bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Carers’ Engagement for Patients Admitted to Psychiatric Intensive Care Unit (PICU): A Quality Improvement Project
Authors: Hossain Simona , Clark Lois , Pettifor Emily , Satisha Shantala , Youn Sua 
Published: August 2024

AimsThe project aims to improve carers’ engagement for patients admitted to our male Psychiatric Intensive Care Unit by improving communication between staff and carers; and by involving carers more in patients’ care.Hypothesis:Among patients admitted to PICU, there is inconsistency in communication with carers and in involving carers in patients’ care. We expect an improvement in these parameters with the quality improvement project.Background:Within PICUs, patients with severe psychiatric illness face social isolation. Challenges arise when carers are not engaged, impeding patient support and personalised care. Involving carers becomes crucial for informed decision-making, ensuring both patients and carers actively participate in the care process. National Association of PICUs and The Royal College of Psychiatrists' Guidance for PICU sets out recommendations regarding timelines and types of interventions to be offered to carers.MethodsInitial baseline data was collected by reviewing patient electronic notes.We then tested interventions to improve carers’ engagement by using the Plan-Do-Study-Act (PDSA) methodology over 2 cycles. In the first cycle, we engaged the nursing staff by presenting the baseline data and recommendations to improve carers’ engagement. In the second cycle, we introduced an admission protocol to ensure carers were engaged consistently. The parameters assessed were documentation of carers details; contacting carers within 24 hours of admission; documenting carers' views in care plan; inviting carers to Care Plan Approach (CPA) meetings and offer an appointment for carers with staff.Data was collected after each PDSA cycle to monitor change.ResultsOf the patients admitted to PICU, 29% had their carers’ details documented at baseline, 40% after the first PDSA and 80% after the second PDSA. 42% of carers were contacted within 24 hours of admission at baseline; 66% and 30% after the two PDSA. 50% of carers had their views included in the care plan at baseline; 0% and 30% after the interventions. At baseline, 42% of patients’ carers were invited to the CPA meeting, 66% and 30% after the two PDSA cycles. 50% of patients’ carers were offered an appointment with staff at baseline, 66% and 30% after the two interventions.ConclusionAs a result of this quality improvement project there has been an improvement in engaging carers of patients admitted to PICU. This was not sustained for the second cycle due to many regular senior staff being on leave during Christmas. The next steps will be to implement this consistently and produce a carers’ information pack.
Quality Improvement Project – Producing an Information Poster to Improve Easily Accessible Practical Information to Junior Doctors Whilst On-Call at Fieldhead Hospital
Authors: Winder-Rhodes Harriet , Thompson Amelia , Nazari Jamshid 
Published: August 2024

AimsTo create an information poster for the doctors’ on-call room and doctors’ office at Fieldhead Hospital (a Psychiatric Inpatient Hospital in Wakefield) to improve readily available practical information to doctors whilst on-call.Background – Psychiatry on-call shifts can feel daunting, especially if this is the clinician's first (and perhaps only) exposure working as a doctor within this specialty. Psychiatric hospitals are not equipped to deal with physically unwell patients which can be challenging especially as the only junior doctor on-call out of hours. Although there is a comprehensive induction programme, doctors in training raised concerns that there is insufficient, readily available practical information whilst on-call.MethodsSurveys were sent out to doctors in training to ascertain their initial viewpoints about producing a poster and which information they feel should be included. Doctors included were foundation years, GP and core trainees on their psychiatry placement in the South West Yorkshire Partnership NHS Foundation Trust. Both qualitative (free text responses) and quantitative information (yes/no responses) were obtained via SurveyMonkey. An initial draft poster was produced and sent out to all doctors in training as well as the project lead and clinical lead. The poster was amended accordingly. The posters were printed and displayed in the on-call rooms and doctors’ office.ResultsFour respondents responded to our initial pre-poster survey. They were highly receptive to the suggestion that this information would be in poster format to provide easily accessible information to help whilst on-call. Key topics identified for the poster included navigating logistical issues and information on-site, clerking new admissions and the relevant investigations required, important telephone numbers, personal safety and where and how to access relevant information and guidelines.Feedback regarding the initial draft poster survey and the included information was also positive. Seven respondents replied and overall, they felt that the poster provided the relevant information. The project supervisor and clinical lead also provided constructive feedback and identified that locating risk assessments and discussing with a consultant when a patient is recalled to hospital on a CTO should also be included. The initial draft poster was amended following this feedback.ConclusionIn conclusion, we found that there was an unmet need for easy to access logistical information regarding on-call work. The on-call poster provided the necessary information in a succinct and clear manner which the trainees benefited from.
Digitalising Regional Induction for Junior Doctors in Mental Health and Learning Disabilities Department of Betsi Cadwaladr University Health Board
Authors: Loo Jiann Lin , Zachariah Vinila 
Published: August 2024

AimsInduction training is a crucial part of starting work in a new organization as it orientates new staff to their work role and environment, which ensures that they can work safely and competently. Given the wide geographical area of North Wales, there is logistic difficulty to continue with face-to-face induction sessions for new junior doctors. A digital format for regional induction for new doctors from all sites was introduced in 2021. This virtual induction has dealt with the accessibility problem effectively. Nevertheless, there seemed to be some ongoing issues regarding organising the session with speakers due to overlapping clinical duties. Therefore, a quality improvement project has been initiated to improve the delivery of the sessions with minimal disruption to clinical duties. This paper is aimed to share the preliminary experience of the process of digitalisation of the induction programme.MethodsThe pilot regional induction with the above changes was carried out on August 4, 2023 via Microsoft Team Meetings and was accessible to new starters from all three sites in North Wales. The sessions consisted of talks from consultants, the lead clinical pharmacist, the ST in psychiatry and clinical services/Rota coordinator. The induction was divided into morning and afternoon sessions. The participants consisted CTs in psychiatry, GPSTs, and FY trainees. The session was recorded and a pre-recorded session on history taking was introduced. Any queries about pre-recorded session were answered by the chair of session.ResultsIt was found that an estimated time saved per induction was 285 minutes with an overall saving for 3 inductions per year of 14.25 hours. The estimated cost saved (based on the lowest pay scale in NHS, £) was £151.13 with an overall saving for 3 inductions per year of £453.39. There were two Assessments of Teaching (AoT) and two Direct Observations of Non-Clinical Skills (DONCS) signed.ConclusionDigitalising the regional induction helps to save both time and cost for the health board. It also reduces the risk of speakers in availability. Furthermore, the recording can be sent out early to all the JDs before they join MHLD, which can facilitate a quicker orientation into the new role. It is also a good opportunity for core and specialty trainees to achieve competencies for leadership and teaching.
Out of Hours Work: A Trainee-Led Review
Authors: Hall Charlotte , Garnham-McEwan Drew 
Published: August 2024

AimsThe 2016 Junior Doctor’s contract offers guidance as to the rest periods needed during non-resident on-calls (NROCs). The Rotherham, Doncaster and South Humber (RDaSH) NHS Foundation Trust currently works on a NROC trainee rota. NROC work undertaken is monitored via a log form, returned by the trainee after their shift. A retrospective audit was completed with only a 28% return rate of log forms. Though anecdotal evidence suggested inadequate rest and high workloads during on-calls, due to low engagement in monitoring formal data was lacking. Therefore, a trainee-led prospective audit was designed to formally monitor on-call workload over a period of 4 weeks.The main aim of this project was to review the average amount of hours worked during an NROC shift and compare achieved rest periods against agreed standards (derived from 2016 contract). These standards indicate that 90% of shifts should achieve 8 hours rest in 24 hours and 5 hours continuous rest between 22:00–07:00. In order to accomplish this we first aimed to increase the return of completed on-call log forms to 75%.MethodsWork was predominantly concentrated around increasing return rate of the log forms including: running teaching sessions, regional promotion, and sending daily reminder emails to return the forms. These forms were then reviewed and analysed.ResultsAcross the 4 week audit period, the return rate of log forms was 95%, compared with the previous return rate of 28%. Average hours worked across all three localities exceeded the expected hours by RDaSH. When compared with the standards outlined, 1 in 3 shifts in Rotherham, 1 in 5 in Doncaster and 1 in 4 in South Humber did not achieve contractual rest periods. Out of these, not reaching 5 hours continuous rest was the most common reason for not meeting contractual rest periods.ConclusionRDaSH worked collaboratively with trainees to generate a number of interventions to mitigate the breaches in rest periods including: creation of a new clinical role to filter calls, reviewing the suitability of the NROC rota and increasing pay to reflect the increased workload. There is currently work underway to redesign the rota.This audit highlights the importance of prioritising regular reviews of NROC work to ensure the safety of both staff and patients through achieving adequate rest periods.
Rapid Tranquillisation Practice and Debriefing; an Observational Study in Adult Psychiatric Inpatients
Authors: James Georgina , Mir Asif 
Published: August 2024

AimsRapid Tranquillisation (RT) is the administration of parenteral sedation to de-escalate situations where patients may harm themselves and/or others. RT is a restrictive intervention potentially breaching patients’ human rights and is reserved for situations where other measures have failed. NICE guidelines (NG10) state that once immediate risks are managed, post-RT incident debriefing of patients and staff should be conducted. This study examines concordance with NG10 at an adult inpatient psychiatric unit and explores ways to improve compliance and patient/staff experience.MethodsAdult psychiatric inpatients (aged 18–65) who received single or multiple RT therapy during the admission study period (October 2023) were included. Data collected from Electronic Patient Records and chart review included gender, age, ward type, date of RT and drug(s) administered. Following RT, anonymised data was collected on the presence, nature and details of debriefing.Results49 adult psychiatry patients were admitted during the study period and there were 32 episodes of RT use in 9 patients (18.4% of inpatients). 56.7% of these occurred on general wards and 43.8% on psychiatry intensive care, with 6 patients (66.7%) >1 episode. Intramuscular drugs used included one or more of lorazepam (78.1% of patients), haloperidol (25%), promethazine (21.9%) and aripiprazole (9.4%). After 46.9% (15/32) of RT episodes debrief was offered, and occurred in 28.1% (9/32); 40% (6/15) of those offered debrief did not participate. 52.4% (11/21) of female patients were offered debrief with 81.8% (9/11) uptake, compared with 36.3% (4/11) of male patients offered with 25% (1/4) uptake. No accounts were taken from patients’ advocate, carer or witnesses. Details of debriefs conducted were documented in 33.3% (3/9). Reasons for not conducting debriefing were documented in 43.5% (10/23). The most common reason given was “not clinically appropriate”. During debriefs, no patients were offered information leaflets about the RT medication used. Finally, staff debriefing occurred in 31.3% (10/32) of episodes.ConclusionCompliance with NG10 guidelines for debriefing inpatients following RT was low and was worse in male than female patients. Staff debriefing was poor and no witness or advocate accounts were utilised. These findings may be due to the stressful ward environment or disrupted patient-professional relationship immediately following RT administration. Understanding the reasons for the gender differences in uptake, patient, staff or environmental factors contributing to lack of debriefing will allow interventions and improve holistic patient care following RT. Information and awareness of RT therapy should be available for patients more readily on ward admission and following RT.
Transition of Care in Young People With Attention-Deficit/Hyperactivity Disorder (ADHD) From Child to Adult Services
Authors: Jung Sangwoo Richard , Saunders Catherine , Cardinal Rudolf , Ford Tamsin 
Published: August 2024

AimsThis retrospective cohort study using routinely collected administrative clinical data from the Cambridgeshire and Peterborough Foundation Trust (CPFT) Research Database, aims to understand how many children and young people (CYP) with attention-deficit/hyperactivity disorder (ADHD) undergo successful transition from child and adolescent mental health services (CAMHS) and community paediatric services, to adult mental health services and investigate the factors that are associated with the successful transition of care in young people with ADHD to adult services.Many young people with ADHD, in need of service transition from child to adult services, experience serious barriers in receiving the care they need, constrained by scarce resources, low capacity in specialist services and variable awareness or training across various levels of care.MethodsWe explored the numbers and clinical and socio-demographic characteristics of CYP with ADHD who undergo successful transition from CAMHS and paediatric services, to adult mental health services. We will explore whether children with certain sociodemographic factors/treatment/service attended are more likely than others to successfully transition using multivariable logistic regression.ResultsNote results are rounded for statistical disclosure control. We identified 24,240 unique CYP for whom a referral (age < 18) exists to CPFT between 1 Sep 2007 and 31 Aug 2019 (with follow up until 2020). Of this cohort, 2300 were referred at any time to any ADHD service, 1760 CYP had a record of ADHD medication in their clinical notes at any time of whom 1590 CYP had a record of ADHD medication under the age of 18. Of these 1590 CYP, 330 had at least 1 year follow up in the database before and after their 18th birthday and a record of ADHD prescribing during the year before they turn 18. This is a cohort of CYP who should have transitioned from child to adult services. Of these 330, 160 (48%) had been referred to any ADHD service between their 17th and 19th birthday and 190 (58%) had any record of ADHD medication in the year after they turn 18. Further analyses will explore the characteristics of CYP who successfully transition, and we will carry out a series of sensitivity analyses.ConclusionWith an increase in the number of children with ADHD who are prescribed medication, we can expect an increasing cohort of emerging adults who need continued care. This study will provide evidence on the current state of care to help identify areas for improvement.
Self-Perceived Competence in Providing Eating Disorder Interventions for Young People: A Service Evaluation Project
Authors: Rogers Emily , Lusby Joshua , Oginni Olakunle 
Published: August 2024

AimsDespite the rising prevalence of eating disorders among young people and their associated morbidity and mortality, the level of self-perceived competence of professionals in providing health interventions is unknown. It could be expected that those with low self-perceived competence would be reluctant to initiate therapeutic interventions, which may increase the burden of unmet need for this population. Consequently, a service evaluation project was carried out in Cardiff and Vale Health Board Trust to assess the confidence of healthcare providers in working with young people with eating disorders, and to identify interventions acceptable to clinicians in order to meet this service need.MethodsFifty-two healthcare workers who worked with young people below 18 years responded to a brief survey. The survey was advertised via email through the medical education department between December 7 2023 and January 5 2024 to healthcare workers based at Adult and Paediatric Emergency departments, in-patient units of General Adult Medical and Paediatric departments and the Community-based Child and Adolescent Mental Health Services (CAMHS). The survey elicited participants’ specialty, location of practice, self-assessed confidence in managing eating disorders in young people, aspect of management participants require support in, and preferred interventions which might support greater literacy in this topic.ResultsFifty-two participants responded to our survey of whom 48% (25) were doctors, 17% (9) were psychologists, and 13% (7) were nurses. The larger proportion of participants worked in CAMHS (42%) and Paediatric wards/emergency department (37%). About 43% reported having a role in managing young people with eating disorders. Half of the participants reported having “average” to “good” confidence in managing young people with eating disorders while none reported “very good” confidence. Discussion with colleagues was reported as the most common means of getting information about managing young people with eating disorders (79%), while the least cited was local teaching (13%). Most participants wanted support with recognising high risk presentations (60%) and providing psychological interventions (58%). The most highly requested interventions were written resources (65%), and teaching events – virtual (63%) and face-to-face (54%).ConclusionConsidering the rising prevalence of eating disorders, self-rated confidence of participants in working with young people with eating disorders was relatively low. Interventions can include providing summarised policy documents, simple reference resources, and targeted teaching. These interventions will be implemented and the survey repeated to assess impact of the intervention, with a view to repeating this cycle in order to further drive improvement.
Dementia and Driving
Authors: Al-Dabbagh Mohammed , Muhammad Faquiha , Odegbaro Dolapo 
Published: August 2024

AimsThis audit focuses on assessing the compliance of health professionals with the UK law by informing the drivers with dementia about their legal requirement to report their condition to the DVLA and their insurance companies. The aim of this audit is to ensure public safety by adhering to the General Medical Council (GMC) guidance; “Confidentiality: patients’ fitness to drive and reporting concerns to the DVLA or DVA”, as well as the Driving with Dementia or Mild Cognitive Impairment Consensus Guidelines for Clinicians; endorsed by RCPsych and Alzheimer's Society. This will help ensure public safety and prevent potential accidents or incidents caused by impaired driving.MethodsThe audit reviewed retrospective data of 40 patients selected randomly (17 males, 23 females and mean age 78 years old), referred to the memory clinic at Watermill Resource Centre in Berrywood Hospital, Northampton. The inclusion criteria was patients referred between 1st January and 31st December 2022 that were diagnosed with dementia. We set a compliance target of 100%.ResultsThe results showed that out of the 40 patients diagnosed with dementia, 23 had a recorded risk assessment. 11 patients were driving at the time of assessment. 7 patients were referred to occupational therapy for a driving assessment. The compliance in informing patients about reporting to the DVLA and their insurance companies was low. 8 out of 11 (73%) patients were informed about reporting to the DVLA, and 5 out of 11 (45%) were informed about contacting their insurance company. Additionally, only 4 out of 11 (36%) patients were informed about the consequences of not reporting to the DVLA and their insurer. There was also a lack of systematic documentation regarding driving risk assessment. There was no record of medics contacting the DVLA.ConclusionOverall, the audit revealed a need for improvement in compliance and documentation. It is recommended that health professionals strictly adhere to their responsibilities in risk assessment and informing drivers with dementia about their legal requirements regarding informing DVLA and insurance companies. Clear documentation should be made using a standard template available.