS Foundation Trust CAMHS, before and during the COVID-19 pandemic in 2020 (months March–October 2018–2020). Changes in symptom severity were measured using the health of the nation outcome scale for children and adolescents (HoNOSCA). Total HoNOSCA and three HoNOSCA items were used; emotional symptoms, family relationships and school attendance. Patient clinical records were reviewed to assess if COVID-19 had exacerbated OCD symptoms. The type of treatment offered (cognitive behavioural therapy -CBT- only vs combined CBT and medication) was also compared. Analysis was carried out using Chi-square, Kruskal–Wallis and Mann–Whitney U tests.

Result

26 (5.62%) initial assessments to CAMHS were related to OCD in 2020, compared to 12 (1.30%) and 20 (2.27%) assessments pre-pandemic (2018 and 2019), showing a significant increase in the proportion of OCD cases (X2 (1, N = 58) = 20.3, p < .001). There was no significant difference in total HoNOSCA, emotional, family relationships, or school attendance scores on initial assessment. However, 69.2% of clinical records in 2020 showed symptom worsening over the COVID-period, compared to 30.8% of cases assessed pre-pandemic.There was a significant difference between the type of treatment offered before and during COVID-19 (X2 (2, N = 58) = 12.7, p = .002), with a higher proportion of patients who were referred to CAMHS for OCD but discharged without treatment before the pandemic (37.5% vs 0%). While CBT only remains the most frequent treatment offered, combined treatment was more frequent during the pandemic, although this difference was not significant.

Conclusion

The proportion of OCD-related initial assessments in CAMHS increased during the pandemic despite the overall number of referrals falling. Furthermore, fewer cases were discharged without treatment in CAMHS during this period. Given this, and that many were reported to have deteriorated during the pandemic, services will likely need to address the increased burden of more severe cases. Further research is warranted to assess the generalisability of our findings.
A national cross-sectional survey and interviews exploring the relationship between well-being and burnout in doctors
Authors: Jenkins John , Boxley Emma , Simons Gemma
Published: June 2021

Aims

Doctors’ mental health is a national concern – the General Medical Council, British Medical Association and Health Education England pledge to improve their well-being. Well-being has no common definition, instead pathogenic measures such as burnout are published as a demonstration of doctors’ wellbeing. Yet, the relationship between burnout and wel-being has not been explored.

Aim

to investigate the relationship between burnout and well-being.

Hypothesis

they are negatively associated, but not opposites.

Method

An online cross-sectional national survey was distributed to doctors of all grades and specialties via the Royal Colleges and doctor organisations. The Oldenburg Burnout Inventory (OLBI) measured burnout, and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) measured well-being. Correlation coefficients between total scores of these measures estimated the relationship. Additionally, semi-structured interviews explored personal definitions of wellbeing and its relationship with burnout. Thematic analysis was carried out.

Result

64 doctors completed the OLBI and WEMWBS. Comparing the total scores for the questionnaires with Spearman's rho indicates a moderate negative correlation (rs= –0.658, p = 0.00, n = 64). Total scores were made into binary variables, a Chi-square test showed that a low WEMWBS score (<40) and a very high risk OLBI score (≥2.85 exhaustion and ≥2.6 disengagement) were statistically significantly associated (X 2 (1, N = 64) = 4.232, p = 0.04). Three themes emerged from the 10 interviews conducted: the importance of networks/relationships outside work; scepticism towards the proposal of an NHS wellbeing check-in; and how participants do not strive to improve their wellbeing until its decline.

Conclusion

This research demonstrates that wellbeing and burnout have only a moderate negative correlation when using commonly employed measurement tools. Therefore, measures of burnout are not a surrogate for wellbeing. Further research could adopt a salutogenic approach by using the WEMWBS to monitor doctors’ wellbeing and could explore interventions to increase well-being, rather than waiting for its decline.
Profile of sleep pattern, psychiatric comorbidity and problematic electronic gadget use in children and adolescents with autism and ADHD
Authors: Kaur Darpan , Patani Sanay , Verma Rishab , Ghildiyal Rakesh
Published: June 2021

Aims

To assess the profile of Sleep pattern, Psychiatric comorbidity and problematic electronic gadget use and explore demographic factors and correlations in children and adolescents with ADHD and Autism.

Hypothesis: There are statistically significant problems and associations across sleep pattern, psychiatric comorbidity and gadget use in children and adolescents with autism and ADHD.

Background

Literature highlights increasing global trends and emerging concerns over the problematic use of electronic gadgets and sleep related problems in children and adolescents with autism and ADHD. There is sparse literature on the profile of sleep patterns, psychiatry comorbidity and problematic gadget use in children and adolescents with autism and ADHD from developing countries.

Method

This was an observational study conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a tertiary care Institution under the STS ICMR Project 2019 with Institutional Ethics Clearance. Apriori Sample size calculated was 70. Children and adolescents diagnosed with autism or ADHD as per ICD 10 criteria, fulfilling the inclusion criteria and willing to participate in the study were included. Informed consent was obtained from caregivers. Sleep Disturbance Scale for Children, Self Designed Parent based Problematic Electronic Gadget Use Scale, Vanderbilt ADHD scale, Indian scale for Assessment of Autism and the Child and Adolescent Psychiatry Clinic structured Performa were the tools for data collection. The results were analyzed with descriptive tests, chi square test and multiple logistic regressions using SPSS.

Result

Mean age of the sample was 9.1 years and majority (57%) were boys. Forty nine patients had ADHD and 21 patients had Autism. Problematic gadget use was higher in children ranging from 6 to 15 years of age and 12.8% had severe levels of problematic gadget use. 34.3% patients experienced severe problems in initiating and maintaining sleep. Oppositional-Defiant disorder was the most common comorbidity, predominantly inattentive type (76.4%) was the most common subtype of ADHD and mild autism (54.3%) was the most common type of autism in the sample. There were statistically significant associations (p < 0.05) between age and gadget use; hyperactive subtype of ADHD and problems with initiating and maintaining sleep and ADHD subtype, sex profile and problematic gadget use.

Conclusion

We conclude that sleep problems, psychiatric comorbidity and problematic gadget use are prevalent with statistically significant associations in children and adolescents with autism and ADHD as per our study findings. Our study has relevant clinical, research and policy implications.
Factors in psychiatric admissions: before and during the COVID-19 pandemic
Authors: McCarron Robyn , Swann Peter , Thompson Fiona , Murray Graham
Published: June 2021

Aims

The COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown.

Method

A retrospective case-note review study with an exploratory mixed-methods design was used to examine factors in psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018.

Result

Themes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6⋅19 (s.d. = 2⋅43), with a mean number of categories per case of 3⋅73, (s.d. = 0⋅98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20⋅80, p < 0⋅00001) and older adults (χ2(1, N = 98) = 8⋅61, p = 0⋅0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0⋅035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0⋅023), were more likely to have a COVID-19 related admission factor.

Conclusion

The COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, the elderly and those with affective disorders.
Vive la difference! Celebrating and supporting autistic psychiatrists with autistic doctors international
Authors: McCowan Sue , Shaw Sebastian C K , Doherty Mary , Grosjean Bernadette , Blank Paula , Kinnear Malcolm
Published: June 2021

Aims

We aim to raise awareness of the existence and value of autistic doctors in psychiatry and to also signpost psychiatrists who are or suspect they might be autistic towards peer support.

Method

Autism refers to a lifelong difference in how people communicate and interact with the world. These differences lead to strengths and challenges with individual profiles which include special interests, hyper-focus, and often sensory differences and anxiety. Autism has an estimated prevalence of 1-2%, which is likely an underestimate. It was noted that there was little in the way of advocacy for autistic doctors around the world. Anecdotal evidence also suggested possible issues of misunderstanding and stigmatisation of autistic doctors. As such, there was a need to tackle this to promote positive change. MD founded the group Autistic Doctors International (ADI) in 2019 to foster camaraderie, advocacy and support. ADI has flourished with 250+ members currently. In a recent member poll, 24 of 180 respondents identified themselves as psychiatrists – second only to general practice (n = 54). Several other consultant psychiatrists are known to self-identify as autistic but have not formally joined due to the fear of disclosure. The group has additionally supported multiple doctors to tackle prejudice and discrimination in the workplace / training environment. It has also brought together autistic doctors with academic interests and has generated multiple academic outputs in the form of publications, research grants and conference posters/papers regarding autism.

Result

Psychiatrists, and doctors in general, are a self-selecting group for many autistic strengths such as hyper-focus, curiosity, self-motivation, a desire to study social communication, attention to detail, pattern recognition, problem solving and empathy, which, contrary to prevailing stereotypes, can be marked in autism. The increasing numbers of doctors joining ADI supports the assumption that autistic individuals are safe and effective clinicians. It is worth noting that many members are not ‘doctors in difficulty’. Those who have been able to achieve suitable accommodations, often without realising why they were needed, have flourished. Such accommodations and outcomes are in line with the neurodiversity movement, which promotes a view of autism as difference, rather than pure disability or disorder. This aims to challenge stereotypes and the tragedy narrative surrounding autism.

Conclusion

Autism awareness is increasing amongst doctors but more open discussion is still needed in order to facilitate appropriate peer and workplace support. This is likely to improve mental wellbeing and resilience for autistic psychiatrists.
Clinical audit of prescribing for attention deficit hyperactivity disorder (ADHD) in children and young people services (CYPS)
Authors: Parker Mary , Martin Elaine
Published: June 2021

Background

The audit aimed to assess, when 3rd and 4th line medications were prescribed for ADHD, if practice was compliant with Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) prescribing guidelines and the updated NICE Guideline NG87: Attention deficit hyperactivity disorder: diagnosis and management 2018.

Method

The audit was conducted in the four Teesside Child & Adolescent community teams during April/May 2018. Each team identified all patients prescribed 3rd and 4th line ADHD medications leading to 30 responses (n = 30).

Information was collected from electronic and paper medical records using a designated audit tool compiled from the above evidence based guidelines. The data were analysed for compliance against standards using an excel spreadsheet and reviewed by the audit lead.

Result

There were many areas of good practice demonstrated in the audit including diagnostic recording, pre-treatment non-medical interventions where ADHD was not severe, and use of Methylphenidate as first line medication in accordance with BNF limits. In the majority of records reviewed, there was good evidence of a variety of NICE recommended non-medication interventions which were often continued post medication initiation.

There was also very good evidence of comprehensive verbal and written information and psychoeducation including benefits and potential side effects of medication (92% verbal and 58% written).

A pre-treatment assessment was completed in all but 3 cases, 1 of which had no assessment documented and 2 cases were transferred from out of area.

Issues identified by the audit, where there was deviation from guidelines, included 4 cases where Methylphenidate was not prescribed as first line, of these, 3 were prescribed Atomoxetine due to parental choice and one was due to contraindications, suggesting patient choice was an important factor in selection of 2nd line medication.

The audit demonstrates that clinical practice had moved away from the previous guidance in NICE CG72 (to prescribe atomoxetine 2nd line) towards the prescription of Lisdexamfetamine 2nd line (75%) as reflected in the new NICE guidelines: NG87, 2018 (updated 2019).

Conclusion

This audit cycle has demonstrated that use of an evidence based approach has been instrumental in improving patient care. The Audit evidenced good practice in areas such as pre-assessment, information and psychological education, initial use of Methylphenidate, use of Lisdexamfetamine 2nd line, as well as consideration of patient choice. Importantly the audit highlighted that implementation of updated NICE compliant trust guidance, followed by a planned trust-wide audit will promote continuous improvement in patient care.
Working in the woodlands: a mixed methods evaluation of Green Care in first episode psychosis
Authors: Sharp Harriet , Cuthbert Sharon , Berry Clio
Published: June 2021

Aims

Recognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.

We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.

Method

This was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.

Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.

Result

Session attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.

Conclusion

This small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.
Sociodemographic, clinical and personal characteristics of patients with borderline personality disorder in a public general hospital in Lima, Peru during the first wave of the COVID-19 pandemic
Authors: Valdivieso Glauco
Published: June 2021

Aims

To describe the main characteristics of adolescent and adult patients with Borderline Personality Disorder (BPD) treated in Emergency and Hospitalization services of Villa El Salvador Emergency Hospital during the first wave of the COVID-19 pandemic in Lima, Peru.

Method

An analysis of 17 cases of patients with BPD according to DSM 5 criteria was carried out in SISGALEN PLUS software database that have been evaluated in the Emergency and Hospitalization areas during the first wave of the COVID-19 pandemic. Sociodemographic, clinical and personal variables were taken into account. A descriptive analysis of frequencies and proportions was carried out in SPSS 24.0 software.

Result

Regarding sociodemographic variables, the average age was 27.47 (SD = 11.242), 82.4% single, 88.2% female, 52.9% from Villa El Salvador, 82.4% catholics, 76.5% have completed secondary school and 47.1% were housewives. For clinical variables, 64.7% located in the Emergency Service, 58.8% had no current diagnosis of COVID-19, 64.7% without medical comorbidity, 35.3% without psychiatric comorbidity, 52.9% with suicide attempt as the main reason for consultation, 52.9% without regular use of medications, 88.2% with psychopharmacological treatment; 70.6% received a psychiatric interview intervention; Regarding symptoms, all presented interpersonal problems, impulsivity, emotional instability and inappropriate anger, while 58.8% had alteration of identity and 94.1% had suicidality. For personal variables, 82.4% had no family history, 88.2% had no history of abuse or trauma, 52.9% had a history of substance use, and 88.2% had no previous hospitalizations.

Conclusion

The most of patients with BPD were young adults, women, single, from Villa El Salvador, catholics, completed secondary school, housewives, from Emergency, no diagnosis of COVID-19, without medical or psychiatric comorbidity, consulted for suicide attempt, without habitual use of medications, with indicated psychopharmacological treatment, a psychiatric interview was conducted, they had active symptoms, history of substance use and no family history, abuse or hospitalizations.
Audit examining memantine initiation in dementia patients in an older adult service in the north west
Authors: Casapu Irina , Dickinson Ste , Shroff Chirag , Almeida Sofia , McSharry Kieran
Published: June 2021

Aims

Dementia is a progressive condition inflicting significant costs for health and social care services. In December 2017, there were 456,739 people on GP registers with a formal diagnosis of dementia. Making the right choice of anti-dementia medication with essential monitoring is one important aspect of care. Thus, the aim of this audit was to identify if current practice at Mossley Hill inpatients and outpatients service for older adults in Liverpool, was in accordance with the NICE Guideline NG97 (Dementia: assessment, management and support for people living with dementia and their carers). Additionally, we aimed to evaluate whether Memantine was commenced according to BNF/SPC recommendations about e-GFR and whether this was documented on patient records, as well as to highlight areas of improvement.

Method

An audit was carried out for all patients for whom Memantine was initiated, between June and August 2019. Sixty-nine patients were identified through trust Pharmacy records. Data were collected retrospectively, reviewing local electronic records (ePEX, RIO) and GP referrals. This included age, sex, diagnosis, indication for starting Memantine, decision context, prescriber, documentation of renal function status and communication of decision to the GP. Findings were compared to NICE guidance NG97 and presented at the local audit meeting with a view to recommend strategies for improvement.

Result

Results indicated that most of the patients were female (64%) with the most common diagnosis being Alzheimer's disease (75%). Recurrent reasons for initiating Memantine were: contraindication for AChE treatment (25%); illness progression on AChE (22%); and severe dementia on initial presentation (23%). Usually, the decision to start Memantine treatment was made in MDT or after prescriber clinical review. In 68% of the reviewed cases, renal function status was documented. Patients' GP was informed of medication change in 86% of cases.

Conclusion

To conclude, in the majority of cases Memantine initiation was in line with NICE guidance. However, documentation can be improved, so as to facilitate future audit. We recommended creating a checklist for prescribing Memantine that could be integrated within the electronic records system.
Audit on antipsychotic prescribing in children and young people with a learning disability under the care of mental health services in Surrey
Authors: James Timothy Cherian , Zainab Asifa , Mura Salvatore , Vallance Aaron , Okusi Dola
Published: June 2021

Aims

To check the extent to which National Institute of Clinical Excellence (NICE) guidelines were being followed in clinical practice with regards to prescribing antipsychotic medication to Child and Adolescent Mental Health Services (CAMHS) patients with a diagnosed learning disability (LD).

Method

A data collection tool (based on a similar Royal College of Psychiatrists [RCPsych] audit) was filled out with retrospective data from patients’ clinical records, then analysed using Microsoft Excel and Microsoft Powerpoint.

The agreed standards were the NICE guidelines.

There were no ethical issues as the data were retrospective and anonymised.

Sample size was 13, comprising 7 males and 6 females.

All service users were less than 18 years of age.

Result

7 out of the 13 patients who were prescribed antipsychotics had a Severe/Profound LD.

Among the 5 patients who had been prescribed antipsychotic medication, 4 were on Risperidone and 2 were on Aripiprazole. The reasons for starting antipsychotic medication were clearly documented for all 5, the most common reasons being overt aggressive behaviour and general agitation/anxiety.

Only 1 patient had antipsychotic medication initiated in the previous 12 months. NICE guidelines had been generally followed for the management of this case, with good documented evidence.

For the other 4 patients, in whom antipsychotic medication was initiated more than 12 months ago, there was a lack of documentation of the subsequent assessment of side effects, extra-pyramidal side effects, body weight, blood pressure, glycaemic control and lipid profile. 1 of these patients did not have a documented review of antipsychotic medication in the previous 6 months. For the other 3 patients, their medication reviews did not consider whether to reduce the dose or stop antipsychotic medication.

1 patient had been transferred to primary care, with a clear transfer of prescribing responsibility and documented evidence that written guidance was provided to primary care which addressed all the necessary management details.

Conclusion

Although there was clear documentation of reasons for initiating antipsychotics, there appeared to be a lack of awareness of NICE guidelines for antipsychotic medication reviews, side effect and metabolic markers assessment, and their documentation. This is an area for potential change in practice to conform better to national guidelines and improve patient care.
“Are they medically fit?” - clinical audit on the physical assessment of mental health patients in A&E
Authors: Cooper Ashley
Published: June 2021

Aims

A&E departments are busy places; with quick triage decisions required to prioritise urgent care to those who need it. This requires the use of predictions based on past experiences and probabilities. However, this runs the risk of patients being categorised by the prejudices and stigmas associated with their conditions; particularly in the case of mental health patients and the assumption they are otherwise ‘medically fit’. This is especially of concern when considering that mental health often deteriorates during acute physical illness.

Following a number of dangerous ‘near misses’, this audit was conducted to review the practice of triage and physical assessment of patients presenting to A&E with mental health symptoms. The aim was to compare practice against the Royal College of Emergency Medicine (RCEM) guidelines, to identify repeated issues and systemic vulnerabilities which endangered patients through a lack of appropriate assessment.

Method

Using the online Electronic Patient Record (EPR) system, the notes of 100 patients referred to the Bolton Mental Health Liaison Team (MHLT) from Bolton A&E were reviewed. They were assessed for whether or not the patients had been appropriately physically assessed, according to the RCEM guidelines, before being referred to the MHLT. These results were analysed anonymously.

Result

The findings showed that less than half (44%) of all referred patients had physical observations taken at all, and even fewer (37%) received the full, physical assessment before referral. Out of the patients identified as having abnormal physical observations only 58% were acted on. Many patients had no history or triage assessment completed; with triage referrals consisting of only the words “mental health”. Most importantly, the audit identified this lack of adequate physical assessment resulted in a 2% ‘near miss’ rate, including a missed diabetic ketoacidosis and delayed treatment for a missed overdose.

Conclusion

Following this audit and the above result, it is clear that triage and physical assessment of mental health patients attending A&E is inadequate; with resulting risk of severe consequences to patients. It is therefore recommended to co-develop joint guidelines and teaching to guide A&E and MHLT practitioners on the process of completing the physical assessment prior to referral. It is also recommended to repeat this audit throughout other hospital trusts, in order to review the local referral pathways to ensure adequate physical assessment to avoid any ‘near misses’ or serious incidents.
Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh
Authors: Devadas Ritika , Murdie Douglas , Thomas Idris , Hannah Rhona , Karbowniczek Wiktoria , Kinney Tara , Lacey-Solymar Oscar , Łukaszuk Adam , MacDonald Seona , McIntosh Sarah , Taha Danya , Taylor Charles
Published: June 2021

Aims

COVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).

Method

Measures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.

Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.

In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.

Result

Referrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).

Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.

Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.

Conclusion

The COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.

The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.

Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.
An audit to assess physical health monitoring of patients following their admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust
Authors: Hyland Declan , Milner Agatha , Carter Ellen
Published: June 2021

Aims

This audit aimed to establish whether patients undergo physical health monitoring within 24 hours of admission to one of the general adult inpatient wards in Mersey Care NHS Foundation Trust, as per Trust policy.

Background

Mean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. Shared care of SMI patients between primary and secondary healthcare professionals causes uncertainty over who is responsible for monitoring the physical health of these patients.

Method

A list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.

An audit tool was designed, capturing demographic data – gender, age, ethnicity. The patient's psychiatric diagnosis was recorded. The tool captured whether each of the following were measured following admission – body mass index (BMI), blood pressure (B.P), serum cholesterol level, QRISK score and HbA1c level, and, if so, whether this was done within 24 hours of admission. For those patients who were smokers, being offered nicotine replacement therapy was documented.

Result

Of the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. 91% of the sample had a BMI measured within 24 hours of admission, but only 62% had a B.P done, 59% had a serum cholesterol level done and 58% had an HbA1c level done within 24 hours of admission. 78% of eligible patients had a QRISK score calculated. 97% of inpatients who were smokers were offered nicotine replacement therapy, but only 13% accepted it.

Conclusion

The majority of patients admitted to the general adult inpatient wards have an SMI. The audit findings show need for improvement in physical health monitoring following admission. Creation and implementation of a checklist of physical health parameters to be measured within 24 hours of admission could help improve performance. Use of motivational interviewing may help increase uptake of nicotine replacement therapy in smokers.
Escalation of care planning on an older adult inpatient unit during the COVID-19 pandemic
Authors: McDermott Alexander , Rankin Jennifer
Published: June 2021

Aims

Initial planning during the first wave of the COVID-19 pandemic involved difficult decision making for many clinicians. The Older Adult Mental Health Wards in Bridgend were relocated from the district general hospital (Princess of Wales) and merged at Angelton Clinic, an off site separate unit. It was therefore essential that patients had clear escalation of care plans as access to medical input was limited and transfer to hospital potentially not appropriate in the later stages of chronic illness such as dementia.

The initial aim of the PDSA cycle was to assess the level of compliance with Do Not Attempt Resuscitation (DNAR) discussions and if appropriate, DNAR documentation. The other aim was to assess the utilisation of Escalation of Care plans.

Method

An audit of patients MDT medical notes on 38 admitted to Angelton clinic was carrired out in March. It was documented if the patient had a clear DNAR or Escalation plan that was easily accessible in the front of the notes. The guidelines compared to were the GMC recommendations that patients 12 months of should have a discussion about risks and benefits associated with Cardiopulmonary Resuscitation. If the patient lacks capacity a best interest decision should be made with nearest relatives. Discussions should also be had with patients and family in in regards to and transfer to a medical ward.

Upon completion of the initial PDSA cycle, views were sought from the wider MDT a new escalation of care proforma was designed. This was implemented by education and communication with members of the medical team. This was to be clearly placed in the notes, with the DNAR form if that was appropriate.

Result

All inpatient notes were audited at Angelton Clinic in March 2020. It was found that only 18% of patients had Escalation of Care plans in comparison to 84% of notes which had DNAR forms. Previous escalation of care forms were not being utilised appropriately.

Upon implementation of the Escalation of Care proforma, a re-audit of the audit cyle was completed. In July 2020 it was found that 78% of notes had completed Escalation of Care forms with 83% had completed DNAR forms.

Conclusion

To enable ongoing sustained improvement, the unit Nurse Practitioner will champion its completion. The audit findings have been shared with the newly rotated junior doctors and proformas were made available on all inpatient wards.
An audit comparing telephone reviews to standard face-to-face consultations within child and adolescent mental health services at Massereene House
Authors: Moss Eileen
Published: June 2021

Aims

This audit was carried out in response to the Coronavirus pandemic. The COVID-19 pandemic has forced many teams to review how they provide care to their patients. Due to attempting to reduce the spead of COVID-19, the Child and Adolescent Mental Health Service within the Northern Health and Social Care Trust largely switched to telephone reviews instead of face-to-face reviews for non-urgent outpatient appointments from March 2020 onwards. The aim of this audit was to establish whether or not service users found telephone reviews to be as useful and therapeutic as the previous standard face-to-face reviews.

Method

A questionnaire was used to assess opinions on telephone reviews. Those who were answering the questions were asked to rate their answers on the following scale: “not at all”, “a little”, “somewhat” or “a great deal”. There was an “any other comments” section at the end where service users could give detailed opinions on how successful they thought telephone reviews were. A sample of twenty patients was involved. This cohort of twenty patients was a mixture of ten ADHD reviews and ten medication reviews. The audit was conducted by one person and this was done via the telephone.

Result

For questions one to four (which will be fully outlined in the poster), the most popular category chosen was “somewhat” and this indicates that the majority of patients found telephone reviews somewhat better than face-to-face appointments. For question five (which was- “Overall, was the help you received good?”), 80% of service users stated that the help that they received was “a great deal” better than the help that they had received at previous face-to-face appointments. Lastly, for question six (which was- “If a friend or family member needed similar help, would you recommend that they are phoned by our service?”), 80% of service users said that they would recommend our service “a great deal” to family members or friends.

Conclusion

Generally the feedback was positive for the telephone reviews. However, some still outlined a preference for face-to-face reviews. There may have been bias in this audit as it was the same doctor who did the telephone reviews as conducted the audit. To conclude, telemedicine is likely to become more popular in the future especially as the Coronavirus pandemic is still currently a worldwide problem therefore it is important to explore how service users feel about this as a way of communicating with the clinicians who are treating them.
Audit of patients absent without leave from a psychiatric intensive care unit
Authors: Naismith Hamish , Rahman Mehtab , Magadlela Biganani
Published: June 2021

Aims

We aimed to reduce the number of patients absent without leave (AWOL) by carrying out an audit of processes around granting leave for those patients and the action taken when they absconded. We also wanted to determine factors which might be associated with patients absconding.

Background

Nile ward is a 14-bedded male psychiatric intensive care unit (PICU). All patients admitted to the ward are under section 2 or 3 of the Mental Health Act. Patients who are AWOL may pose a risk of harm to themselves or others. The Royal College of Psychiatrists’ Quality Network for PICUs has developed applicable standards, which include criteria on developing a leave plan, actions to take when patients are AWOL and involvement of carers.

Method

Patients who went AWOL during a six month period in 2019 from ward records. The electronic medical records for identified patients were reviewed to assess whether the following eight criteria were met: risk assessment documented; leave conditions specified; consultation with the multi-disciplinary team; crisis card provided to patients or families; risk management plan enacted when AWOL; relevant authorities informed; incident form completed; relatives/carers involved in patient's care if they consented. In reviewing the notes, factors that might have been associated with an increased risk of AWOL were also assessed in order to inform risk assessment.

Result

Six patients were identified who went AWOL during the six month period in question. For six of the criteria, all of patients' cases met the audit standards. Five patients' did have involvement of relaties/carers if they consented, but in one case no details were available for making contact. All patients lacked documented details of crisis numbers being provided before they went on leave. Preliminary findings that might be associated with an increased risk of AWOL are differing views between the patient and the treating team on the care plan and concerns about mental state.

Conclusion

The audit showed many of the standards are met. However, a quality improvement intervention is planned to ensure all audit standards are met, in particular around providing a crisis card to patients and these findings will be presented on the poster, if accepted. Further research is needed into factors which might be associated with an increased risk of absconsion in PICU.
Overdose admissions to a district general hospital intensive care unit
Authors: Nechowska Aoife , Samuels Theophilus , Ranjan Sameer
Published: June 2021

Aims

This audit aimed to analyse the patient population coming into East Surrey Hospital's Intensive Care Unit from 1993 to 2019.

Background

The Office for National Statistics (ONS) published a report in August 2019 on ages most likely to die by suicide and drug poisoning. Their data showed that Generation X were dying by this method in greater numbers than other age groups. This is in contrast with data from 1990s for England and Wales which showed people in their 20s were most likely to die by suicide or poisoning. This audit set out to look at admission data from an intensive care unit (ICU) in a district general hospital in Surrey over a similar period of time.

Method

Patient records from 1993 to September 2019 were accessed using the WardWatcher database. To access the maxim number of admissions qualifying under the aims, the database was accessed by searching under “admission comments” for: overdose, self-harm, poison, suicide. These reports were downloaded and the lists were checked against each other to delete duplicates. This gave a total of 331 patients. The data were analysed by year, according to age, gender, season, psychiatric diagnoses and previous overdose attempts. Their outcomes were checked against recorded deaths. There was not enough information to investigate method of overdose.

Result

A total of 331 patient records were accessed. The youngest patient was 15 years old, the oldest was 84 years old. The age dataset was non-parametrically distributed with the median age of 43 years (IQR 33-51 years). The age distributions for each year appeared symmetrical but total numbers for each year were small. The population was split as 191 female (58%) and 141 male (42%). 16 patients died on the ICU on admission with an overdose, 5% of total numbers, of which 19% had a previous overdose attempts and 44% had a psychiatric diagnosis. The youngest death was 22 and the oldest was 81 years old. The average age was 47 years, with the spread consistent in the 2000s and 2010s.

Conclusion

The results from East Surrey Hospital's ICU do not reflect the analysis from the ONS. The mean age for each year has remained similar. Numbers for the audit were small and admission criteria to the ICU prescribe that the patient be critically unwell and may not be indicative of the total admissions to a district general hospital.
Implementation of smoking cessation policy at the antelope house in Southern Health NHS Foudation Trust in Southampton
Authors: Neru Sunday , Ededet Edet
Published: June 2021

Aims

To ensure that health care practitioners at Antelope house, Southern Health NHS Foundation Trust in Southampton are providing service users information, advice and stop smoking support in line with smoke free policies in the trust.

Background

Smoking is the single largest preventable cause of ill health and premature death in England. Cigarette smoking causes a wide range of diseases and medical conditions like cancers, heart diseases and stroke.

The prevalence of stroke is extremely high among people with mental health problems especially those admitted to hospital.

Stopping smoking reduces the risk of developing preventable diseases and premture death.

These are the background behind this audit.

Method

Data were collected using the following ways:

Use of desinged questionaire.

Looking into Rio elecronic records

Standard used and compared against was Southern Health NHS Foundation Trust '' smoke free trust policies'

20 cases were looked into and examined.

Result

Most staff are not implementing the Trust no smoking policies well and documentation of the informtion given are not complete.

Most service users prefer to use e-cigarettes.

Most people between 30 and 50 years old range do not smoke.

For those of clozapine, the impact of cigarettes smoking not explained.

Conclusion

The trust smoke free policies are not well implemented by health care practitioners at Antelope house mental health unit, Southern Health NHS Foundation Trust in Southampton.