bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of ADHD medication prescription and monitoring in intellectual disability services, Greater Glasgow & Clyde
Authors: Bansal Neha , Hayat Muzammil 
Published: June 2021

AimsStudies have shown that people with intellectual disability (ID) show a greater severity of attention deficit hyperactivity disorder (ADHD) symptoms and atypical presentation, as well as having a greater risk of developing comorbidities, such as challenging behaviour, anxiety, tic disorders and sleep problems. It is estimated that 1.5% of patients with ID will have a clinical diagnosis of ADHD.The aim of this audit was to find whether individuals with ID and ADHD, who are prescribed medication for ADHD are adequately monitored and reviewed in accordance with the ADHD medication prescription guidance by NICE and the Royal College of Psychiatrists (RCPsych).MethodThis audit looked at ADHD medication prescription for the ID population within Greater Glasgow & Clyde NHS. This is the 6th audit cycle where electronic records (EMIS) were analysed between 28/9/19 to 09/10/20. (The 5th cycle data collection period ended on 28/9/19). We collected data on all patients aged over 18 years.An audit tool was developed to find whether the following were documented; patient demographics, physical health monitoring, symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review. 100% of patients should have all components on the ADHD audit tool documented, as per NICE/ RCPsych prescription guidance.Result32 patients were identified as being diagnosed with ADHD prescribed medication. One patient was impacted by the COVID-19 pandemic which meant that the required monitoring was not fully carried out. The age ranged from 18 to 56 years. 75% had mild intellectual disability, 19% had moderate and 6% had severe, with no cases of profound intellectual disability. Blood Pressure/pulse was recorded in 84% of patients. Height/weight/ BMI was recorded in 81% of patients. 97% of patients had ADHD symptom severity, medication dosage, side effects, need for ongoing treatment and frequency of review recorded.ConclusionThere is further scope for improvement in the monitoring and documentation of physical health observations, however there was a significant improvement compared to the previous cycle of the audit. Other aspects of monitoring and documentation appear to be recorded in almost 100% of patients. This finding emphasises the challenges of physical health monitoring and compliance in psychiatry as a whole. We need to continue to encourage awareness and education around the physical health risks to our patients, not only due to their comorbidities but also as a result of the psychotropic medications we prescribe them.
Annual physical health checks within a forensic inpatient service
Authors: Cooper Michael , Gangopadhyay Partha 
Published: June 2021

AimsPatients prescribed antipsychotics are at risk of ill effects to their physical health. Our aims were to assess whether inpatients within a forensic service, on antipsychotic medications, were receiving annual physical health monitoring in accordance with current NICE and SIGN Guidelines. Based on these Guidelines the following objectives were identified:
1: Physical examination, BMI and blood pressure recorded within the past year2: FBC recorded within the past year3: U&Es recorded within past year4: LFTs recorded within the past year5: HbA1C / random glucose / fasting glucose recorded within the past year6: Random lipids / fasting lipids recorded within the past yearMethodInclusion Criteria: Patients admitted for longer than a year currently prescribed an antipsychotic.Data were collected cross-sectionally on 24/7/20 for all inpatients meeting the inclusion criteria. Medical notes and the blood results system were reviewed for results of any annual physical examinations and blood monitoring over the past year.Anonymized data were analysed using Excel.Result13 out of 17 inpatients fulfilled the inclusion criteria. Of these 13 inpatients, 9 (69.2%) were prescribed clozapine, 1 (7.7%) zuclopenthixol, 1 (7.7%) paliperidone and 1 (7.7%) amisulpride.All patients had BMI and blood pressures recorded within the preceding month. Only 1 patient (7.7%) had an annual physical health examination within the past year.Findings for bloods taken within the past year were as follows:12 patients (92.3%) had an FBC recorded9 patients (69.2%) had U + Es recorded9 patients (69.2%) had LFTs recorded11 patients (84.6%) had HBA1c recorded7 patients (53.8%) had lipids recordedConclusionThere is scope for improvement with both annual physical examinations and blood monitoring.All patients had regular BMIs and blood pressure recorded which is largely attributable to nursing staff protocols. Low compliance with full annual physical examination could be explained by there being no local system in place for annual physical health checks and also frequent changes in junior doctor ward cover.Blood monitoring showed variable compliance with established standards. FBC monitoring had the best compliance, likely because the vast majority of our patients are prescribed clozapine, which necessitates minimal monthly FBC monitoring.This audit was presented to the Forensic Team and thereafter it was agreed for a local system to be put in place for annual physical health checks in the summer each year. This will improve oportunities to optimise our patients health. We plan to re-audit at this time.
Audit of the quality and content of discharge summaries from mental health inpatient units across Betsi Cadwaladr University Health Board
Authors: Dhandapani Asha , Soundararajan Sathyan , Williams Laura , Aghahowa Ediriverere Endurance , Clifford John 
Published: June 2021

AimsOur aim was to carry out an audit of summaries sent from inpatient psychiatric units across North Wales (namely Heddfan in Wrexham, Ablett in Rhyl, and Hergest in Bangor), against recommendations from ‘Standards for Inpatient Mental Health Services’ (RCPsych 2014) and PRSB Mental Health Discharge guidelines (2018).MethodAblett summaries are typed onto and electronically sent through the Welsh Clinical Portal (WCP) directly to the GP. Hergest and Heddfan both have their own templates which are then sent to the GP and filed in the case notes. Data were collected from both sources. The first audit cycle used 25 discharges selected at random from the male and female open wards in each site (n = 75 summaries). Data were collected over 3 months time using the audit proforma.ResultAll mandatory headings are automatically inputted into the WCP summary used in Ablett therefore documentation was 100% for information such as patient name, DOB, and GP Details. Documentation of allergies was poor across 3 sites, particularly in Hergest, in which there was no mention of allergy status in 96% of summaries. Only 13% of Ablett summaries and 0% of Hergest summaries reach the GP on the day of discharge, however, 100% of summaries from Heddfan do, possibly due to their method of ‘discharge notification’. The date and location of discharge were documented in 84% of Heddfan summaries, 100% of Hergest summaries, and 100% of Ablett summaries. This implies that this heading is already incorporated into the templates for the 2 sites which scored 100%. In the Ablett, medication was documented in 88%, but we found that in 49% of discharge summaries, the medication was the only field filled in! In these cases, the GP may not even know why the patient had been admitted. This is clearly unacceptable. Risk history is poorly documented across the sites, with 0% in Hergest and Heddfan, and 12% in Ablett. 0% of summaries across the Health Board mentioned crisis contacts. 0% of summaries in Heddfan and Ablett contained details of the patient's care coordinator.ConclusionOur audit has identified a lack of psychiatry-relevant headings in the discharge summaries, particularly for those working in Ablett.
An audit of ECG monitoring in patients admitted to the general adult wards at clock view hospital
Authors: Hyland Declan , Thandi Unmol , Mahamithawa Udani , Elagamy Yasmine , Uddin Mohammed 
Published: June 2021

AimsTo identify whether patients admitted to the general adult inpatient wards at Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust, have an ECG performed following admission and whether, if this done, the ECG report is properly documented in the patient's electronic record, and whether those patients with an abnormal ECG have any further investigations requested.BackgroundAn important risk factor for development of cardiac disease is use of psychotropic medications. Antipsychotics can increase the QTc interval.NICE guidelines recommend that, before starting antipsychotic medication, an ECG should be offered if physical examination identifies cardiovascular risk factors, there is personal history of cardiac disease or if the individual is being admitted to hospital. The Royal College of Physicians states all patients should be assessed for cardiovascular disease, including having a routine ECG. Mersey Care's physical health policy recommends all new admissions to inpatient wards have an ECG performed within 24 hours of admission as part of their admission physical examination and investigation.MethodA sample of 60 patients discharged from the general adult wards at Clock View Hospital between 16th of July 2019 and 30th of September 2019 was obtained. An audit tool was designed and each patient's electronic record scrutinised to determine whether an ECG was performed within 24 hours of admission; in those patients who didn't, whether the reason why was recorded; and whether those patients who had an abnormal ECG were referred for further investigation. The quality of documentation of ECG reports was also analysed.ResultAge range of patients was 19–66 years. Only 31 patients had an ECG performed within 24 hours of admission. Of the remaining 29, there was documentation of why an ECG was not performed in only 16 cases. Thirteen patients had an abnormal ECG, but only three were referred for further investigation. Of the ECG reports that were analysed, only a minority met the required standard for “good”, with there being no documentation of the ECG report in one third of cases.ConclusionThere is significant room for improvement in performance of ECG monitoring and documentation of the ECG report. The importance of the ECG as part of the admission process needs to be highlighted in the induction of junior doctors. Training nursing staff on the wards to perform ECGs would reduce the likelihood of unnecessary delay to a patient having an ECG done following admission.
An evaluation of the prevalence of weight-related comorbidities in patients following admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust
Authors: Hyland Declan , Prime Millie , Khaliq Rabia 
Published: June 2021

AimsThis audit aims to evaluate the prevalence of any weight-related comorbidities in patients following their admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust.BackgroundObesity has an increased prevalence in those with mental disorder. There are many factors that influence this, e.g. sedentary lifestyle and poor dietary intake. Medication prescribed to treat mental disorders may increase risk of weight gain, particularly most of the second generation antipsychotics. Patients with severe mental illness are at increased likelihood of developing weight-related comorbidities - essential hypertension, ischaemic heart disease, hyperlipidaemia and type II diabetes mellitus.Many patients with severe and enduring mental illness do not readily or regularly access primary care services. Admission to the psychiatric ward therefore provides an ideal opportunity to address, not only the patient's mental health issues, but also any physical health issues.MethodA list of all inpatients on the eight general adult wards was obtained on 3rd of December 2020. Inpatients on the Psychiatric Intensive Care Unit were also incorporated, providing a final sample of 148 inpatients.An audit tool was designed, to collect demographic data for each inpatient – gender, age, ethnicity, psychiatric diagnosis, as well as the presence of any cardiovascular comorbidities and, if so, what were they and how many were present.ResultOf the 148 inpatients, 91 were male, 57 female. Patient age ranged from 19 to 71 years. The majority were of “white British” ethnicity. The most common mental disorder diagnosis was schizophrenia (35 inpatients), followed by schizoaffective disorder (22 inpatients). Twenty-one of the 148 patients had at least one weight-related comorbidity recorded. Only 2 of the 21 inpatients with a diagnosis of one or more weight-related comorbidity had a recorded BMI in the “healthy” range. The gender split for the presence of weight-related comorbidities was almost equal. The most common comorbidity recorded was type II diabetes mellitus. Most patients with a weight-related comorbidity had only one recorded, but three patients had two comorbidities recorded, and one patient had three recorded.ConclusionA significant proportion of patients admitted to the general adult inpatient wards in the trust have a weight-related comorbidity. Admission to hospital provides an ideal opportunity to review the management of any such comorbidity and optimise this as required. There is a need to ensure there is a strong focus on, not only the patient's mental health issues, but also his / her physical health status.
Audit of section 2 and section 3 mental health act paperwork in Derby inpatient psychiatric units using an audit tool by Mason et al. (2012)
Authors: Pearson Abigail , Horton Andrew , Akroyd Mike 
Published: June 2021

AimsComplete an audit of Section 2 and Section 3 Mental Health Act Paperwork in Derby Inpatient psychiatric units using an audit tool developed in a study by Mason et al. (2012).BackgroundThe 1983 Mental Health Act enables doctors approved on behalf of the Secretary of State under Section 12 to be able to make recommendations for the detention of individuals with a mental health problem where the degree and/or nature, and associated risk to that person's health or safety, or that of others, makes inpatient care necessary. For the detention and the associated deprivation of their liberty to be lawful, it is necessary that the clinical situation meets certain criteria as outlined in the Mental Health Act.MethodWard status was reviewed for each inpatient ward in Derby and the first five patients alphabetically, who were detained under sections 2 or 3 were selected. The Mental Health Act medical recommendation documents were reviewed according to the necessary criteria, using an assessment tool generated from a study by Mason et al. in 2012 ‘Compulsion under the Mental Health Act 1983: audit of the quality of medical recommendations’. A junior colleague was trained to analyse Mental Health Act paperwork using the audit tool. Medical recommendations were reviewed and rated as ‘clear’, ‘implied’ or ‘none’ for each criterion.ResultEvidence of a mental health problem and the nature or degree of illness was well documented. Evidence regarding why informal admission was not appropriate was also reasonable but with room for improvement. Poor compliance was evident mostly in relation to the justification related to risk to health, safety or others, the lowest clearly documented percentage of these appear to be regarding health.ConclusionFrom analysing the documentation, often written justification incorporated general safety as a whole; however health and safety are identified by the mental health act as separate criterion requiring clear justification of each. In a number of occasions people failed to identify which of the three risk categories were relevant for the patient. Potential criticisms of this audit include the subjective nature of the interpretation of clearly explained and implied and that data analysis was completed by a non-section 12 approved doctor. Data were presented at the local weekly academic teaching to raise awareness of the results and a recommendation was made for the subject to be included in the junior doctor induction.
An audit of liaison service provision in Aneurin Bevan University Health Board
Authors: Rankin Jennifer , Espley Heledd 
Published: June 2021

AimsAneurin Bevan University Health Board (ABUHB) isundertaking a review of the Mental Health Liaison Service provision within it's acute general hospitals. The current liaison service is a small nurse led team which is available between 8am and midnight. ABUHB has recently opened a new Specialist Critical Care Hospital with the liaison service moving into a new base. A new model of care has been developed across the healthboard which has stretched the Liaison Service across several sites. Therefore, the liaison service may need to expanded to be able to provide high quality and timely care across a wide geographical area. The audit aims to idenitfy areas in which the liaison service is performing well in while identiying areas that need improvement. This audit may provide a focus for recommendations to enhance the current liaison provision.MethodThe liaison service was audited against RCPsych Psychiatric Liaison Accreditation Network (PLAN) quality standards. PLAN identified eighteen functions of a liaison team and provided details of quality standards within each function. These standards are either considered essential, expected or desirable. An accredited service is expected to meet 100% of essential standards, 80% of expected standards and 60% of desirable standards. Data were taken from a combination of sources including ABUHB policies, service managers and senior clinicians within both mental health and acute services.ResultWhen comparing the current liaison service provision in ABUHB, 30% of essential standards were not met and 21% were only somewhat met. Particular domains that were identifed as needing improvement included policies and procedures and urgent and emergency mental health care. 36% of expected standards were met with 41% not met. Notable domains that the service was performing poorly in included governance; induction, and providing teaching and support to acute colleagues. 89% of desirable standards were not met.ConclusionThe audit idenitifed that the current liaison service fails to meet core standards set out by RCPsych. This audit provides quantitative data to demonstrate that the liaison service is in need of improvement and investment. As a result, enhaving the current liaison service is now a priortity for the health board. A business case is being developed to consider enhancing the liaison service with a view to developing a Consultant led multidisciplinary team. The business case can use PLAN quality standards to make recommendations for improvements to the service.
A closed loop audit of clerking psychiatric histories in an acute psychiatric inpatient unit
Authors: Smith Samuel Richard , Ark Rajiv , Aravinth Thirunavukkarasu 
Published: June 2021

AimsAn accurate and complete history is a key component of a medical consultation. Evidence suggests that up to 80% of diagnosis may be made entirely off the patient history. The aim of this closed loop audit was to examine the effects of a clerking pro forma on the quality of doctors clerking histories of new patients admitted to an acute psychiatric inpatient unit, against standards suggested in the New Oxford Textbook of Psychiatry.MethodData for this audit were gathered by finding the initial clerking history for inpatients at The Orchard on ECR and RIO. The clerking histories of the 18 inpatients present on 12.10.20 were initially audited. These standards recommend in the in the New Oxford Textbook of Psychiatry include; Patient Identification (ID), Presenting Complaint (PC), History of Presenting Complaint (HPC), Psychiatric history, Medical history, Family history, Forensic history, Social history, Personal history, Premorbid personality, Mental state exam (MSE). After analysis of the results of the first loop, a clerking pro forma was created and distributed to junior doctors to implement. The clerking histories for the subsequent 18 patients to be admitted were then audited and compared.ResultThe results of the first audit cycle were poor. Only patient identification and presenting complaint were present in 100% of clerked histories. Concerningly, only 72% of the histories included the patients’ medical histories, forensic histories were included 44% of the time, and social history just 39% of the time.The implementation of a clerking history proforma showed improvements in all areas of clerking. Patient ID, PC, HPC, psychiatric history and MSE were now present in 100% of clerked histories. Forensic history showed a statistically significant improvement from 44% to 73% [X2(1) = 5.9; p = 0.015]. Social history showed a statistically significant improvement from 39% to 78% [X2(1) = 5.6; p = 0.018]. Premorbid personality showed a statistically significant improvement from 44% to 89% [X2(1) = 8.0; p = 0.005]. Personal history showed a non-statistically significant improvement from 39% to 56%, as did medical history from 72% to 94%, and family history from 39% to 61%.ConclusionIn conclusion, the implementation of a clerking history pro-forma has significantly improved the quality and completeness of clerking histories gathered by doctors at The Orchard. This is hopefully increase diagnostic accuracy and improve the quality of care of patients in the hospital.
Auditing improvements to physical health in the acute psychiatric inpatient setting
Authors: Silverblatt Joshua A. , Ruparelia Risha , Shodunke Ayotunde 
Published: June 2021

AimsWhilst patient psychiatric health is the primary focus in the acute psychiatric inpatient setting, there has been a recent focus on ensuring a greater integration with physical health to address the physical health outcome inequalities between patients with psychiatric conditions and those without. Despite the ward having a robust physical health clerking proforma, there were issues with its completion; at initial clerking patients often aren't able, or refuse, to consent to physical examination or investigations. This lead to the trust's electronic physical health form, designed to collate these results, not always being completed. Our aim was to increase the rates of completion.MethodChanges to ward handover sheets were made in an effort to increase rates of physical health form completion and improve 24 and 72 hour completion rates. Columns were added delineating which parts of the physical clerking were outstanding, ensuring the MDT were aware of which jobs needed actioning. Data for two months prior and post intervention were analysed.Result266 admissions were analysed for the two months prior and post the intervention. Form completion rose from July (88%) to October (100%), with 24 and 72 hour completion rate increasing from 47% & 55% respectively, to 84% & 96%, during the same time period. Greater completion rates of physical health forms led to increased knowledge of patients’ physical health issues. Having 96% of patients physical health issues within three days of admission (cf. 55%, July), led to a 'physical health huddle' being held during the MDT. This provided a platform to discuss relevant physical health treatment plans with the whole team. These findings were summarised under a new column on the handover sheet and updated biweekly during the MDT meeting. Placement on the handover sheet ensured daily visibility to all staff.ConclusionSimple structural changes can bring physical health to the fore in psychiatric care. Timely and more complete physical health data enabled biweekly reviews of physical health issues and allowed input across the MDT. Increased knowledge and awareness of physical health issues led to an increase in medical review requests. These are currently performed on an ad hoc basis, which can be quite disorganised and inefficient. The results above, of improved physical health outcomes based on a structured approach, have led to a recommendation of a biweekly physical health clinic, with specific staffing allocation, to ensure a more thorough and efficient way to address physical health.