bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperprolactinaemia: audit of practice and new guidance
Authors: Janaway Benjamin , Anwar Lubna 
Published: June 2021

AimsHyperprolactinaemia is a problem secondary to antipsychotic use. Current management guidelines are heterogeneous and impractical. We aimed to assess coherence to common themes monitoring and intervention, reasons for failure, and to design new guidance for both general use Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and beyond.We hypothesised that performance would be poor and new guidance warranted.BackgroundHyperprolactinaemia is defined as blood prolactin of >530 miu/L in females and >424 miu/L in males, with 49.9% is due to medication. Several agents are deemed higher risk Symptom profiles and risk are idiosyncratic and there are adverse long-term outcomes. Treatment is based on symptom profile and severity and cause. Current guidance is trust specific or advised through The Maudlsey Prescribing Guidelines.Comprehensive and practical guidance reflecting front-line limitations is lacking. There is no clear delineation of a risk stratified pathway.MethodWe wished to ascertain data on surveillance, aetiology and signpost opportunities for service improvement. We also designed ‘risk strata’ to guide intervention.A random sample (n30) was selected from Enfield South Locality Team and data captured using local records. No ethical considerations were raised.A number of audit standards (95%) were developed based on previous guidance and agreed within the team and included frequency of monitoring, time to review and need for further referral.New guidance was developed based on results, MDT agreement and consultation with medical specialities.ResultData (n 30) showed predominant male bias to sample (66%) and average age of 48.87 yrs. Predominant diagnoses were Paranoid Schizophrenia (53.33%) and Schizoaffective disorder (33.33%.) Only 7/30 (23.33%) had undergone testing within the last year.Of those sampled, 2 (6.667%) had a new diagnoses of Hyperprolactinaemia, one on routine monitoring, one incidentally on admission to hospital. Both were on high risk agents. Both were reviewed and treated within one month. No audit standards were met, but no further referrals were required.Reasons for failure varied, but included loss to follow-up, no test requested or appointments missed.ConclusionBased on these data it was noted that monitoring was poor and reasons for failure varied. New Guidance was developed in response. The scope and validity of this guidance was agreed by MDT and awaits formal ratification.Re-audit will occur in 2020, and if successful the guidance submitted to other Trusts and RCPSYCH for national use.No financial interests to declare.
Quality improvement project: improving the confidence of junior doctors to manage emergencies; Drs abc in an acute psychiatric setting
Authors: Jayakumar Ahrane , Erin-Jones Wren , Edwards Simon 
Published: June 2021

AimsTo improve the confidence and preparedness of junior doctors in managing medical or psychiatric emergencies when on call at an inpatient psychiatric unit.BackgroundFacilities for emergency care differ between acute medical and psychiatric units. Protocols for managing acutely deteriorating patients and those requiring immediate resuscitation differ across these organisations.Managing medical emergencies can be stressful for all involved. Junior doctors rotate between services where the level of support varies depending on specialty and setting. For doctors who have worked in a setting where the minimum emergency response includes a Resuscitation team, moving to an environment with less support available is a challenge.In our unit, the protocol following an urgent call is for the on-call doctor (who has access to basic resuscitation equipment) to attend and assess the need for paramedics and transfer to local hospital. Stress can be worsened by change of environment, change of expectation and concern about best management in new settings.MethodA cohort of junior doctors were recruited. Baseline assessment included rating their confidence level (scale 1- 10), listing common medical and psychiatric scenarios they had experienced and those they felt least confident managing. Over a period of 10 weeks, follow-up data was obtained. Interventions to improve confidence were assessed during this period, including a handbook and a teaching session on emergency medications. At the end of the project a wordcloud was created in response to the request to “choose 5 words to describe your feelings when called to an emergency”. Identified themes have been fed back to relevant senior staff and will form the basis of future projects.ResultThe initial average confidence score improved from 4.9 to 9.2 and was sustained out to 14 weeks. According the word cloud the most commonly used words were “morale” and “education”.ConclusionPrior to the study, confidence levels amongst the Junior Doctors was low. Introduction of the handbook and teaching session led to an improvement which was sustained. Key themes identified using a word cloud were “morale” and “education”.For junior doctors moving from between services, different expectations and protocol for management of emergencies can influence confidence levels. Psychiatric units should be cognisant of these concerns and implement evidence-based intervention to support junior doctor confidence and improve quality of working experience.
An audit: fitness to drive assessment in inpatients of general adult and old age psychiatry
Authors: Khan Ismail , Asiodu Nneamaka , Divyanish Dr , Yaqoob Anum , Qureshi Hasanain 
Published: June 2021

AimsTo determine if fitness to drive is assessed on admission and discharge, if applicable, and for this to be documented during clerking and on discharge notifications.To determine if patients are being educated about the impact of their condition on the ability to safely drive.To ascertain if patients are aware of the duty to inform the DVLA if they for any reason are not fit to drive.BackgroundRisk factors include social, behavior and iatrogenic factors such as social withdrawal, increased likelihood of substance abuse and side effects of anti-psychotic medication.MethodThis trust wide audit involved the random sampling of a total of 71 case notes, 4 case notes per Consultant team in general adult psychiatry and old age psychiatry across Dudley and Walsall sites (total of 3 sites). A data collection tool was developed and included relevant questions regarding fitness to drive. Data were collected between October and December 2019.Result18/49 patients had physical health screening prior to medication initiation.ConclusionAn important aspect of good medical practice is to educate patients about their condition, this includes their fitness to drive as this can be affected both by their diagnosis and medication. It is clear that clinicians also need to be educated about this responsibility to ensure assessment is performed especially on inpatient discharge.
Improving accessebility to psychiatry in NHS Tayside
Authors: Leung Thomas , Etherington Lori-an , Stevenson Neil 
Published: June 2021

AimsOur aim is to improve the accessibility of Psychiatry to other specialties when being contacted for review and advice, both in hours and out of hours.BackgroundFrom clinical contact and informal conversations, other specialties sometimes have difficulties contacting psychiatry for advice/review. The aim of this is quality improvement project is to determine how accessible we are to other specialties and work on improving how we communicate with the general hospital.MethodWe created a questionnaire for colleagues from other specialties to fill in from 26/9/19 for 6 weeks. We gathered information regarding their grade, work site, previous contact with psychiatry, whether they knew where to find our contact information and if they could identify the correct method to ask for advice from general adult psychiatry (GAP), Psychiatry of old age (POA) , and out of hours psychiatry (OOH). We also asked colleagues to put in free text comments regarding their experience in contacting psychiatry. We also asked if our colleagues were aware of how to perform an Emergency Detention Certificate as this is advice we sometimes give which does not always need our input immediately.ResultThere was a total of 39 responses, 29 from Ninewells Hospital (NW) and 10 from Perth Royal Infirmary (PRI). There was a mixture of staff grades from Foundation Doctors to Consultants. 23/39 colleagues knew where to find contact information for Psychiatry, 14/39 colleagues correctly answered how to contact GAP (Phone), 15/39 colleagues correctly answered how to contact POA (Email), 15/39 colleagues correctly identified who to contact OOH, and 16/34 colleagues who could do emergency detentions (FY2+) knew how to do one. Free text comments often referred back to the difficulty of finding the right grade of staff first try, Feedback from PRI where there was no dedicated Liaison Service and relies on a duty doctor system was less positive, with terms ‘tricky’, ‘difficulty’, ‘awkward’ used in majority of responses.ConclusionFrom our results we can conclude that contacting Psychiatry in NHS Tayside can be confusing for other specialties. Taking this forward, we will utilize the ‘referral finder’ system in NHS Tayside and review the existing information available, and to update the contact information for our subspecialties to make contact ourselves more streamlined and accessible. We will also review appropriate clinical protocols that we can link to our page on referral finder to help save time for our colleagues as well.
Improving attendance in addictions - do quality improvement plans work?
Authors: Mayet Soraya , Shahbaz Shumaila 
Published: June 2021

AimsWe assessed whether a quality improvement plan initiated in 2018 had sustained benefits for improving attendance rates at addiction prescriber reviews, after 13 months.MethodThe QIP re-audit had Humber Teaching NHSFT approval. We assessed electronic healthcare records of patients prescribed OST at a specialist addictions service, spanning a large geographical area, split into three Hubs. Data were analysed via Microsoft excel.Baseline data for the whole addictions service were collected in April 2018 (n = 343), followed by QIP implementation. The QIP included a new appointment letter explaining the importance of the prescriber review, text message confirmation and reminder the day before, verbal reminder from keyworker and a call from the prescriber explaining the importance of attending (for persistent non-attenders). In the event of nonattendance, a medication safety review was completed. Further data were collected in December 2018 (n = 339) and a re-audit of one Hub (n = 91) was completed in Jan 2020.ResultAt baseline in April 2018, half (50% n = 170/343) of all patients had attended an addictions prescriber review in the last 3 months; Hub 1 (55%; n = 52/95), Hub 2 (34%; n = 45/133) and Hub 3 (65%; n = 73/115). The Quality Improvement Plan was implemented. Attendance rates for subsample (Hub 1) conducted in Oct 2018 showed a reduction in attendance (51%; n = 48/92). This led to the enhanced Quality Improvement Plan.After the enhanced Quality Improvement Plan implementation in Dec 2018, attendance rates improved for all Hubs to 76% (n = 258/339); Hub 1 (77%; n = 72/93), Hub 2 (73%; n = 97/133), Hub 3 (79%; n = 89/113). For non-attending patients, a medication review was conducted in their absence by the prescriber for most (94%; n = 74/81) patients (see table 1 and Figure 1).In January 2020, reassessment of attendance rates for Hub 1 (subsample), in January 2020 (n = 91) which showed attendance had increased to 86% (n = 78/91). All (100% n = 13) patients who did not attend for the prescriber review in person, had a medication review in their absence. In addition, the reasons for nonattendance were discussed with the patient and their keyworker, following which they were booked for a subsequent appointment.ConclusionNonattendance at clinical appointments causes a significant financial burden across the NHS. It was fantastic to see that the QIP improved patient attendance rates and this was sustained and improved, over a year later. Serial non-attenders may need an enhanced strategy.
Remote psychotropic medication advice for general practitioners: a quality improvement project
Authors: Rackley Emily , King Rosemary 
Published: June 2021

AimsOur first aim was to first find out how confident general practitioners were about referring in to the Gloucester Recovery Team and managing psychotropic medications. Our second aim was to then improve general practitioner's self-rated scores of confidence in managing psychotropic medication whilst also improving general practitioner's satisfaction with waiting times for patient's referred to the Gloucester Recovery Team.MethodWe planned to introduce an email address for GPs to use to seek medication and diagnostic advice for patients known to and not known to the Recovery Team. We initially introduced this for the ‘Team 2’ catchment area consisting of five practices within Gloucester. These were then read and replied to by the Team 2 consultant, Dr Ikram, as appropriate. A further survey was then sent out.. These results provided both quantitative ordinal data through a likert scale, which was then transformed into binomial data, such as those scoring ‘extremely confident’ ‘very confident’ ‘somewhat confident’ vs ‘not so confident’ and ‘not confident at all’ which is then compared using relative risk.ResultOur response rate for our initial survey was 8 general practitioners, and for our follow-up survey 1 general practitioner and 2 nurse prescribers. Confidence in continuing psychotropic medications increased from 7 out of the 8 (78%) stating somewhat confident to extremely confident to 3 out of the 3 (100%) after the introduction of the email; a relative change of 1.14 (95% confidence interval 0.87-1.48 p = 0.318). Confidence in initiating psychotropic medications increased from 4 out of the 8 (50%) stating somewhat confident to extremely confident to 2 out of the 3 (66%) after the introduction of the email; a relative change of 1.33 (95% confidence interval 0.46-3.84 p = 0.594).ConclusionAnalysing the qualitative data showed the email address was used for a variety of requests and advice including: 1) A capacity assessment, 2) Initiating medications for depression and anxiety, 3) Medications during pregnancy, 4) Medication for those with Intellectual Disability, 5) Switching medication, 6) Medications for poor sleep and 7) Mood stabilising medication.This change appeared to be well received, however the response rate was very low which makes full analysis difficult. We also included nurse practitioners working in primary mental health in our second survey, whereas the initial survey was only sent to GPs. This initiative was also only started for 5 of the GP practices within Gloucester, and there may be a different knowledge base/confidence amongst the other practices.
Abstract : stomp in HPFT
Authors: Sharma Anu , Mukherji Kamalika , Shah Chetan 
Published: June 2021

AimsAnalyse the pattern of psychotropic drug use and deprescribing (in the context of STOMP) in people with Intellectual disability and Challenging behaviour in Hertfordshire community team(s) during 2016-17. STOMP stands for Stopping Over Medication in People with Learning Disability, Autism or both.BackgroundPublic Health England in 2015 estimated that on an average day in England, between 30,000 and 35,000 adults with a learning disability, autism or both were taking prescribed psychotropics without appropriate clinical indications . HPFT signed up to the STOMP pledge in 2017 to actively review psychotropic prescribing in line with NICE guidance alongside patients, carers and professional partnerships. This audit provides the outcomes of applying the STOMP Pledge to clinical practice.MethodData collection for the current audit occurred over Q1-5 in 2016–2017. All patients with Intellectual Disabilities on psychotropic medication were reviewed in psychiatric clinics. Awareness was raised about STOMP in teams. A semi-structured tool was developed based on the Self assessment framework published by the ID faculty RCPsych and prospective data were collected after each outpatient visit.Result347 patients were prescribed psychotropic medication and reviewed quarterly between 2016-2017. 96 patients were prescribed antipsychotics for challenging behaviour. Other prescribed medications included mood stabilisers, anticonvulsants, anti-depressants and benzodiazepines. Common antipsychotics used: Risperidone (63), Aripiprazole (14), Quetiapine (9), Olanzapine (4); Chlorpromazine (2). Four patients were maintained on two antipsychotics in varying combinations. The data collection tool noted that alternatives to medication were tried in 32 cases. Deprescribing occurred in 41 casesConclusionThis study represents an attempt to capture the impact of the STOMP principles in a clinical sample. Various alternatives to medications were pursued in the sample such as positive behaviour support, sensory integration, psychological therapies, social support. Younger adults (under 30 years) represented the largest proportion of cases where medication was increased. Adults over 30 years represented the largest proportion of cases where a STOMP reduction occurred. This may reflect the individual factors at play. Younger people with ID and /or Autism are more likely to experience changes in support and structure at transition, whilst older adults may have more physical comorbidities that may influence this decision.zcvv
Views of medical educators on virtual teaching methods and curriculum changes within an undergraduate psychiatry rotation during the COVID-19 pandemic – a quality improvement project
Authors: Williams Ellen , Gupta Nidhi , Oyebode Femi 
Published: June 2021

AimsMedical students at the University of Birmingham have historically undertaken a 9 week psychiatry rotation consisting of clinical placements accompanied by lectures and small group teaching. During the COVID-19 pandemic teaching has been offered in a virtual format and clinical placements have been restricted. Our aim was to survey medical educators regarding these changes, seeking their views on resources and skills required for virtual teaching, student engagement, and adaptations to placements.Method73 medical educators who had undertaken teaching or clinical supervision were invited to complete an anonymous online survey during December 2020. The survey consisted of Likert scale and open space questions surrounding changes necessitated by the pandemic. Following survey closure quantitative data were analysed using Google Forms and Excel. Qualitative data from the survey were reviewed by all team members to identify relevant themes.ResultOverall response rate was 40% (29), with participants from 5 NHS trusts. 72% (21) of educators felt they had adequate equipment and resources to facilitate virtual teaching. 55% (16) felt they had adequate training and skills to use virtual teaching platforms effectively. However only 17% (5) felt that students were able to engage in virtual teaching to the same extent as face to face sessions, and just 35% (10) of educators reported enjoying virtual teaching. 76% (22) agreed that information from the University about adjustments to clinical placements was adequate. 66% (19) felt that there had been adequate support to ensure the safety of students, supervisors and patients. However only 20% (6) felt that students had adequate patient contact and 69% (20) did not feel that students had been able meet their clinical competencies.ConclusionOur results suggest that the majority of educators have not enjoyed teaching virtually, and feel that students were less engaged. However educators were able to identify some benefits, such as inviting speakers from outside the local area, improved access to manager's hearings and tribunals and the use of simulated patients. There were also innovative suggestions, such as interactive quizzes and feedback polls within sessions. Most educators felt students had not received adequate patient contact during the pandemic and suggestions for improvement were less readily identified, they included changes to work place based assessments and timetabling. We hope using these results to work with the University to develop resources to support educators using virtual teaching methods, and to consider adjustments to clinical placement while the pandemic persists.
Trust-wide improvement and standardisation of the medical handover
Authors: Yisa Kabir , Ramkisson Roshelle , Mohan Anoop 
Published: June 2021

AimsPrimary: To improve the quality of medical handover by increasing trust-wide completion rate for agreed quality standards from baseline to 80% by July 2019To standardise the medical handover across all 5 boroughs within the trust by July 2019Secondary: To separately assess the completion rate for new patient checks in relation to baselineBackgroundNot only is there a recognised variation in the medical handover across Pennine care foundation trust's (PCFT) 5 boroughs (Tameside, Rochdale, Bury, Oldham and Stockport), but there also appears to be diminished adherence to quality standards to a varying extent. This was shown to result from a combination of human factors and process errors consequently leading to near-miss clinical incidents. This project was therefore designed to highlight and address these issues in order to promote patient safety.MethodHaving identified the problems and agreed on quality standards, baseline data were gathered through May 2019 with the primary outcome measure being the percentage completion rate for quality standards across all handovers. Changes were made to the handover document in June 2019 followed by introduction of a new handover document and post-intervention data collection through July 2019. Doctors’ satisfaction with the new handover document using a typical 5-level Likert scale was measured using a trust-wide online survey.ResultOur results showed a considerable Trust-wide improvement in the completion rate for agreed quality standards from 54% at pre-intervention to 77% at post-intervention with all 5 boroughs demonstrating improvement to varying extents. This is noted to be reasonably close to the project aim of improving the completion rate from baseline to 80%. With regards to new patient checks, there was a marginal Trust-wide increase in completion rate from 53% at pre-intervention to 56% at post-intervention. Additionally, the trust-wide online survey measuring doctors’ satisfaction with the new handover revealed a majority (82%), either strongly agreed (27.3%), or agreed (54.6%), that the new handover document has improved the overall quality of handovers.ConclusionTrust-wide standardisation of the handover has now presented the opportunity to benchmark boroughs within PCFT against one another in terms of adherence to quality standards and alignment with best practice relating to patient safety. While substantial improvement may have been made in the overall quality of handovers across the trust, the inter-borough disparity in the extent of improvement identified gaps for future follow-up or related projects.