bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Medical Student Experience in Psychiatry Placement in Stockport: A Quality Improvement Project
Authors: Darod Nafisa 
Published: August 2024

AimsFourth-year medical students from Manchester University undergo a four-week Psychiatry rotation in Stockport as part of their curriculum. Placed in both community and inpatient teams within General Adult and Older Adult Psychiatry services, this placement offers a unique opportunity for students to gain clinical and educational experience in Psychiatry, potentially shaping their perception of the field. This quality improvement project aimed to enhance the overall experience of medical students during their Psychiatry placement in Stockport.MethodsA retrospective review of quantitative and qualitative feedback from the March to April 2023 cohort (n = 4) involved a 5-point Likert scale and comments covering 10 domains. The feedback focused on aspects such as induction, orientation, learning objectives, patient assessment, procedural skills, supervisor feedback, access to resources, timetables, and the overall experience. An average total score was calculated.Subsequently, strategies were implemented for the April to May 2023 cohort based on the feedback. Weekly check-ins, updated timetables, team introductions, additional teaching sessions, and opportunities for case presentations were among the interventions.Quantitative and qualitative feedback from the April to May 2023 cohort (n = 4) were collected and compared with the previous cohort's feedback.ResultsThe feedback scores demonstrated improvement, with the average total score increasing from 4.1/5 (82%) in March – April 2023 to 4.7/5 (94%) in April–May 2023. Students praised the helpful staff, opportunities to present cases, and the tailored and useful nature of the placement. Feedback on improvements included addressing vague timetables, unannounced cancellations of teaching sessions, and limited opportunities for case presentations.ConclusionThis quality improvement project demonstrated that the targeted interventions helped enhance the educational experience of medical students during their psychiatry placement. The increased feedback scores underscore the positive impact of targeted interventions. The findings emphasize the importance of continuous quality improvement in medical education, ensuring a more positive and enriching experience for medical students in Psychiatry rotations.
Weight Management Quality Improvement Project in Tower Hamlets Community Learning Disability Service
Authors: Dundas Lucy , Deniz Irem , Hirsz Genevieve , Prior David , Eady Nicole 
Published: August 2024

AimsThe project's aim is to record up-to-date BMI readings of 70% or more of our service users by September 2024. We have identified barriers limiting current data collection, such as challenges weighing wheelchair bound clients or limited availability of weighing scales, and will action our change idea methods to reach our target in this time period.Significant health inequalities have been identified in the learning disability population, with men and women in our cohort dying 23 years and 27 years younger respectively compared with the general population. Furthermore, people with learning disabilities are at increased risk of being overweight or obese compared with other cohorts, which itself leads to a range of health and social complications. A recent audit of our psychiatry caseload revealed the need to improve weight monitoring and subsequent management for our service users, to help reduce health inequalities identified.MethodsWe have weekly project meetings with our MDT including psychiatrists, dietetics, occupational therapists, nurses and psychologists. We have arranged stakeholder involvement by inviting service users to these weekly meetings to contribute their own ideas to the project, and have organised focus groups for service users, carers and staff. We intend to generate change ideas by using quality improvement methodology to identify primary and secondary drivers. One of these already incorporated into the project is a machine in our waiting room monitoring our clients’ weight, height and blood pressure. Having identified obstacles in our service users obtaining their weight, we have successfully bid for funding for one of these machines.ResultsWe will use Plan Do Study Act (PDSA) cycles to evaluate the effectiveness of our change ideas. Convenient sampling of our psychiatry caseload showed only 26.7% of 71 service users have an updated weight and BMI, and identified that we don't have a robust process for monitoring patients' weights (total project caseload is 1264).ConclusionDuring the development of this project, we identified a variety of approaches to improve health outcomes for our service users including educating staff on incorporating weight monitoring into consultations and how to manage the results. This project comprises one part of East London Foundation Trust's overall Triple Aim: to improve population health; improve the quality and improve value for the system. Going forward, our intention is to incorporate weight management into our routine reviews and ensure staff are educated in the importance of regular weight monitoring, the health benefits and how to refer.
A Quality Improvement Project to Improve Staff Confidence in Managing Incidences of Patient Violence and Aggression on the Neurosciences Wards
Authors: Staffurth Isabel , Hoque Rahima , Duric Bea , Rogowska Marianna , Posporelis Sotiris 
Published: August 2024

AimsIncidents involving patient violence and aggression are a common occurrence on the neurosciences wards. Many staff do not know how to de-escalate or manage such incidents, leaving them vulnerable and unsupported. This project was designed to increase mean staff confidence by at least 2 points (on a scale of 1–10) regarding confidence and satisfaction in managing patient violence during a 6-week period.MethodsUsing Plan-Do-Study-Act (PDSA) quality improvement methodology, we carried out a preliminary survey on 2 neurosciences wards. Multidisciplinary staff were interviewed about their confidence (on a scale of 1–10) in managing violence. The survey and interview assessed which measures were already in place on the wards, such as Datix reporting and referral pathways. The first intervention focused on preventing patient violence with informative posters on referral pathways and verbal de-escalation techniques; these were distributed throughout the wards and staff were notified via email. Follow-up surveys were collected, enquiring whether staff had seen the posters and how their confidence levels have changed. The second intervention was implemented 2 weeks later and focused on post-incident support. We distributed leaflets on Critical Incident Staff Support and sent an email link to a verbal de-escalation playlist. Follow-up surveys were collected again to track changes in staff confidence and satisfaction. Weekly electronic clinical record searches were recorded to track the number of incidences of patient aggression during the same 6-week period.ResultsStaff confidence (N = 24) in verbally de-escalating violence and aggression increased by 1.1 and 1.75 points for Wards A and B, respectively. Of the 6 staff members who were followed up, only 1 experienced a 2-point increase from baseline in confidence in verbal de-escalation; 1 staff member experienced a 1-point increase, 3 experienced no change, and 1 reported a 1-point decrease. Staff satisfaction in management of violence on their wards increased by 1.04 and 1.75 points for Wards A and B, respectively. Staff confidence in knowing which team to refer patient violence to increased by 1.167 and 1.07 points for Wards A and B. Incidences of patient violence reported on EPIC decreased by 8 episodes for Ward B and increased by 2 episodes for Ward A.ConclusionLow-cost, simple intervention techniques are largely ineffective in improving staff confidence in handling violence. During verbal feedback, most staff agreed that training and simulation-based days would be useful. Ward managers should seek to include well-structured training to improve staff confidence.
Improving the Management of Neuropsychiatric Presentations in Early Intervention Services (EIS)
Authors: Finn Henry , Easter Emily 
Published: August 2024

AimsEarly Intervention Services (EIS) are in a unique position to assess patients presenting with their first episode of psychosis. The possibility that an organic disorder may be underlying their presentation must be ruled out, often necessitating neuroimaging and/or input from neurology and neuropsychiatry.We aim to improve the management of neuropsychiatric presentations in EIS. We will determine the incidence of cases, from the London Boroughs of Sutton and Merton, which warrant referral to neurology, neuropsychiatry and neuroimaging. We will then review referral pathways and provide justification for community services, such as EIS, to autonomously request referrals and neuroimaging.MethodsWe retrospectively reviewed the complete caseloads of EIS for Sutton and Merton (n = 121). We considered the neurological comorbidities of patients to determine the incidence of cases which warranted a referral to neurology, neuropsychiatry and/or neuroimaging. We reviewed how requests were made and the subsequent results.Results15% of the EIS caseload had a neurological comorbidity. Migraine was the most common condition (8.3%), followed by traumatic brain injury (3.3%), headache (2.5%), and seizure (1.7%). There was one case each of epilepsy, stroke, transient ischaemic attack, cavernoma and cerebral venous thrombosis. 83% of patients with a neurological comorbidity had received neuroimaging and all imaging results were either normal or confirmed known pre-existing neurological disease. The 17% of patients who did not receive neuroimaging had only migraine as a neurological comorbidity. One patient was reviewed by neurology and diagnosed with psychosis presumed to be secondary to paraneoplastic syndrome. All patients that fulfilled criteria for a neuropsychiatry referral had this completed electronically. However, there was no clear pathway to request a review by neurology, and Sutton EIS had difficulties autonomously requesting and accessing the results of neuroimaging, delaying provision of appropriate care.ConclusionThere is a small but significant burden of neurological comorbidity among EIS patients. In our brief study, we found one patient whose symptoms of psychosis were likely attributable to an organic cause. Accessible pathways to refer patients for neuroimaging, and subsequently to neurology and/or neuropsychiatry if indicated, are crucial in the assessment and management of first episode psychosis where an organic cause is suspected. Access to these resources should be efficient and autonomous for EIS. We are in the process of implementing referral guidance alongside a direct electronic referral process to request neuroimaging and further input from neurology and/or neuropsychiatry, to optimise care for patients and our service.
Improving the Visibility and Accessibility of Physical Health Information in a Forensic Medium-Secure Inpatient Unit
Authors: Bohra Rijul , Kelsey David , FitzGerald Jon 
Published: August 2024

AimsTo improve the visibility and accessibility of secure inpatients’ physical health needs by measuring staff satisfaction levels towards physical health information and monitoring.MethodsThrough purposive sampling we conducted a five-point Likert Scale on members of the multidisciplinary team (MDT) on one medium-secure forensic ward, within Oxleas NHS Foundation Trust, which provides 124 forensic inpatient beds to southeast London. We collated physical health data from across electronic patient records to create a single-point-of-access workspace on Microsoft OneNote, accessible to all members of the MDT contemporaneously, comprising past medical history, psychotropics requiring close monitoring (e.g. lithium, clozapine, valproate), vital signs, weight, bloodwork, electrocardiogram findings, hospital appointments/results and cancer screening.We re-sampled members of the ward MDT after the workspace had been created and implemented.ResultsNine members of the multidisciplinary team were sampled before and after the OneNote workspace was implemented.
•Pre-intervention, 56% disagreed that they were confident in quickly viewing recent investigation results. Post-intervention, 99% of users agreed/strongly agreed, with no negative responses.•Pre-intervention, 67% disagreed or strongly disagreed that they were confident in knowing what physical health appointments were scheduled. Post-intervention, 100% of respondents agreed/strongly agreed.•Pre-intervention, 78% disagreed or strongly disagreed that they were happy with the availability of past medical history information. Post-intervention, this increased to 99% agreed/strongly agreed.•Pre-intervention, 89% disagreed/strongly disagreed that they knew where to see patients on psychotropics requiring close monitoring. Post-intervention, this increased to 100% strongly agreed.•Pre-intervention, 66% disagreed/strongly disagreed being able to see single-point, up-to-date physical health information, at baseline. This increased to 99% agreed/strongly agreed post-intervention.Overall, 89% agreed/strongly agreed the workspace would allow them to better understand the physical health and monitoring needs of patients, whilst 78% agreed/strongly agreed it allows for more effective work across wards/sites in the Oxleas forensic directorate.ConclusionPhysical health information is often overlooked in secure inpatient settings. Due to the limitations of the electronic patient record, it can be difficult to find relevant physical health information quickly. This can lead to dissatisfaction and a lack of confidence in the MDT, as shown in the baseline data.After the Microsoft OneNote dashboard was introduced, there was a marked improvement in staff confidence, happiness, and awareness of physical health requirements for each patient.Further data needs to be collected to assess for sustainability of these improvements. We intend to expand the scope of this system across the secure inpatient units in the Trust.
Are Patients Aware of Clozapine Side Effects?
Authors: Golding Charlotte , Sud Neeti 
Published: August 2024

AimsPatients should have a comprehensive understanding of the side effects, and monitoring requirements of the medications prescribed to them. Making the patient aware of serious side effects is important for patient safety and informed consent. Patients should know when and how to seek help for side effects. Health literacy also increases patient autonomy and shared decision making.As an inpatient, a psychiatric patient’s medications are closely monitored, and there is frequent contact with healthcare professionals who can identify any health needs. Within our trust, there is a side effect checklist to be completed by community staff each time a community patient has clozapine monitoring. However, in our clinical practice, we have observed that some patients have needed prompts regarding need for re-titration if dose missed for 48 hours.We aimed to assess medication safety information awareness in a small sample of patients open to forensic community team who are prescribed clozapine.MethodsA 26-point questionnaire was used to assess the participant's depth of knowledge of clozapine. A combination of 3 open and 22 closed questions were used. Patients were scored for their answers to the closed questions, using a predetermined marking scheme, being awarded 1 point per appropriate answer. We set the standard as maximum score of 22.All participants (n = 7) were male and had been prescribed clozapine for at least one year.ResultsAll participants were able to accurately state why they were prescribed clozapine. The mean score was 16. Zero participants scored 22. Lowest score was 14. One participant omitted two questions (Do you know what to do if you take more clozapine tablets than you are supposed to? Do you know what to do if you forget to take clozapine?). He stated that he was very careful regarding his medication and therefore, will not forget or miss any doses.71% of patients were unsure what they should do if they were to accidentally take more tablets than prescribed.Five out of seven participants were able to cite at least one side effect of clozapine without prompting.Two patients were not able to spontaneously recall the monthly blood test requirement.ConclusionThere was a range of knowledge deficits about clozapine in our sample. After including reminders of safety information about clozapine at quarterly care coordination reviews, we plan to re-assess in a year's time.
Improving Bone Health Care and Monitoring of Intellectual Disability Patients on a Low Secure Female Unit
Authors: Hinze Serena , England Rosie , Rashid Ambreen , Freeman Nicole 
Published: August 2024

Aims•To ensure all patients on a low secure female inpatient unit have bone health risk factors assessed, identified and interventions initiated within 3 months of admission.•The above to be achieved through creation of a Bone Health proforma, integration of a Bone Health checklist into the Intellectual Disability (ID) Annual Health Check and delivery of bone health education for patients and staff.BackgroundIntellectual Disability has been shown to be associated with poor bone health, osteoporosis and increased fracture risk. The current NICE guidelines and risk tools (QFRACTURE), do not adequately reflect the true risk within this patient group who present with additional risks of epilepsy, antiepileptic medication and greater likelihood of low vitamin D. Bone health has not routinely been monitored in this population hitherto. This quality improvement project sought to develop a process whereby potential risk factors for poor bone health were identified and managed effectively.MethodsThe project was undertaken between February 2022 – October 2023 on a female low secure unit. All 8 patients on the unit were included. A baseline screening of risk factors was conducted to assess current practice and explore the clinical need for the project. Most patients were found to have multiple risk factors which had not previously been highlighted, indicating the need for formalised monitoring. Based on questionnaire feedback, a Bone Health Care Plan, a risk factor checklist which was integrated with patients’ ID Annual Health check and Educational workshops were developed. Primary and secondary drivers were identified at the outset and plan, do, study, act cycles were used to refine change ideas. The changes were evaluated using quantitative and qualitative measures.ResultsEvery inpatient has a completed Bone Health Care Plan. Twenty-five percent of patients were identified as having a particularly high risk and have had referrals accepted for Dual-energy X-ray absorptiometry (DEXA) scans. All patients are using a new easy-read ID Annual Health Check form with Bone Health checklist incorporated. All staff and patients were given the opportunity to attend a series of four bone health workshops, 43% of patients attended at least one session. Positive written and verbal feedback was received from both patients and staff.Conclusion100% of service users have had their risk factors for bone health assessed and any necessary interventions applied. There is now an embedded process for reviewing the bone health of these patients annually where previously there was no regular monitoring.
Young Person and Parents/Carers' Experiences of the Transition Into a Child and Adolescent Mental Health Services (CAMHS) Inpatient Unit: What Could Be Improved?
Authors: Shajan Georgina , Shah Ashika , Briley Paul , Majumder Pallab , Holland Josephine 
Published: August 2024

AimsTo investigate the themes within young people and parents/carers’ experiences of the admission process. A focus was placed on potential targets for change to improve experiences of CAMHS admission.MethodsYoung people and parents/carers with an experience of inpatient CAMHS admission within the past two years were approached by the Involvement team of an NHS trust. Focus groups and interviews were conducted capturing the views of 8 young people and two parents/carers. The notes and transcripts from these conversations were analysed using Braun and Clarke thematic analysis.ResultsTwo key themes were identified within the data. The first focussed on information provision and communication. This captured young people's experiences of both: what information was available to them, e.g., websites and leaflets, and how this information was conveyed to them. The second theme brought together the young people's interpersonal experiences during the admission process. Within this, the impact of consistent contacts as well as both positive and negative transient encounters was highlighted.ConclusionAdmission to a psychiatric ward is often a highly distressing time for young people and their families. The provision of easily accessible, clear, and correct information can improve their expectations and initial impressions of a unit. How this information is presented is also important. Consistent staff support and response to distress and difficulties during this time can also shape the perspectives of young people and their parents/carers.Clear, accurate, and young person friendly information about a unit and the admissions process could be an easily achievable change which units could make to improve young person experiences. Improvements to clinicians’ skills and response may represent a more complex and expensive goal.
Impact of Raising Staff Awareness on Recording Patient Consent to Receive Text Message Reminders of Appointments and Increasing the Frequency of Reminders on Did Not Attend (DNA) Rates in Community Mental Health (CMH): A Quality Improvement Project
Authors: Kaur Gonjan , Tandanu Edelyne , Ojha Prem 
Published: August 2024

AimsPatients not attending appointments without letting the service know prior (referred to as did not attend – DNA) is a significant problem in community mental health (CMH). However, there are limited studies conducted in the United Kingdom on this issue. Patients forgetting appointments was a reoccurring reason for DNAs in the literature. To address this, we aimed to assess the impact of raising staff awareness on recording patient consent to receive text message reminders of appointments and increasing the frequency of reminders on DNA rates in Arndale House (a CMH service covering Dartford, Gravesend and Swanley as part of the Kent and Medway NHS and Social Care Partnership Trust – KMPT).MethodsDNA rates at Arndale House from August to October 2023 were assessed to determine a baseline before implementing interventions. Following this, two interventions were put in place; the first occurred on 18/10/23, consisting of an online teaching session for the staff at Arndale on documenting patients’ consent to receive text message reminders for their appointments. Posters with instructions on this were posted on the trust intranet and set up within the building. The second intervention occurred on 20/11/23 and included sending out text message reminders more frequently, from three and one day prior to appointments to seven days beforehand as well. DNA rates for November were analysed to assess the impact of intervention one and December for intervention two. Patient characteristics were also examined monthly to identify any trends among those who DNA. The analysis comprised 109 patients (69 for pre-intervention, 27 for intervention one, and 13 for intervention two).ResultsPre-intervention DNA rates were 13.4%, 17.5%, and 13.5%, respectively. The incidence of DNA increased to 19.9% after intervention one. However, this was lower than November 2022. The rate for intervention two was 11.6%, lower than that of December 2022. Being White, having a mood disorder and having mental health disorders which fell under more than one category were prominent among those who DNA.ConclusionIncreasing the frequency of text message reminders of appointments had a significant impact on reducing DNA rates, highlighting a potential intervention which can be implemented in CMH to tackle the issue of DNAs.