bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of Annual Blood Tests for Patients on Antipsychotic Medications in the Recovery Team
Authors: Apantaku Omolayo , Mohamudbucus Mohamed Yaasir , Somashekar Bettahalasoor , Kumar Ashok , Borges Daniela 
Published: August 2024

AimsAll patients who are prescribed antipsychotic medications require annual blood tests which must include Full Blood Count (FBC), Urea and Electrolytes (U&E), eGFR, Lipids (Cholesterol & Triglycerides), Liver Function Test (LFT), HbA1c/Plasma glucose. Some patients also require prolactin blood test depending on their prescribed antipsychotic medication.NICE and Maudsley guidelines recommend an annual check of the blood tests mentioned above.This audit ascertained compliance in terms of annual blood test monitoring for patients who take antipsychotic medications and provided recommendations to improve where necessary.MethodsHalf of the caseload from two General Adult psychiatry Community Mental Health Teams (CMHT) were recruited from a sample population of 228 patients. Odd number randomisation was applied to select our sample (e.g., 1, 3, 5…). Sample size was of 114 patients, 8 of whom were not prescribed antipsychotic medications and excluded. Hence, 106 patients were identified as representative for inclusion in this audit.Retrospective data collection was from clinical entries, clinic letters and blood test results.Data obtained from these patients was collated and analysed using MS Excel spreadsheet.ResultsThe audit revealed that compliance was suboptimal for all required blood tests (Compliance 80% or above is recommended). The kidney function test of Urea & Electrolytes was the closest to recommended standards and best performance overall (77%), eGFR, was subpar at 60%. 74% of patients had the glucose monitoring tests (Plasma glucose/HbA1c) done while Full Blood Count and Liver Function Test were both completed in 76 patients (~72%). The worst performing category was Prolactin monitoring, of which only 9 of patients who required this had it done, recording a mere 31%.Majority (66%) of the blood tests were done at General Practice (GP) surgeries, 25% by Mental Health Services, while the rest were contributed to by Accident & Emergency and Acute Hospital visits.ConclusionFollowing completion of this audit, recommendations were made to advise existing antipsychotic blood monitoring services (GP surgeries and private clinic affiliated with the Trust) of the recommended blood parameters for monitoring, and the need to update current systems. Also, Liaison with service managers and service leads to set up a dedicated physical health clinic for this purpose. The latter has been particularly successful as the Trust is now in the process of recruitment for the new physical health clinic team. A re-audit is planned in the near future.
An Audit on Telephone Referrals to Beechcroft, a Step 5 Regional Child and Adolescent Mental Health Inpatient Unit
Authors: Breakwell Andrew , Kelly Claire , Brakspear Lucy , McMurray Owen , Szczygiel Karolina 
Published: August 2024

AimsTo audit telephone referrals to Beechcroft inpatient unit.Beechcroft inpatient unit is a step 5 regional child and adolescent mental health inpatient unit in Belfast. It receives a large volume of referrals from across all five health and social care trusts in Northern Ireland. The process of referral to Beechcroft can vary between trusts and clinicians; the majority of admissions are emergency. The demand for beds has risen by 30% since 2019. Emergency admissions are commonly telephone referrals whilst others submit written referrals. The referrals process is managed by the ward sisters, as there is no bed manager post. Referrals are discussed with a consultant psychiatrist.Referrals received often lack key clinical information, which makes decisions around appropriateness of admission or prioritising multiple referrals difficult. Furthermore, as the admitting doctor relies on this information, missing clinical information could result in patient safety issues.Methods24 telephone referrals were recorded between August to December 2023. 5 referrals were excluded for either no request for a bed (3) or telephone update following previous written referral (2). 19 telephone referrals were analysed across 7 different criteria as below, based on necessary information.Criteria 1 Patient identifiable informationCriteria 2 Source of referral/referrer detailsCriteria 3 Current location of patientCriteria 4 Legal statusCriteria 5 Presenting symptomsCriteria 6 Working diagnosisCriteria 7 Risks warranting admissionResultsYes No %YesCriteria 1 19 0 100Criteria 2 19 0 100Criteria 3 13 6 68Criteria 4 14 5 74Criteria 5 18 1 95Criteria 6 2 17 11Criteria 7 15 4 79Total 100 33 75.2Patient identifiable information and source was documented in all referrals. Only 10% of referrals included a working diagnosis. Location of patient, legal status and risks warranting admission were documented between 68 and 78%.ConclusionCrucial information such as working diagnosis was missing in 90%. Risks or legal status missing in up to a quarter of referrals. This has an impact on timely access, bed flow and potentially patient safety.A need for improvement in receiving and documenting telephone referrals has been identified. To aid improvement in patient safety and flow, a bed manager for in hours has now been appointed. A standardised proforma for recording data will be developed by inpatient staff in collaboration with community staff to include the above criteria. A re-audit will be carried out following these service improvements.
Applying the CORE20PLUS5 to Address Health Inequalities for Patients Under the Rehabilitation and Recovery Service in the London Borough of Hackney
Authors: Brennan Ailbhe 
Published: August 2024

AimsThe NHS England Core20PLUS5 aims to reduce national healthcare inequalities by identifying five clinical areas requiring accelerated improvement for the most deprived 20% of the population. Three of these clinical areas are: Severe Mental Illness (SMI), Early Cancer Diagnosis and Maternity Care.Hackney has the highest proportion of areas within the most deprived 10% nationally. The Hackney Rehabilitation and Recovery Team is a specialist service for those with SMI. While the service does not provide maternity care it is uniquely placed for women's health outreach work in this population. Research has shown that lower participation by those with SMI in screening may make them 2.5 times more likely to die prematurely from cancer. Bearing this in mind, this project aimed to improve early cancer diagnosis and management of women's health to improve health inequalities for females with SMI in Hackney.MethodsI audited cancer screening compliance from the medical records of the 19 female patients under the Hackney Rehabilitation and Recovery Team and obtained patient feedback to explore barriers to access screening. I used a pool of possible keywords to perform a search for any discussion of women's health issues during contact with mental health professionals. Encouraging a culture of ‘Making Every Contact Count’, I presented the results of this audit at a Team Education Session, after which attendees received a personalised list detailing their caseload's outstanding health needs as identified from the audit. I led a weekly physical health clinic which addressed women's health issues. I designed a referral pathway for patients with complex psychiatric needs with the local cervical screening service which allows for longer appointments.Results16% of the female patients under the care of the Hackney Rehabilitation and Recovery Service had never had a discussion covering women's health issues. 73% of mammograms and 53% of smear tests were outstanding. Barriers to access include a lack of knowledge of cancer screening programmes and practical issues in booking appointments. Some cited a lack of confidence in travelling to appointments and communication issues (access to a mobile phone, email address or post) as an issue.ConclusionDesigning interventions to boost the uptake of cancer screening appointments for female patients with SMI is a practical application of the CORE20PLUS5 approach. An MDT approach including patient participation and feedback is key when developing effective outreach initiatives.
Audit on Discharge Summaries From General Adult Inpatient Units to Primary Care at Black Country Healthcare NHS Foundation Trust
Authors: Chandra Pallavi , Ahmed Omair , Vajawat Bhavika , Ojuawo Olutobi , Varshney Prateek 
Published: August 2024

AimsDischarge summaries act as a key source of condensed information of inpatient stay as well as follow-up plan. Its timely availability to primary care and other multi-disciplinary teams involved in patient care is vital, especially when patients are being managed out of locality by different teams.The project aimed at assessing if discharge summaries for General Adult inpatients across all four localities of the Trust was made available and in a timely fashion on patient electronic records as well as to primary care using national guidelines as the standard. Using the same guidelines, it also evaluated the quality of the summaries based on the information contained.MethodsData was retrospectively collected in October 2023 for general adult inpatient discharges for the month of January 2023 across all four localities of Black Country Healthcare NHS Foundation Trust. Records for 148 out of the 152 discharges were assessed. Data was collected from electronic patient records Rio and evaluated on Microsoft Excel. The evaluation checked whether discharge summaries were available, duration between discharge and its availability on electronic records as well as contents of summary. Professional Record Standards Body and the RCPsych guidelines were used as standards.Results28 of the 148 (18.9%) patients did not have a completed discharge summary. Of these, 14 (9.4%) were out of locality patients. The average duration from discharge to summary being made available was 12.7 days. Most of the summaries contained all relevant information as per guidelines.ConclusionThe findings were presented to the Trust’s QI committee. It was concluded that while majority patients had a summary made available, there is a need for additional strategies to ensure summaries are available soon after discharge to ensure safe post-discharge care.It was identified that the bed management team should notify parent teams of admissions and discharges promptly.The medical secretary is to monitor the admissions register and ensure the junior doctors in the team complete discharge summaries in a timely manner.Business intelligence team to use clinical coding to identify any missing discharge summaries and provide medical teams with a monthly report in case any are missed by the secretaries.Once above recommendations are implemented, a re-audit would help to analyse the improvements in practice. The results would also help guide the Trust in developing a policy to harmonise processes across the Trust and thereby ensure safe patient care post-discharge.
Antibiotic Prescribing in Acute Wound Management
Authors: Al-khatib Hani Dourado , Corn Emma , Ozidu Victoria 
Published: August 2024

AimsThe primary aim is to ensure patients receive recommended acute wound care. Specific objectives include improving wound management, enhancing antimicrobial stewardship, and aligning practices with national guidelines.MethodsA retrospective audit spanning May to October 2023 assessed prescriptions for in-patients receiving antibiotics for wound management. Detailed patient records were scrutinized to evaluate compliance with standards, including wound assessment documentation, antibiotic indication adherence, tetanus status recording, and wound swab collection.ResultsA total of 21 patients/encounters met the criteria for inclusion. Documentation deficiencies were prevalent, with only 61.9% of prescriptions featuring complete wound assessments. Additionally, antibiotic indications met NICE criteria in only 42.8% of cases, while tetanus status documentation was absent across all records. Despite 76% receiving first-line antibiotics, only 19% had wound swabs collected.ConclusionSelf-harm rates in the United Kingdom, particularly among those with mental health disorders, are alarming. Hospitalizations are often required to address acute self-inflicted wounds, yet in-patient settings present unique challenges exacerbating self-harming tendencies.This audit underscores the imperative of optimizing acute wound management in in-patient settings. By implementing evidence-based practices and addressing identified deficiencies, healthcare providers can enhance patient outcomes and ensure optimal care delivery.
A Re-Audit of Physical Health Monitoring of Day-Care Patients in the Adult Eating Disorder Service at Surrey and Borders Partnership NHS Foundation Trust
Authors: Fulmali Amit , Pathan Tayeem 
Published: August 2024

AimsTo determine if the physical health monitoring of day-care patients in the Adult Eating disorder service (AEDS) is done in line with the recommendations of NICE guidelines and relevant Medical Emergencies in Eating Disorders (MEED) Guidance on Recognition and Management.Methods1. For every attendance of patients to the day-care Clinic it is expected that the physical health monitoring to be offered would include:
•Weight•Height (if first attendance)•BMI•HR (Pulse rate)•Sitting/Standing BP•Temperature2. Relevant blood tests and ECGs on a schedule based on patient's BMI or as needed based on clinical indication.23 patients were identified as having been seen in AEDS day-care centre between April 2021 till the point of discharge. 9 were deemed inappropriate due to incomplete information. Of the remaining 14, 9 patients were randomly selected, their documentation were looked from admission to day-care to the point of discharge. The monitoring was audited at 3 points of contact over the course of their first clinic appointment, the middle and point of discharge.Results1.Comparing data from previous audit, the average admission in day-care decreased from 5.5 to 3.5 months.2.There was overall improvement in the ECG and blood test monitoring.3.At the admission and the last assessment there was 100% monitoring of BMI, weight, blood pressure and pulse.4.There was a drop in temperature monitoring by 11.1% in the first and last assessment due to faulty equipment.5.The ECG and bloods percentage dropped by 11.1% at all the monitoring points.6.At the midpoint there was no documentation of BMI, Blood Pressure, and pulse for 1 patient.Conclusion1.Investigations were delayed from the patient's side.2.Due to COVID there was difficulty in accessing the primary care appointments for investigations.3.The temperature equipment was not working properly.Recommendations:1.Keeping a fixed format for documenting day-care visits on the SystmOne software. A Sample format made available for documentation.2.Document all the parameters checked in the patients’ electronic records on the same day.3.Day-care clinical team to upskill on ECG via training.4.Team Resources to be allocated to have in-house ECG in day-care.5.SUSS test to be done for all RED (High risk) patients as clinically indicated and clearly document in the notes, e.g. SUSS: done/not done and reason with date SUSS conducted on.
Evaluating Adherence to Rapid Tranquilization Protocols in Psychiatric Emergencies: An Audit of a Tertiary Care Facility in Pakistan
Authors: Gul Naima , Nizami Asad 
Published: August 2024

AimsThis audit assesses the adherence to and effectiveness of rapid tranquilization protocols in a tertiary care psychiatric facility in Pakistan, particularly focusing on the use of intramuscular (IM) haloperidol and promethazine. The evaluation also includes an analysis of how these practices align with the prescribed guidelines for managing psychiatric emergencies.MethodsA comprehensive retrospective analysis of patient records from January to December 2023 was conducted. The focus was on assessing the sequence of interventions (de-escalation techniques, oral medication, IM administration), medication choices, adherence to protocol steps, and documentation of patient monitoring post-administration. Descriptive and inferential statistical methods were applied to analyze the data.ResultsAmong 482 patient records:The primary diagnoses included schizophrenia (44%), bipolar disorder (29%), and severe depression with psychotic features (27%). IM haloperidol and promethazine were predominantly used, with 68% of cases bypassing oral medication or de-escalation attempts. Only 60% of cases showed adherence to the recommended protocol steps, including assessment for medical causes and optimization of regular prescriptions. In 12% of cases, a second injection was necessary, with the interval between injections undocumented in 15% of these cases. Vital monitoring post-administration was not recorded in 30% of cases. Medication unavailability was an issue in 8% of aggressive cases. Protocol deviations included the omission of recommended pre-treatments, such as ECG for haloperidol and the lack of alternative options like buccal midazolam or inhaled loxapine.ConclusionThe audit reveals significant deviations from established guidelines in the rapid tranquilization process. The frequent omission of non-invasive interventions and the lack of consistent monitoring and documentation practices highlight areas needing immediate improvement. Training in de-escalation techniques, adherence to step-wise intervention protocols, and ensuring the availability of a range of medications are crucial. This study underscores the importance of aligning psychiatric emergency practices with established guidelines to ensure patient safety and effective treatment outcomes.
An Audit of Baseline Physical Health Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Commenced on Lithium
Authors: Hyland Declan , Chinnari Gopal , Elhaj-Houssen Tawfik , Orrell Rose-Anne 
Published: August 2024

AimsLithium is clinically indicated for use in the UK for treatment and prophylaxis of mania, treatment and prophylaxis of bipolar disorder, treatment and prophylaxis of recurrent depressive disorder and treatment and prophylaxis of aggressive or self-harming behaviour. Prior to commencing lithium, there is a need for several physical health checks and blood tests to be completed to ensure that lithium remains appropriate to prescribe.This audit aimed to establish whether Mersey Care NHS Foundation Trust’s prescribing practices of lithium are in keeping with national guidance prior to initiation and how the Trust’s performance compared with national performance as identified by the Prescribing Observatory for Mental Health (POMH) lithium audit.MethodsA total of 127 patients under the care of the Trust who were prescribed lithium (lithium carbonate and lithium citrate, tablet and liquid formulations) were identified using the Trust's electronic record system and electronic prescription chart system. The POMH lithium audit tool was used to capture data for each lithium patient as Mersey Care NHS Foundation Trust was participating in the national POMH lithium audit. Each patient's electronic record was scrutinised to determine whether the following were measured prior to lithium being initiated – weight/body mass index (BMI)/waist circumference, Thyroid Function Tests (TFTs), serum calcium level and estimated Glomerular Filtration Rate (eGFR).ResultsOf the sample of lithium patients included in the audit, 78% of patients had a weight/BMI/waist circumference done prior to initiation of lithium; 80% of patients had a serum calcium level; 93% had TFTs done; and 100% of patients had an eGFR completed prior to initiation of lithium.ConclusionThe results of this audit indicate that the Trust is performing well with the required physical health monitoring prior to initiation of lithium. Trust performance for all four parameters that were included and assessed in this audit were above the national compliance level reported in the POMH lithium audit. There is clearly a need, however, to improve performance and to ensure that both medical and nursing staff across the Trust are aware of the physical health monitoring required before initiating any patient on lithium. A Quality Performance Alert will be sent to all medical and nursing staff to raise awareness and lithium monitoring will be included in the induction for junior doctors working in the Trust. Future auditing of Trust performance on required physical health monitoring prior to commencing lithium will be conducted.
An Audit of Whether Patients on the General Adult Inpatient Wards and the PICU in Mersey Care NHS Foundation Trust Who Are Prescribed High Dose Antipsychotic Therapy Are Being Monitored as per Trust Policy
Authors: Hyland Declan , Singh Roopa , Dainton Kerry 
Published: August 2024

AimsHigh Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.This audit aimed to determine whether patients on the 16 general adult inpatient wards and Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust who are prescribed HDAT are managed as recommended by the Trust's HDAT policy.MethodsA list of all inpatients admitted to the 16 general adult inpatient wards and the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was prescribed HDAT. For each HDAT patient, the patient's electronic psychiatric record was analysed to determine whether baseline physical health assessments – ECG, BMI, waist circumference, BP, pulse rate, FBC, U and Es, LFTs, serum prolactin level, HbA1c level and random serum total cholesterol level and lipid profile were completed before commencing HDAT. Each HDAT patient was reviewed to determine whether a cardiovascular assessment was completed prior to commencing HDAT.Results29 inpatients on the 16 general adult wards and the PICU were prescribed HDAT. The Trust's HDAT policy states 13 baseline physical health assessments should be completed prior to commencing HDAT. For the 29 patients, 13 baseline physical health assessments should have been completed on 378 occasions. On 98 occasions, the patient refused and these were excluded from the compliance. There were 226 (81%) occasions they were completed and 54 (19%) when they weren't completed. 12 (41%) of the 29 HDAT patients had a cardiovascular assessment done prior to commencing HDAT.ConclusionThere are a significant number of inpatients in whom not all the required baseline physical health assessments prior to commencing HDAT are completed. A cardiovascular assessment is an important aspect of deciding whether to prescribe a patient HDAT and yet commonly not completed. There is a need to ensure that nursing and medical staff on the inpatient wards are aware of the Trust's HDAT policy and need to refer to and to adhere to it.