bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial representation of psychological services in a London male remand prison
Authors: Covey Josh , Williams Joanne , Kothari Radha , Bartle Scott 
Published: June 2021

AimsTo investigate whether racial groups are proportionally represented in referrals for trauma, hearing voices, emotional regulation and psychological therapy.To understand the psychological needs across racial groups in HMP Wormwood Scrubs, the UK's 4th-most diverse prison.To see if the long-established under-representation of Asian males and over-representation of Mixed males in psychological services in the community is also occuring in the prison system.MethodPsychological referrals were recieved via the medical notes system (SystmOne), whereby a prisoner's name, age, location, racial group and reason for referral are trasnferred into the psychology referrals database.773 referrals were made between October 2018 and May 2020. As the prison's population throughout this time period was fluid, the month of December 2019 was used as a reference for the general prison poipulation.Racial groups were specified using the Office of National Statistics' 5-category classification system (White, Black, Asian, Mixed and Other).ResultThere is a consistent under-representation of Asian males in psychological referrals in relation to their general prison population. Whilst this group makes up 17% of the population of the prison, only 10% of prisoners referred to psychological services identified as Asian.Those identifying as Mixed are over-represented in trauma referrals and psychological therapy referrals. The prison's mixed population is 7%, whereas 16% of those being referred for these two reasons were from the same racial category.The proportion of patients who identified as Black, White or Other and were referred for psychology input were found to be representitive of the wider prison population, suggesting no clear over or under-representation.ConclusionTrends seen in the community in regards to Asian males being under-represented in psychological services are also evident in one of the UK's most diverse prison populations.Public health campaigning to reduce stigma and promote help seeking in BAME communities is of vital importance to provide the needed support for those silently dealing with psychological problems.The two largest racial groups in the prison, White and Black individuals, where found to be proportionally represented in their respective referrals to psychological services.One key finding was in regards to Mixed race individuals, who comprise 7% of the total prison population but 16% of psychology referrals. As this racial group is one of the fastest-growing in addition to be over-represented in referrals, it is vital to understand how provisions can be put in place to appropriately address the needs of this group.
Psychotropic prescribing practices in adults with intellectual disability and autism spectrum disorder in Richmond Neurodevelpmental Services
Authors: Dissanayake Anushka , Davey Nicholas , Patel Rupal 
Published: June 2021

AimsOur aim was to evaluate psychotropic prescribing practices in adults with intellectual disability (ID) and autism spectrum disorder (ASD) across the Richmond Neurodevelopmental Service (NDS).Stopping over-medication of people with a learning disability, autism or both with psychotropics (STOMP) aims to reduce the potential harm of inappropriate use of psychotropic medications. We aimed to evaluate our prescribing practices in keeping with STOMP and the NICE guidelines.MethodWe collected information from our clinical records on patients that met the inclusion criteria (≥18 years + diagnosis of ID and autism) from October-November 2019. We gathered the following: age, sex, severity of ID, psychiatric diagnoses, psychotropic medication, presence of challenging behaviours, involvement of positive behaviour support (PBS) and documentation of a PBS plan.Result32 patients met our criteria (3:1 Male-Female ratio with an age range of 20-74 (Median 33 years old)). All 32 patients showed evidence of challenging behaviours. In the cohort, mild ID represented 18.8% (n = 6), moderate ID 40.6% (n = 13) and severe ID 40.6% (n = 13).17 patients (53%) had a PBS plan in place. For those without a PBS plan (47%, n = 15), a referral to behavioural analysis had been considered/requested in 67% (n = 10).31 patients were on psychotropic medication and 84% (n = 26) had an indication documented in the notes although every patient had had a medication review in the last 6 months. 67.7% (n = 21) of the prescriptions were for challenging behaviours.The average number of medications prescribed was 2 (median 2, mean 2.41) but this was reduced to 1 (median 1, mean 1.76) when additional psychiatric diagnoses and epilepsy were excluded.ConclusionPrescriptions are regularly reviewed in keeping with STOMP guidance but there is more scope for utilising behaviour analysis input as well as the need to improve documentation of the rationale for psychotropic medications.
An audit of Individual Care Plan (ICP) in Dublin North City and County (DNCC) child and adolescent mental health service (CAMHS)
Authors: Egbuta Uchechukwu , Howley Cillian , Selvarajoo Anitha , Iqbal Muhammad , Meskauskait Diana 
Published: June 2021

AimsThe objectives/aims of the Audit include:
1.To standardize and implement ICP for service users attending DNCC CAMHS team in accordance with the established policy.2.To achieve greater involvement of service users/parents in ICP.3.To standardize and improve treatment of care involving all members of one team.BackgroundEvery patient should have a care plan. Each care plan has a set of needs and goals. These are agreed between the service user and key worker and are assessed and measured frequently. Consultation with each service user/parents, as far as practicable is important. Specification of treatment and care required in accordance with best practice should be recorded. Identification of the necessary resources should be recorded and discussed with service user and key worker. Records kept in one composite set of documentation, and a signed copy should be made available to the service user/parents.MethodFirst Cycle commenced 15th October 2019. 166 files were selected from CAMHS team. Data were collected from clinical records from time of admission into CAMHS service to the time of audit. The audit report was prepared on the 6th December 2019, and intervention discussed at the multidisciplinary team meeting and wider DNCC CAMHS academic meeting. Second Cycle 23rd March 2020. 30 files randomly selected and audited. Data were collected by Dr Uchechukwu Egbuta, Mr Cillian Howley, Dr Anitha Selvarajoo, under supervision of Dr Muhammad Iqbal and Dr Diana Meskauskaite.Method of data input/analysis is IBM SPSS.ResultFor each ICP, the following were looked at: Files with ICP, Identifiable key worker, Formulation, Goals, Action plan, Copy of ICP to young person/parents, Next Review Date, Projected discharge date.Overall compliance shows 62% in first cycle, and 68% in second cycle after intervention.There was a 6% quality improvement of ICPs in terms of overall compliance in applying the various components of ICP.ConclusionEach service user should have an individual care plan. Each individual care plan should be measured regularly. To develop a therapeutic individual care plan, a formulation of the case from history taking is essential looking at the bio-psychosocial model and should be service user focused. Care plans are part of clinical governance, therefore continuous re-audit every three months was recommended. The follow-up audit will be carried out by the multidisciplinary team members.
Constipation and clozapine: a QI project in Leicestershire Partnership NHS Trust, (LPT)
Authors: Evbuomwam Ehimwenma , Kinnair Dan , Mirza Mohammad , Coleman Julian 
Published: June 2021

AimsConstipation in patients on Clozapine is the biggest cause of mortality. We have no set protocol in LPT for how to manage and monitor Constipation in Clozapine initiation in the inpatient setting. Internationally protocols, (such as the Porirua protocol) exist but have not been widely used locally.We wanted to assess local compliance with monitoring constipation in patients admitted to hospital and started on Clozapine. We also wanted to assess whether patients are prescribed PRN or regular laxatives, before considering implementing a local protocol.MethodIn LPT we use the ZTAS system for prescribing Clozapine. They provided us with a list of patient IDs who had recently started on Clozapine.We captured data on patients started on Clozapine.
1.What date was this started?2.What date was either PRN or regular laxatives started?3.Was a bowel chart recorded?4.Any evidence of constipation or significant bowel issues relating to Clozapine?ResultWe initially analysed 30 patients, (20 of whom were initiated on Clozapine as inpatients, and 10 as outpatients). A bowel chart was started in only 1 inpatient. Laxatives were started in 50% (15, only 3 of whom were outpatients). 14 were regular and 1 was a PRN prescription. 12 inpatients had constipation, and 1 outpatient suffered with constipation. 2 patients suffered with diarrhoea but there were no other significant issues with bowel problems.ConclusionFrom our initial data we can see that there are many inconsistencies in practice.Existing patients on Clozapine attend a local clinic, (Clozapine clinic) where ongoing monitoring of constipation, (and other parameters, e.g. ECGs etc are completed).We have written a new protocol which we will share, that the trust has implemented, that identifies when PRN and regular laxatives should be prescribed. We have also expanded the protocol to agree for initiation of Olanzapine bowel charts and PRN laxatives should be used.
Audit on availability, quality and frequency of clincal and educational supervision
Authors: Gnanasekaram Gayathri , Hoar Amanda 
Published: June 2021

AimsGMC defines clinical supervisor as a trainer who is responsible for overseeing a specified trainee's clinical work throughout a placement in a clinical or medical environment and is appropriately trained to do so¹.This AUDIT aimed to review the frequency, content and quality of clinical supervision for psychiatric trainees within Somerset NHS Foundation Trust. Both Severn deanery and Somerset NHS Foundation Trust both recommend psychiatry trainees have one hour of supervision per week, involving exploration of trainee clinical and educational needs.MethodAll trainees working in Somerset NHS Foundation Trust psychiatry from February 2020 were invited to participate. A survey was designed to quantify the frequency of supervision amongst this cohort. Survey online software, SurveyMonkey, was chosen for the accessibility and user friendly modality and disseminated via email to all junior doctors (n = 27). Survey responses were collected in the last month of the placement (July–August 2020).Questions on accomplishing workplace based assessments (WPBA), managing e-portfolio requirements were asked, with Likert scale responses available. Quality of supervision was explored via white space answers.Surveys were reviewed by the AUDIT authors and descriptive data collected.Result63% trainees responded (17 out of 27). Educational objectives were discussed at the beginning of the placement. Over half the respondents stated that time was not set aside to look at e-portfolio.Workplace based assessments (WBPAs), and Case based discussions (CBDs) were more frequently achieved than observed assessments of clinical encounters (ACEs/Mini-ACEs) (assessment of clinical encounter).30% core psychiatry trainees respondents (4 out of 7) discussed their audits/QI projects with their supervisors most/always. 42% (3 out of 7) had a discussion sometimes.2 GP and foundation trainees stated they were unable to obtain community mental health experience. The response rate to this question was disappointing and we think it may be secondary to the pressures of the pandemic.100% respondents described educational supervisors as supportive and approachable.ConclusionWhilst all respondents found their supervisors approachable and supportive, completion of formal WPBAs and portfolio reviews was suboptimal.Following regional presentation of results, the pertinence of these findings for all trainees was highlighted. A supervision template has been created and extension of this initial audit to a regional quality improvement project is underway.Specific recommendations included brief and regular supervisor check-ins with trainees regarding projects and psychotherapy competencies and a mid-placement review of portfolio.
Are medications with anti-cholinergic properties prescribed and reviewed appropriately on a male older person's organic ward?
Authors: Greenhalgh Ben , Anwar Hina , Hedley Rosemary , Perkins Celine , Shaw Rachel 
Published: June 2021

AimsPatients admitted to Roker ward (male organic psychiatric ward) should have a decreased anticholinergic burden of medication on discharge compared to admission. This will be demonstrated by a reduced score on the Anticholinergic Cognitive Burden (ACB) scale on discharge compared to admission. Target: 80%.Where new medicines with anticholinergic burden are prescribed during admission, there should be evidence that the anticholinergic properties of these medications have been considered prior to prescribing (via documentation in care co-ordination reviews or progress notes). Target: 100%MethodElectronic records were searched for all discharges from Roker ward between 1/1/2019 – 31/12/2019. For each record the follwing information was recorded: demographics; primary diagnosis; total ACB score on admission; and total ACB score on discharge. For all new medications started with an ACB score of over zero, records were searched to establish whether there was evidence that the anticholinergic properties of these medications had been considered.Result47 patients were identified who were discharged over the time period in question. 30 patients had no difference in ACB score between admission and discharge; 10 patients had a reduction in ACB score and 5 patients had an increase. A total of 9 new medications with ACB scores over zero had been started during all admissions; there were no occasions where there was documented evidence to show that the anticholinergic burden of these medications had been considered.Conclusion27% of patients had a reduction in their total ACB score during admission; the target was 80%.The reasons for starting medications with an ACB score of greater than 1 were documented in 0% of cases; the target was 100%.As both targets were missed by a significant margin, it was recognised that there were significant areas for improvement. The following plan was therefore implemented:
1.Following discussion with the ward consultant and ward pharmacist, regular prescriber meetings have been set up which involve senior nursing staff, medical staff and pharmacy – anticholinergic burden is calculated for each patient as part of these meetings2.A re-audit is recommended after 6 months.
A review of documents assessing capacity and treatment needs to safeguard adults with incapacity
Authors: Hoggard Tereza , Holliday Robin , Julyan Everett 
Published: June 2021

AimsTo audit the completion of Adults with Incapacity (AWI) documents (Assessment of Capacity, Section 47 Certificate of Incapacity and Treatment Plan) to ensure they met the legal standards required. We hypothesised that the forms were not all completed comprehensively, particularly with regards to the Treatment Plans.MethodIn addition to being legal documents, AWI documents provide an important framework to guide clinicians when giving treatment and balancing patient safety with patient autonomy. Correctly completed documents help provide vulnerable patients with ethical and lawful treatment that allows them to be treated with respect and dignity.An audit was conducted across two Old Age Psychiatry wards at Ayrshire Central Hospital during October 2020. We assessed all AWI documents available on the wards (n = 20) using criteria based on the standards set by the Mental Welfare Commission for Scotland to ensure legal competence.Result95% of the forms were signed and dated, and the nature of the incapacity was given in 100% of the documents. On the other hand, 35% of the forms gave no indication of the presence or absence of a guardian. Only one of those identified as having a guardian was consulted with regards to the treatment plan. Another member of staff was consulted on the Treatment Plan in 45% of cases. 30% of the Treatment Plans were not precisely worded enough to be considered justifiable for treatment. In the Certificate of Incapacity, two out-of-date certificates were found, and staff were notified immediately. 45% of certificates were considered over-generalised with regards to the description under medical treatment.ConclusionOverall, the forms were mostly signed and dated, with the nature of incapacity given. The two areas that appeared to be the most problematic were the issue of identifying and discussing plans with a guardian, and the specification of treatment covered by both the Certificate of Incapacity and the Treatment Plan.Discussion with members of the healthcare team found some confusion over how to complete the forms and many cited a lack of formal training as the main reason for their uncertainty. In addition, accessing clear information online or on the wards on how to complete the forms was challenging. We intend to improve the completion of these documents by implementing teaching and a guidance poster, based on the areas that we identified as being problematic, and completing the audit cycle.
Off-label prescribing of quetiapine in HMP Elmley, a Category B remand prison: a re-audit
Authors: Igbinomwanhia Nosa , McCurdy Kathleen 
Published: June 2021

AimsThis was a re-audit of off-label prescribing of quetiapine in order to identify the number of patients on off-label quetiapine in HMP Elmley, to monitor compliance by the Mental Health Inreach Team (MHIRT) psychiatrists with the Royal College of Psychiatrists guideline on off-license prescribing, to compare findings with the baseline audit and to identify areas for improvement.MethodAll patients on quetiapine in HMP Elmley were identified and their electronic patient record was reviewed against the standards outlined in the Royal College of Psychiatrists “Use of licensed medicines for unlicensed applications in psychiatric practice (2nd edition).ResultThere were 60 residents on off-license quetiapine prescription in HMP Elmley.Of this number, four had their prescription initiated by a general practitioner, either while in prison or in the community. Two residents were on quetiapine first prescribed while they were on admission in hospital. 5 patients had been initiated by the MHIRT psychiatrists. 38 residents were commenced off-license quetiapine by another psychiatrist, either while they were in the community or in another prison. In 17 patients, electronic records were inadequate to determine who had prescribed the quetiapine.The number of inmates prescribed off-label quetiapine in HMP Elmley had dropped from 82 to 60 in the 1 year since the initial audit. Of these figures, prescriptions initiated by the MHIRT psychiatrists, had dropped from 28.1% (23/82) to 8.3% (5/60).For those prescribed quetiapine by the HMP Elmley psychiatrists, notes were audited against the RCPsych guidelines:
Licensed medication was considered first in 80.0%Risks and benefits were considered and documented in 80.0%The benefits and potential risks were explained to patient in 80.0%There was documentation of informed consent in 80.0%Quetiapine was started at a low dose and monitored in 100%No residents required withdrawal of medication due to ineffectiveness or adverse effects.Baseline physical health assessment was performed in 80.0%, though all had an ECG done.ConclusionOver the past year there has been an improvement in off-label antipsychotic prescribing practice within the MHIRT.However, the number of off-label antipsychotic prescriptions still remains high throughout the prison. There should be continued effort at minimizing off-label prescribing within the MHIRT, monitored by auditing. However, work needs to be done jointly with other prescribers, such as GP colleagues, in order to avoid unnecessary prescriptions and to monitor regularly the physical and mental health of those on off-label quetiapine.
Vitamin D monitoring and management in the inpatient services – reaudit
Authors: Krishnan Vasudevan , Doyle Ciara , Rusilowicz Maciej 
Published: June 2021

AimsTo survey the prevalence of monitoring of vitamin D on an inpatient ward.To audit the treatment if there is identified vitamin D deficiency or insufficiencyTo compare differences between findings in auditsMethodAll inpatients admitted to Milford centre between August 2019 and August 2020 were selected as part of the sample size.Data were collected by FY1 and FY2Patients’ laboratory results were accessed to determine vitamin D levels.E-notes were used to conclude who were vitamin D sufficient or deficient for treatmentThe standard for the audit were as per:Management of vitamin D deficiency or insufficiency in adults – CKS (2018)The above was based on National Osteoporosis Society (NOS) guideline Vitamin D and bone health: a practical clinical guideline for patient management [National Osteoporosis Society, 2013] and Scientific Advisory Committee on Nutrition (SACN) guidelineResult201748/188 patients had vitamin D levels measured36/48 patients had sufficient vitamin D levels12/48 patients were either deficient or insufficient12/12 patients were treated where found deficient or insufficient202090/115 patients had vitamin D levels measured47/90 patients had sufficient vitamin D Levels43/90 patients had either insufficient or deficient vitamin D levels22/43 patients had treatment documented in noted where found deficient or insufficientConclusionDifficult to make comparisons with previous audit due to difference in number of patients testedVitamin D is routinely tested on Milford ward on admission hence the large number compared to the last audit52% had noted to have sufficient levels of vitamin DConcerning were results that only 51% of those deemed to have insufficient or deficient were treated based on notesPotential reasons could be:Prescribed in medication card and not documented in notes.Vitamin D results checked in another ward, no supplementation given, and then transferred to Milford house.Patients refused treatment but not documented adequately.Patient discharged before results were received due to quick aroundResults were deemed insufficient in terms of the range but very close to normal hence decision made not to start supplementationResults to be disseminated with medical and nursing colleaguesRe-audit in September 2021