bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of paediatric liaison psychiatry services in England 2015-2019
Authors: Hines Declan , Lee William , Ford Tamsin , Westwood Sophie 
Published: June 2021

AimsLiaison psychiatry services (LPSs) provide psychiatric care to general medical patients. This paper aims to evaluate LPS provision for children and young people In England.MethodThe annual Liaison Psychiatry Surveys of England (LPSEs) included questions on paediatric services from 2015 (LPSE-2). Questions were developed in consultation with NHS England and the Liaison Faculty of the Royal College of Psychiatrists. We analysed data from LPSE-2 and three subsequent surveys.LPSs were systematically identified by contacting all acute hospitals with Type 1 emergency departments listed by NHS England. All identified LPSs were emailed a copy of the questionnaire, with follow-up emails and telephone contact for non-responders. Responses by email, post or telephone were accepted.ResultThe number of acute hospitals with access to paediatric LPSs increased from 29 (16%) in 2015 to 46 (27%) in 2019; all of these hospitals had access to adult LPSs. The number of paediatric LPSs with at least 11 full time equivalent (FTE) mental health practitioners (MHPs) has increased from 6% to 24% and from none to 16% with 13 FTE or more MHPs. For both LPSE-4 and LPSE-5, there were only two acute hospitals where both 8 FTE MHPs and 1.5 FTE consultants were present. For LPSE-4, only one site met the Core 24 criteria (for adults - there are no criteria for paediatric LPSs) of 11 FTE MHPs and 1.5 FTE consultants, and for LPSE-5, both these sites exceeded them. Other paediatric services did not meet the adult core 24 criteria for a LPS.Acute hospitals with access to 24/7 paediatric LPSs increased from 12% to 19% between LPSE-4 and LPSE-5. In LPSE-5 68% of paediatric LPS worked to a one-hour response time target to the ED. This is an increase from 42% (14/33) in LPSE-4.ConclusionThere are still far fewer paediatric than adult LPSs, but the provision of paediatric LPSs improved from 2015 to 2019, with more services, more staffing, and faster response times. Services need to continue to improve as few services match the adult core 24 criteria for an LPS.
PERCEIVE – Patterning Employment, Race, and Clinical Experience In Violence against Employees
Authors: McClure Ben , Reid Keith 
Published: June 2021

AimsPERCEIVE is a service evaluation counting whether nurse demographics correlate with reported subjection to violence and verbal aggression. The setting was a large mental health, learning disability and neuropsychiatry NHS trust in England. This continues our work to understand correlations reported in the literature between temporary staff and violence.MethodWe consulted the Caldicott, legal, equality & diversity, teams and gained service evaluation permission SER-19-031 from CNTW R&D department. We briefly consulted with staff regarding themes relevant to temporary nurse workers. They expressed concern that staff perceived to be “other” would be at more risk.Employees’ age, ethnicity, employment status, nationality, length of service and seniority are routinely collected for the running of the trust. Therefore, these were anonymously collated then cross-referenced with violence and aggression incident reports (VA IR1s). Chi-squared was used to identify statistical significance. Ethno-national status was taken from self-report. We could not control for hours worked nor could we get agency staff demographic data.We compared “exposure to at least one violent incident” in June, July and August 2019 against the following demographic categories:Substantive vs bank staffBand 5 and above vs band 4 and belowStaff with < 1 year of service vs staff with ≥ 1 year of service“White British” staff vs Non-“White British” staff“British” staff on self-report vs “Non-British” staffAge ≤30 years vs ≥ 31yearsA minimum of 1682 nursing staff were analysed for each category in each month.ResultSubstantive staff, “White British”, “British”, younger, and staff of shorter employment length had greater frequencies of at least one VA IR1s compared to the complementary groups. Length of service was significant only in two months but judged significant overall. There was no statistically significant correlation with seniority. Substantive staff have three times the risk vs bank staff, perhaps mediated by hours worked. Other risk ratios were in the region x1.2 to x1.8.ConclusionBeing British, White British, younger, less experienced or substantive staff correlate with subjection to reported aggression. This did not fit with staff speculation during consultation. Survival effects may be relevant. We are working to get more detailed information. Induction may help reduce aggression against newer staff.
Evaluation of an attention deficit hyperactivity disorder (ADHD) assessment & treatment service
Authors: Nyein Chan , Oyewole David 
Published: June 2021

AimsThe Central and North West London NHS Foundation Trust ADHD clinic offers diagnosis and medication stabilisation for adults with ADHD, in preparation for discharge back to GP for continued prescribing and monitoring. Referral waiting time is shortened by efficiently managing the service and soon transfer of care to GP whilst referrals have been increasingly accepted years on years. A snap shot service evaluation was made to understand characteristics of service exploring its strength and areas to improve.MethodAll 115 patients offered in March and April 2019 for an ADHD specialist assessment were sampled from the new electronic patient record SystmOne in use since 1st March 2019.Data were collected forMale & Female ratioAge range distributionClinical Commissioning Group referral sourceClinic attendance characteristicsADHD diagnosis, sub-types and psychiatric comorbidityADHD Medication prescribedFP10 Prescription duration by prescribersPatient data were anonymously encoded into Microsoft Excel Sheet for sorting, counting, summating and illustrating into tables and pie charts.ResultThe male & female ratio of the sample was 6:5 and nearly half were in age range 20-29 years. Majority were referred from Westminster and West London Clinical Commissioning Groups.107 patients completed the assessment, of which 106 were diagnosed as having an adult ADHD.22% of follow-up clinics were cancelled or not attended (DNA) by patients. The majority of the patients (62%) required 1-2 follow-ups before transfer to GP, whilst 8% did not require or want follow-ups either already being on ADHD medication, not wanting medication or having lost to reviews. Only 3% require six or more follow-ups.Majority were reviewed after two- to five-week prescription, the peak being four-weekly.91% of completion to GP were discharged on ADHD medication, majority being singly on Elvanse (48%) and Concerta XL (25%). Discharge without ADHD medication was due to concerns for its addiction, preference on non-medication treatment, intolerance of medication adverse effect or mental health priority treatment.ConclusionCollaboration with GPs for their pre-treatment physical health screening facilitated prompt prescribing initiation on assessment with most discharges taken place after 1-2 follow-ups, enabling service turn-over with short waiting time (6-9 months in 2018/2019). Service expansion for increasing referral uptake is probably feasible from this baseline by appointing additional sessional clinicians and further efficiency management on clinic scheduling & DNA with a target majority likely requiring 1-2 follow-ups with average four-weekly prescribing.
Changes in patients characteristics and service provision in liaison psychiatry during the COVID-19 pandemic
Authors: Passos Frederica , Constante Miguel , Delgado André , Heitor Maria João 
Published: June 2021

AimsThe SARS-CoV-2 pandemic has led to core changes in the healthcare systems worldwide in terms of access, resources and patient's management. Patients admitted to a general hospital with COVID-19 are at a higher risk for developing or exacerbating various psychiatric disorders, due to the virus brain tropism and associated psychosocial factors. However, there are still limited data regarding the psychiatric needs and mental health care of these patients. The present study seeks to evaluate the changes in liaison psychiatry, patients’ characteristics and outcomes, brought on by SARS-CoV-2.MethodWe retrospectively analyzed liaison psychiatry patients’ characteristics during the second wave of COVID-19 pandemic, between October and December 2020, in comparison with the same trimester pre-COVID-19 in 2019.ResultAt admission to hospital, we found no differences between liaison psychiatry pre-COVID-19 (n = 96) and COVID-19 period (n = 114) groups, for age (p = 0.35), gender (p = 0.96), or hospital resource utilization in the previous year : number of hospital admissions (p = .40), Accident and Emergency presentations (p = 0.61), outpatients clinics (p = 0.20). There was, however, a significant association between pre-COVID-19 vs COVID-19 period groups and psychiatric diagnosis during hospitalization (Χ2(5) = 11.56, p = 0.04), influencing overall respective rates of delirium/dementias (29.2 vs 42.1 %), mood disorders (18.8 vs 26.3 %), anxiety and stress related disorders (22.9 vs 14.0 %), psychoactive substance use disorders (12.5 Vs 9.6 %) and psychotic disorders (10.4 vs 2.6 %). Mortality rate in pre-COVID-19 Vs COVID-19 period increased from 5.2 % to 15.8 % (Χ2(1) = 5.98, p = 0.01), mostly due to increased mortality in COVID-19 patients (7.3 vs 30.3 %, p < 0.001). Referrals to liaison psychiatry increased by 18.8 % during the COVID-19 period, 28.8 % of referred patients were positive for SARS-CoV-2 and time to referral was positively correlated with hospital length of stay (ρ = 0.60, p < 0.001). In the COVID-19 period, fewer patients were referred to outpatient psychiatric follow-up after discharge from hospital (p < 0.001), and delayed discharges for social reasons were of shorter duration (p = 0.001).ConclusionOur findings are consistent with emerging data on comorbid or superimposed mental illness in hospitalized patients with COVID-19, showing a strong impact in neuropsychiatric mani-festations, clinical prognosis and mortality, as well as clinical management. Consideration should also be given to adequate staffing of psychiatry liaison services during the pandemic, in order to attend and safely manage general hospital inpatients mental health needs.
Clinical Audit cycle of Mental Health Act (MHA) documentation for patients on section 3 staying 90 days and over in adult wards at Roseberry park hospital
Authors: Ravishankar Rohini , Kumar Raj , Badanapuram Ramanand 
Published: June 2021

AimsTo complete the audit cycle on compliance of MHA documentation (including MCA1 form at admission and 3 months, T2 form, SOAD request and T3 form authorization) on patients on section 3 staying 90 days and over in adult wards at Roseberry park hospitalMethodIn the initial audit, we collected data from all inpatients on section 3 staying 90 days and over, in Adult acute and rehab wards on Roseberry park hospital between the time period 28/10/19–04/11/19. Using a designated audit data collection tool, information was gathered from each patient's electronic record pertaining to the standards. The same method was used in re-audit where data were collected from all inpatients on section 3 staying 90 days and over in Adult acute wards on Roseberry park hospital between the time period 04/11/20–11/11/20. To note, the rehab ward at Roseberry park hospital was closed in Feb 2020. The data were analysed by the project lead.ResultIn the initial audit, 16 patients records were identified as meeting criteria,out of these 7 (44%) patients were on acute wards and 9 (56%) at rehab ward. Where as in re-audit 5 patients records were identified as meeting criteria and all were on acute wards. Days in Hospital - Ranged from 120 days to 664 days, average being 295 days and median of 186 days in the initial audit compared to121 days to 290 days, average being 170 days and median of 150 days in the reaudit. Percentage of patients records with documented capacity assessment at admission and 3 months were same at 80% and 60% respectively in both audits.T2 form was completed in all consenting patients in both audits. SOAD request sent was recorded in only 1 (25%) patient in the reaudit, which was lower than the initial audit, where in SOAD request was sent in 7 (78%) patients but recorded in 5 (56%) of them. For patients lacking capacity, T3 form was documented only in 4 (45%) patients but T3 form authorisation was discussed with patient and evidenced in case notes in only 1(11%) case in the initial audit, where as in reaudit T3 form was not documented or discussed for any patient.ConclusionThere needs to be improvement in MHA documentation for detained patients.
An audit of vitamin D monitoring and management of deficiency in women's secure services
Authors: Bustin Claire , Pantall Shay-Anne , Rampling Jeremy 
Published: June 2021

AimsTo audit the investigation, identification and treatment of vitamin D deficiency within Women's Secure Services.BackgroundIt has been suggested that vitamin D and vitamin D deficiency may play a role in the pathogenesis of psychiatric illness. There is evidence that vitamin D inadequacy is prevalent among patients in long-term hospital settings. Patients within secure hospitals are considered to be at high risk due to their often lengthy admissions, having been transferred from other hospital or prison settings. Ardenleigh in Birmingham is a blended female secure unit. Here we present the findings of an audit, completed in 2019, of vitamin D monitoring and treatment in this service.MethodA retrospective review of electronic patient records, for all inpatients admitted within women's secure services at Ardenleigh as of 1st September 2019 (n = 27). Standards were based on the Trust accepted guidelines for management of vitamin D deficiency.ResultKey findings included:-The majority of inpatients were Caucasian (44%) and African-Caribbean (41%). Median age was 31 years (range 20–56).Approximately two-thirds (60%) had been in hospital for over a year.89% of patients had their vitamin D level checked at some point during admission.Of those checked, 25% were tested within 1 week of admission. Seven patients were tested after being in hospital for over one year (30%).Only 25% of patients tested were found to have adequate vitamin D levels. Nine patients were found to have insufficient levels of vitamin D (37.5%) or deficiency (37.5%).89% of those identified as requiring treatment were prescribed supplementation, of which the majority was prescribed at the correct dose for the appropriate duration (94%). One patient refused treatment. Of those with sufficient levels, 67% were prescribed ongoing maintenance treatment due to previously detected deficiency.Of those found to have sufficient vitamin D in the last 12 months (n = 14), 71% were continued on maintenance treatment.ConclusionWe identified a high prevalence of vitamin D insufficiency in women admitted to secure services. Testing was delayed for a number of patients from the point of admission. However, once identified, the vast majority of those in need of treatment were managed appropriately by the medical team. We advise that vitamin D be considered an essential routine blood test at the point of admission to minimise delays in identifying those with deficiency and establishing necessary supplementation.
Where is my sample? Investigating pre-analytical pathology sampling errors in a psychiatric hospital
Authors: Scholes-Pearson Emma , Mercadillo Nieves 
Published: June 2021

AimsErrors in the pathology sampling process can be costly for all stakeholders in any clinical setting; however, this process is often overlooked within psychiatry. Over the space of just a few short months at Hollins Park Psychiatric Hospital (HPH) such errors were reported to be numerous with staff raising multiple issues relating to the pathology sampling process. These issues often had a negative impact on patient care, leading to outcomes such as as re-bleeding of patients and delays in interventions. Here, we aim to identify the predominant sources of error in this process and suggest possible improvements to minimise these errors in the future.MethodInitially, we mapped and analysed each step of the sampling process as it is currently performed in order to identify areas of possible improvement. We then distributed questionnaires to all junior doctors - who are responsible for the handling of samples within the clinical setting – in order to establish error type and frequency. Questions also assessed individual confidence and familiarity with the sampling process.ResultWhen mapping the sampling process, we identified all key steps required when sending samples from HPH to Warrington and Halton Hospitals laboratory. This included one pathway for sending routine bloods, and one pathway for urgent bloods. The process for sending routine bloods required more steps and ultimately took longer for samples to reach the laboratory – as expected. Of the issues identified during mapping of the pre-analytical phase, a majority of 77.7% of clinicians reported samples had gone missing or were unreported – with the reasons for this being undetermined in most cases – and 55.5% reported their samples never reached the lab. While on the whole participants were comfortable with the steps involved in sending samples to the laboratory, 77.7% were not aware of the requirement to log samples as they were being sent.ConclusionThe reasons underlying errors in the sampling process at HPH were multifactorial and included a lack of clinician familiarity with correct procedure, poor sample recording/tracking and lengthy transit times between the patient and laboratory. Here we outline some simple evidence-based recommendations (including education of staff and improved tracking through an electronic requesting system) to help reduce errors and streamline the sampling process in the hopes of improving both efficiency and accuracy, reducing the financial and clinical impact.
Addiction service changes due to COVID-19
Authors: Shahbaz Shumaila , Hashmani Zeeshan , Mayet Soraya 
Published: June 2021

AimsAddictions services had to respond rapidly to reduce COVID-19 transmission to protect patients and staff. Patients with opioid dependence are particularly vulnerable, with high risks. Our community addiction service changed practice in line with COVID-19 guidelines. For patients with opioid dependence; face-to-face contacts were initially reduce and mainly for new starts, restarts and non-attenders. Prescribing changes were completed on an individually risk assessed basis to reduce attendance at the chemist, specifically to reduce transmission, keep patients in treatment and to ensure chemists could continue to function. We document some of the service changes during the COVID-19 lockdown.MethodService evaluation had approval from Humber Teaching NHS Foundation Trust. Data retrieved on one Hub of a community addictions service in North England, UK. Patients prescribed opioid substitution treatment for opioid dependence were assessed, with data retrieval through electronic healthcare records. Data were analysed by Microsoft Excel anonymously.ResultIn lockdown (March 2020 to June 2020), we identified 112 patients with opioid dependence prescribed opioid substitution (OST) with methadone or buprenorphine at the Hub. All white British, mean 42 years, most male (75%) and prescribed methadone (78%). Ten were new starts and 8 restarts to OST. Attendance rates did not change: 91% before and 92% during lockdown. Appointment format changed from predominantly face-to-face (92%) to telephone (99%). Most patients (91%;n = 88) were offered take-home naloxone and overdose prevention training of which 14 refused. Supervision days at the chemist for OST reduced significantly from 75% collecting daily at the chemist, reducing to 20% during lockdown. Five patients were shielding and 7 had covid-related symptoms. There was one death during lockdown which was not attributed to covid or overdose.ConclusionThe addictions service continued to be open and work proactively throughout lockdown, seeing new patients and continuing treatment interventions safely. Major changes were made in line with COVID-19 guidelines, to respond to the threat of transmission. Our service was flexible and able to adapt quickly to remote working. We maintained excellent attendance rates despite changes to the format of consultations. There were no related incidents e.g. overdoses linked to prescribed medications, despite a reduction in supervision, and therefore patients having extra medications. This important finding may be related to the individual risk assessments that we conducted before making changing to prescribing. This was supported by most patients were receiving naloxone to prevent overdoses. Some of the changes, such as telephone consultations, may be beneficial to continue post COVID-19.
An audit of the use of psychotropic medications over the course of admission to a specialist dementia ward
Authors: Singh Sukhmeet , Papworth Margaret , Turrion Concha , Ruhi Shamim 
Published: June 2021

AimsThe aim of this audit project was to establish the practices in prescribing and de-prescribing of psychotropic medications for patients on a specialist dementia ward.BackgroundThere is a great deal of evidence demonstration high rates of polypharmacy, defined as ≥5 drugs, in older adults in general and in those with dementia more specifically. NICE guidelines recommend a structured assessment of a patient with dementia to exclude other potential causes, e.g. pain or delirium. Psychosocial interventions are recommended as first line. Antipsychotics should only be offered second line who present a risk to themselves or others. These should only be used for the shortest time possible and reassessed at least every 6 weeks.MethodData were collected for patients (n = 20) discharged from a specialist dementia ward between September 2018 and March 2019. The unit has 14 beds caring for patients with predominantly severe behavioural and psychological symptoms associated with dementia (BPSD). The team is comprised of doctors, nurses, a clinical psychologist, occupational therapists, physiotherapists and pharmacists who meet twice a week to review patients. Data were coded by drug class and counts of medication on admission, at the midpoint and at discharge were conducted. Antipsychotic and benzodiazepine dosages were converted into haloperidol and diazepam equivalence.ResultOf the 20 patients, 70% were male and 30% female. 95% of the patient (n = 19) were admitted under the Mental Health Act (1983). 20% were managed on 1 to 1 observations and 80% were on 15 min observations. In general, the results show little change in the overall rate of psychotropic prescribing. The mean number of psychotropic medications prescribed per patient on admission was 2.30, at the mid-point of admission it was 2.30 and at discharge it was 2.05. Mean benzodiazepine dosage in diazepam equivalence reduced between admission and discharge from 3.20 mg to 2.10 mg. Mean haloperidol equivalent dosages increased at the midpoint of admission from 1.11 mg to 2.27 mg before reducing to 0.78 mg at discharge.ConclusionThe results demonstrate minimal change in the overall average number and composition of drugs prescribed. There are differences in the use of regular antipsychotics and benzodiazepines between admission and discharge which are consistent with NICE guidelines. Patients had a structured assessment with regular medicines reconciliation supervised by the team pharmacist. Therefore, the ward environment did allow for detailed discussions about de-prescribing which may not be the case elsewhere.