bluuebunny/crossref_metadata_2025_split huggingface dataset:
Benefits & Barriers: Improving Medical Handover in a Psychiatric Hospital
Authors: MacKenzie Nina , Cruickshank Callum , Mahony Ewan , Parker Jessica , Canham Robyn 
Published: August 2024

AimsBackground: Handover aims to achieve the efficient communication of clinical information when responsibility for patients is transferred. The Royal Edinburgh Hospital (REH), a specialist hospital serving the Lothians, has repeatedly received “red flags” (ranked in the bottom 2% of benchmarked areas) on the handover section of the Scottish training survey (STS) and GMC national training survey of doctors in training (DiT).Aims:•Survey DiT to understand their experience of handover.•Introduce a new structured handover process.•Re-audit parameters after intervention.MethodsData from REH DiT were extracted from an anonymised handover survey, disseminated to all psychiatry DiT in Scotland in January 2023. Multiple choice and free-text questions covered handover timings, format, structure, and attendance. The survey was repeated after intervention. In addition, data from the STS were analysed. The intervention consisted of altering shift times to include protected time for handover, introducing a dedicated room, training in the use of an electronic system to record tasks, involvement of senior doctors, and dissemination of the new changes to procedure.ResultsA total of 12 survey responses (25% response rate) pre-intervention (25% FY2s, 17% GPSTs, 58% core trainees) and 14 post-intervention (14% FY2s, 14% GPSTs, 71% core trainees) were analysed. The proportion of respondents reporting that handover always happened at times of shift change increased from 7% to 93% post-intervention. The proportion of those reporting that there was protected time for handover rose from 0% to 50%, and the use of a predetermined structure/format increased from 0% to 43%. After intervention, 86% of DiT felt adequately supported during handover (compared with 17% pre-intervention) and 93% of respondents felt handover ‘allowed for the efficient and effective transfer of information to protect patient safety’ (33% pre-intervention). Prior to the process change, 83% of DiT felt there was no clear senior leadership at handover; this fell to 21%. Post-intervention the use of WhatsApp/texts to hand over information fell by 100%. The new system was welcomed by trainees, but teething problems were identified.ConclusionThe new process led to improvements in the frequency, consistency, format, recording, and senior support of handover. Issues with the use of video call software and electronic medical records systems have been identified, and work is ongoing to address these in an iterative quality improvement process. Good clinical handover benefits patients (fewer mistakes and increased safety, better continuity of care, improved satisfaction) and clinicians (improved communication skills, increased accountability, feel more informed, improved job satisfaction).
Fitness to Drive Policy in Inpatient Setting: Findings of QI Project
Authors: Mahmood Sajid , Radwan Heba , Omotoso Omotilewa , Khokhar Waqqas , Shams Nosheen 
Published: August 2024

AimsBackground: Nature and degree of mental illness can impair abilities of patients to drive safely which puts their own safety and safety of others at risk. There is also an ongoing concern of patients not being properly informed on their duty to inform the DVLA and potentially to stop driving for an extended period.Aims:
1.To assess if risk assessment of patients in term of driving status was completed at time of admission, during their stay on ward, and if any advice regarding fitness to drive was given at time of discharge.2.To improve patients being asked about driving status on admission to 100% of patients.3.To improve rates of service users being informed of the DVLA guidance following a mental health illness to 100% of patients.MethodsIt is a Quality Improvement (QI) project. Baseline information on current practices were assessed against local fitness to drive policy of Leicestershire Partnership NHS Trust in May 2023. Data was collected from 10 inpatient (6 general adult & 4 old age) wards. All patients who were discharged in the month of January 2023 were included for audit. Information was collected about driving status of patients at time of admission, during their stay on ward, and if any advice regarding fitness to drive was given at time of discharge. Data was recorded anonymously. Results are reported in percentages for descriptive statistics.ResultsRisk assessment was completed in 95% of patients on admission. About 12% (15/128) of the patients were driving at the time of admission, 80% of them were female. Assessment of driving risk during admission only took place in 11.7% (13/128) of cases. Advice on fitness to drive at time of discharge was given only in 12.5% (16/128) of cases. About ¼ of patients who were driving at time of admission, did not receive advice on fitness to drive at time of discharge from hospital.ConclusionThere is a huge gap in clinical practice regarding compliance with fitness to drive policy. There is an urgent need to improve awareness among mental health teams that they have a role with regard to assessment of their patients’ risks and fitness to drive. An educational training video will be prepared and shared with clinicians in December 2023 to fill gaps in the service. Further information will be collected on practices related to fitness to drive policy in March 2024 for further evaluation of services.
Review of Improvement in Enhanced Access Services for Mental Health Emergencies in NHS Grampian
Authors: Ojo Jumoke , Rai Dharmesh 
Published: August 2024

Aims1.Identify changes in the services rendered in the Enhanced access/emergency service following the previously suggested modifications.2.Identify areas of possible improvement within the service to provide seamless emergency and out-of-hours mental health support to patients.3.Evaluate adherence to current guidelines for the Enhanced access/emergency service.MethodsAn audit of a total of 100 patients on the list was selected in chronological order. Patient documentation was reviewed against the current criteria for patients on the list, which included having a documented care plan in place, remaining open to a community mental health team, and having been reviewed at least within the last 6 months.The data was then analysed and compared with the previous year's results to see if there was any significant change year over year.ResultsYear on Year improvement:
1.Total number of patients on the list had increased by 16.7%.2.The number of patients without a care plan on the list reduced by 6.3.The number of discharged patients on the list was also reduced by 1.4.The number of patients who had not been reviewed in six months reduced by 9.ConclusionWhile there had been some improvement in the service provision and adherence to the guidelines, there was still ample room for improvement, which would be achieved by adherence to the guidelines and protocols, to ensure better service improvement for enhanced access and out-of-hours emergency services to patients.
Medication Required: P*RN – Promoting Healthy Attitudes and Improved Access to Pornography in Wathwood Hospital
Authors: Parmar Rianne , Parry Joanne , Nicoll Thomas , Dugan James 
Published: August 2024

AimsThe key aim of this project was to update and modernise the hospital procedure on how patients access pornographic material whilst detained at Wathwood Hospital. Within the update, we aimed to promote inclusivity and acceptance of all patients’ sexual identities as well as utilising the opportunity to emphasise healthy consenting sexual relationships.Patients in Forensic Mental Health settings are often inpatients for a significant amount of time, with multiple restrictions imposed on their private and family life. Current policy allows patients to purchase pornography for private use in their own room. It must be material of the same nature available in a main street outlet. In practice, material is usually purchased in DVD format from the Amazon website and subsequently screened for suitability by Security staff and finally approval by the Responsible Clinician. There have been numerous incident reports involving the trading of pornographic material.MethodsQualitative semi-structured group interviews (up to 5 people at a time) were conducted with patients in the medium-secure forensic services of Wathwood Hospital. They were recruited from the fortnightly Patient Forum. Anonymised questionnaires involving Likert scales and free text response spaces were also distributed at the Patient Forum. Data gathered investigated the percentage of patients who were aware of the current procedure, if they felt it worked well and what they thought the impact of accessing pornographic material might be. Staff were invited to complete a similar anonymised questionnaire, again considering their opinions on the positive or negative impacts of pornography for patients. In addition, we gathered data on whether there was a difference on the degree of comfort/discomfort about pornography, depending on whether the material involved opposite sex or same sex couples. In total, there were 40 survey participants.ResultsSome key areas for concern were found, for example, only 17% of staff and 16% of patients thought the current policy works well despite 69% of staff and 84% of patients feeling it is a patient's right to access pornography. Free text and focus group feedback established many benefits to it. It was clear that there were some areas of difficulty in the hospital policy, which would benefit from being refreshed.ConclusionStaff and patients overall feel that access to pornography is important for many of the patients. We identified areas for improvement in how this is accessed and a need to continually be considering the need to consider meeting the holistic needs for the patients.
Systematic Literature Review on the Impact of COVID-19 Pandemic on Referrals to Child and Mental Health Services (CAMHS) in United Kingdom (UK)
Authors: Patil Chetana 
Published: August 2024

AimsChild and Adolescent Mental Health Services (CAMHS) is a highly specialised service to which children with severe mental health problems are referred. The COVID-19 pandemic brought with it a lot of uncertainty, and healthcare systems across the UK struggled to cope with the added pressure. The aim of this systematic review is to analyse the literature exploring the effects of the COVID-19 pandemic on the severity of mental health conditions and referral rates to CAMHS services in the UK. The findings from this study will help the services understand the impact of the pandemic on referral rates to CAMHS, the severity of various mental health conditions, and how the services are managing.MethodsAn extensive search, following PRISMA guidelines, was undertaken across multiple electronic databases using a predetermined search strategy. Studies reporting on mental health conditions in children post-pandemic and on referral rates to CAMHS in the UK were included. Subsequently, data extraction, quality appraisal and qualitative analysis were performed in a descriptive style.ResultsInitially, referrals to CAMHS decreased during the first lockdown, followed by a significant increase in referrals throughout the pandemic period. The referral rate to CAMHS remains steady until adolescence, with a rapid increase in referrals to the services during the teenage years. More adolescent girls were referred to CAMHS compared with boys and are at an increased risk of developing mental health conditions. A higher number of children and young persons presented with urgent referrals and heightened symptoms during the pandemic compared with the pre-pandemic levels. In particular, there was a significant increase in children presenting with eating disorder problems, accompanied by an increased severity of symptoms. Furthermore, there was an observed rise in depression and anxiety among children and young people, along with an increase in the use of antidepressant medication.ConclusionReferrals to CAMHS increased during the pandemic, with increased severity of symptoms observed, particularly in children and young people with eating disorders and neurodevelopmental conditions. Future research should explore the enduring impact of the pandemic on referral rates and presentations to CAMHS. This exploration is essential to aid senior managers and policymakers in decision-making, enabling the implementation of appropriate measures to manage the pattern of demands on CAMHS and shape the future service delivery of CAMHS in the UK.
Outcome Measures in Mental Health – RCPsych Report and Working Group Survey
Authors: Richardson Jonathan , Ryland Howard , Bhattacharya Rahul 
Published: August 2024

AimsOutcome measurement is central to transforming mental health care by quantifying change, enabling comparison and driving improvement. In recognition of this, the Royal College of Psychiatrists (RCPsych) has established a working group on outcome measures, led by an Associate Registrar.To support routine outcome measurement capture in clinical services, RCPsych has developed the ‘Outcome Measurement in Psychiatry’ report.The working group intends to launch a survey of Members to:
1)Understand psychiatrists’ current use of outcome measures.2)Understand psychiatrists’ views on barriers and facilitators to the use of outcome measures.3)Get feedback on the College Report.MethodsThe ‘Outcome Measurement in Psychiatry’ report was developed with input from all RCPsych Faculties and is scheduled for publication prior to the RCPsych International Congress.Feedback will be sought on the ‘Outcome Measurement in Psychiatry’ report about whether the guiding principles are right, and if the College should be endorsing specific measures or advocating for the routine use of outcome measures. This will be used to guide future revisions of the report.The working group believes the proposed survey will enable it to explore the facilitators and barriers to routine outcomes data capture both locally and nationally, including:
•how to consider organisational drivers and buy in of clinical staff•digital enablement•understanding time points in a chronic relapsing remitting condition in the community vs. episode of therapy or hospital admission•clinical burden/benefit and buy in•training. An invitation to participate in the survey will be sent to all College members and advertised via social media, at the International Congress. Analysis will be via descriptive summary of quantitative data and a thematic summary of any free text data.ResultsThe group intends to use the intelligence gather to inform, influence and shape policy that promotes routine outcome data capture and publish its findings for wider dissemination.ConclusionOutcome measurement is a top priority for the RCPsych. A new Associate Registrar and working group is spearheading the College's work in this area, publishing guidance and conducting further research. Engagement and learning from our colleagues would provide critical intelligence to inform and influence future policy and strategy to enable routine outcome gathering embedded in mental health services.
Striving for a Higher Completion Rate of Patient Reported Outcome Measures in Kent and Medway NHS Trust
Authors: Rudolph Leopold , Barnett Isabel 
Published: August 2024

AimsA Patient Reported Outcome Measure (PROM) is a form that patients complete about their health status at a single point in time. The Recovering Quality of Life (ReQoL) questionnaire is a new PROM, developed in partnership with mental health service users to enable them to report on their mental state, and can be utilised by clinicians to track progress. The Commissioning for Quality and Innovation (CQUIN) framework set a target that 40% of adult and older adult patients accessing secondary mental health services should have their PROM recorded at least twice in a 6-month period. The primary aim of this quality improvement project was for 50% of patients under the Kent and Medway NHS Trust (KMPT) to be ReQoL compliant.MethodsFollowing engagement with various stakeholders, a survey was circulated to better understand the barriers stopping staff from facilitating ReQoL completion. Moreover, a poster was created to raise awareness of ReQoLs and illustrate the practicalities behind gathering and recording patient scores. Additionally, local ‘champions’ were assigned for each community/inpatient mental health team to foster a sense of responsibility for PROM collection. Data on PROM compliance was obtained monthly, with meetings subsequently organised to scrutinise the results and brainstorm further ideas to drive improvement, such as providing patients with paper ReQoL copies to fill out in advance of their consultation/ward round.ResultsThe survey revealed that 23% of staff were unfamiliar with the ReQoL questionnaire, and only 31% routinely obtained and inputted ReQoLs. A lack of time to assist patients in filling out PROMs was the main barrier cited by staff, alongside ambiguity as to whose job it was to ensure ReQoL collection. Through the distribution of the poster, the establishment of local leads and other changes such as the paper ReQoL initiative, there was a notable uptick in the rates of PROM completion. Indeed, over a 4-month period, compliance rose locally from 46% to 61% at the acute inpatient unit, and from 0 to 21% in the community mental health service. However, over KMPT as a whole, change was modest.ConclusionThis was a successful quality improvement project, resulting in an increase in PROM completion rates, especially at a local level. The measures implemented, particularly the poster and formation of ReQoL leads, were effective – although more work and participation is required to change Trust-wide compliance. Future ideas include adding a ReQoL tool into nurse/doctor clerking templates to reduce friction in completing PROMs.
Improving Communication at an In-Patient Female Forensic Intellectual Disability Unit – Delamere Ward
Authors: Sibanda Shelton , Lloyd Claire , Hunter Nathan , Williamson Abigail 
Published: August 2024

AimsTo improve communication in a Female Forensic Intellectual Disability ward.MethodsDelamere ward is a medium secure Intellectual Disability female forensic ward in Merseycare NHS Foundation Trust. Admitted patients have varying levels of need and complexities. A Multidisciplinary Team (MDT) comprising of Medical, Nursing, Support workers, Psychology, Occupational therapists and Speech and Language therapists, among others, works with patients in this ward. The MDT meets regularly in various patient meetings with decisions taken communicated to patients and staff through existing means. Communication was noted to be ineffective, leading to patient frequent challenging behaviours and patient dissatisfaction.The Quality Improvement project was registered with the local Trust Quality Improvement Department at the outset. Staff views on ward communication effectiveness were gathered using entrance and exit questionnaires. 12 and 9 staff members responded to the entrance and exit questionnaires respectively.The project was conducted over a period of 12 weeks and was divided into Service user and Staff led initiatives. Service user initiatives focused on strengthening existing community meetings, use of ward health promotion boards, MDT walk arounds and utilisation of ward areas. Staff initiatives included introduction of daily morning handover meetings, strengthening of existing staff meetings, listening sessions with staff, and use of reflective sessions. Daily handover meetings were open to the whole ward team and attended per staff availability. Ward dynamics encompassing the previous day were discussed and documented. Qualitative staff views transcribed and compared pre and post project.ResultsImplementation of the quality improvement project eased tension between the MDT and the wider team, helped foster more shared decision making, increased team participation, bridged the gap between fortnightly held ward rounds, created a platform for prompt information sharing, encouraged bidirectional flow of information and helped therapists plan their sessions accordingly.ConclusionEffective ward communication was beneficial to staff and patients alike, leading to better implementation of care plans, increased staff confidence and teamwork, and service user satisfaction.
Developing and Delivering a Regional Teaching Programme in Liaison Psychiatry: A Quality Improvement Project
Authors: Tulip Sally , Katona Cara 
Published: August 2024

AimsSeveral sites across the North London Mental Health Partnership (NLMHP) do not have a liaison-specific rolling teaching programme. Best practice standards set by the RCPsych Psychiatric Liaison Accreditation Network (PLAN) are therefore not being met.The aims of this quality improvement project (QIP) were to: (1) ascertain the perceived need for liaison-specific teaching across NLMHP sites; (2) develop and deliver a teaching programme; and (3) assess attendance, clinician satisfaction and confidence before and after teaching sessions.MethodsA pre-programme questionnaire on Microsoft Forms was sent to team members across NLMHP sites to assess whether respondents were receiving liaison-specific teaching, the perceived utility of the programme, and suggestions for development.A cross-site monthly teaching programme was developed. Sessions were presented by liaison clinicians from a list of liaison-specific topics via Microsoft Teams.A post-session questionnaire was sent to establish session satisfaction, confidence pre- and post-session, and further comments. Mean satisfaction scores were calculated. Percentage change in confidence score was calculated for each session and overall.Themes were identified from the qualitative data and suggestions implemented.ResultsOf the 11 professionals who responded to the pre-programme questionnaire, 50% were not receiving any liaison-specific teaching. Respondents agreed the programme would be helpful in improving their knowledge and clinical practice (mean score = 4.9/5).Attendance for the sessions ranged from 15–27 professionals (mean = 22). A range of 2–10 professionals completed each post-programme questionnaire (mean = 6.3; total responses = 25). Mean satisfaction for each session ranged from 4.3–5/5 (overall mean = 4.7/5). Percentage increase in confidence scores ranged from 4.6–48% (mean = 24%).Feedback-driven changes made to improve the programme included: making session recordings available; sending reminder emails; creating an online platform and making session feedback available to presenters.Respondents considered the sessions interesting and informative, that topics provoked good discussion, and that the 'bite-sized' training allowed attendance without interfering with clinical work.ConclusionThis QIP highlighted the need for a liaison-specific teaching programme across NLMHP. Participants agreed that this would improve their knowledge and practice. The programme was reasonably well-attended across sites. Respondents reported improved confidence and felt the sessions were relevant to their clinical practice.Limitations included the low and variable questionnaire response rate and limited data on the new programme's utility.The next stages of the project include wider delivery, involvement of patients and carers, and of specialists in related psychiatric and medical fields.