bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of the Completion Rate of BPD Admission Checklist for the Hospital Admitted Service Users With EUPD
Authors: Baruah Ranjan , Graham Simon , Elturky Jehan , Ruth Hannah , Abulais Faraaz 
Published: August 2024

AimsAs admissions have the potential to contribute to iatrogenic harm, Mersey Care NHS Foundation Trust (MCFT) introduced an admission checklist to help the decision-making process around admitting people with Borderline Personality Disorder (BPD).
1.To conduct an audit to review if the admission checklist was being used after its introduction.2.To provide data on the context of admission including the use of MHA.MethodsData from admissions for people with BPD to nine acute care wards in (MCFT) over a three-month period were collected and assessed for 21 parameters.A total of 60 admissions were identified for 51 patients (9 patients had more than one admission).ResultsNone of the recorded 60 admissions had a completed BPD checklist at the time of admission.36 (60%) of the decisions to admit took place during the Normal Working Hours (NWH), 24 (40%) out of hours (OOH).33 (55%) informal admissions, 27 (45%) on Section 2 of the MHA.NWH admissions were associated with a higher number of informal admissions compared with OOH admissions (24 vs 9 respectively).3 out of 27 OOH admissions requested by Crisis Resolution and Home Treatment (CRHT) resulted in informal admissions. The remaining OOH admissions were following a Mental Health Act Assessment (MHAA) by trainee psychiatrists.At the point of admission, 9 (15%) patients were not open to secondary mental health team in MCFT prior to their referral for MHAA; 48 (80%) patients were under Community Mental Health Teams and/or the CRHT; 12 (20%) were open to the Personality Disorder (PD) hub, and 3 (5%) were open to other mental health teams including eating disorders team, Attention Deficit Hyperactivity Disorder (ADHD), Addiction Services and Criminal Justice & Liaison Team (CJLT).ConclusionThere was no engagement with completing the BPD admission checklist. 40% of ST doctors reported on a separate survey that they cannot locate the Checklist on patient information system.Admission decisions made during NWH have led to significantly more informal admissions compared with during OOH where the MHA was more likely to be used.An action plan was designed to improve engagement with the admission checklist:
•Introductory training was provided to CRHT, approved mental health professionals (AMHPs), MHA second opinion doctors and psychiatry ST doctors.•Inpatient teams were asked to complete the checklist.•Bed Management to request an updated completed PD admission Checklist prior to admission.•Re-auditing in 6 months.
Psychiatric Emergency Bleep Documentation Enhancement Audit
Authors: Davidova Anastasija , Young Scott , Al Sayegh Amal , Halford Jude 
Published: August 2024

AimsWest Lothian Psychiatry operates in a district general hospital, fostering a close working relationship between medical and psychiatric practitioners including the Psychiatric 2222 call (akin to medical emergency/cardiac arrest response). No other team like this has been identified in Scotland. Whilst there is a range of scenarios where this is used, there is no ‘gold standard' for defining a psychiatric emergency or how to document these. Preliminary data gathered between August and November 2022 revealed concerns regarding call appropriateness, medical staff proficiency in de-escalation and restraint on medical wards, inadequate handovers, and poor documentation. This prompted a collaborative quality improvement project, undertaken by psychiatric and medical team leaders. Part of this initiative was an audit to improve the documentation of psychiatric emergencies to achieve a 90% compliance rate using a new checklist.MethodsCycle 1 of the audit (December 2022 to April 2023) identified patients through the 2222 calls to switchboard (n = 54). TrakCare notes were reviewed to assess call rationale and outcomes, focusing on documentation by the attending psychiatric team. A documentation checklist within the electronic records system was designed and introduced in July 2023, for completion by the junior doctor. Cycle 2 (November 2023 to January 2024, n = 47) aimed to assess improvements by comparing results with the previous cycle.ResultsThere was a significant improvement in documentation rates with the checklist (44% to 90%). Indirect enhancements were observed in ward nursing documentation (65% to 83%) and medical ward doctor documentation (39% to 57%). Appropriateness of emergency calls increased from 65% to 74%, with attending doctors' participation in emergencies longer than 10 minutes rising to 68% from 47%. The initial audit revealed a lack of awareness among senior medical staff regarding overnight psychiatric emergency calls, especially in cases of repeated calls for the same individual. The improved documentation played a pivotal role in addressing this issue, facilitating effective information sharing and changes in patient management plans, reducing further emergency calls.ConclusionThe documentation checklist significantly improved junior doctor documentation, positively impacting patient care and communication among staff. This successful intervention serves as a promising model that can be replicated in other documentation domains. Moreover, this project has set the stage for broader initiatives within a larger Quality Improvement framework. The ongoing efforts are directed towards establishing a shared model for the psychiatric emergency bleep, optimising staffing resources for restraint procedures and improving staff de-escalation skills.
Is Annual Monitoring of Prolactin for Patients on Long Term Antipsychotics Being Completed and Results Acted Upon in Rochdale Community Mental Health Team?
Authors: El-Nemr Rania , Melling Emily , Yasin Saba 
Published: August 2024

AimsNational guidelines (NICE) recommend that prolactin should be monitored every 12 months for patients on antipsychotics, excluding patients on aripiprazole, clozapine, quetiapine or on doses of less than 20mg daily of olanzapine. The purpose of this audit was to investigate whether patients under our services who are prescribed antipsychotics implicated in causing hyperprolactinemia, were having regular annual prolactin measurements as per the guidelines and whether abnormal results were being actioned appropriately.MethodsA total of 61 patients were surveyed, as a random selection from the Outpatient Consultant case load in Rochdale CMHT. This was a retrospective analysis looking at annual prolactin measurements over 5 years between 01/01/2017 and 31/12/2022. This included all patients who had been stabilised on an antipsychotic for more than 2 years, and excluded patients on antipsychotics that did not cause significant prolactin rise (and so do not require annual prolactin measurements as per NICE guidelines).ResultsOur results showed that the majority of patients were not having regular annual prolactin measurements, with only 3.3% of patients having prolactin measured annually 100% of the time. 23% of patients had no prolactin measurements at all while on antipsychotic treatment during the time period assessed. In cases were there was an elevated prolactin reading, only 15% of these readings had a documented action plan.ConclusionThis audit has demonstrated that the overall compliance with the NICE standards for annual prolactin monitoring for people on antipsychotic medication is of a poor standard, and we highlight possible reasons why this may not be done and areas for improvement.
Carer Engagement and Support in North and West Kent Rehabilitation Services
Authors: Elshafei Ahmed , Heisig Martina , Fuller Amanda 
Published: August 2024

AimsTo compare current practice in local Rehabilitation in audit across North and West Rehab Kent units against standards of ‘Triangle of Care’.Standard 1.3:Carer's views and knowledge are sought throughout the assessment and treatment process.Standard 5.2:An early formal appointment is offered to the carer to hear their story, and history and address the carer's concerns.Standard 5.10:The carer is involved in the discharge planning process.A previous audit was conducted in 2019 using Triangle of Care and AIMS standards. We decided to see whether the standards have been upheld.MethodsWe included all 43 patients admitted over the previous 6-months. No patient had National Opt-Out. The source of information was the RIO system. The data were analysed by 2 investigators.A data collection form was used:Question for Standard 1.3: Were the carer's views and knowledge sought throughout the assessment and treatment process? If this was not the case, the reasons were to be specified.Question for standard Standard 5.2: Was an early formal appointment offered to the carer to hear their story history and address the carer's concerns?Question for standard Standard 5.10: Was the carer involved in the discharge planning process?ResultsStandard 1.3:83.72% had contact with a variety of team members throughout their relative's admission. Reasons for non-involvement included lack of consent, unavailable carers, non-attendance, and carer's preference.Standard 5.2:Only 60.53% of carers had an early appointment offer, and the expectation that this should occur in 80% of cases was unmet.Standard 5.10:(90%) of the patients had carers involved in the discharge planning process, meeting the required standard.ConclusionBest Practice:The audit results demonstrate that carers are involved in their relative's care throughout the admission and discharge process.Lessons learned:Compared with the previous audit in 2019, when the criteria for Standard 5.2 were met, carers were offered a formal early meeting significantly less often. Possible reasons could be the pandemic and resulting changes in practice have certainly led to a reduction in face-to-face meetings. Offering individual time to all carers is essential, and efforts should be made to integrate this into practice.Next steps:To allocate a team member to offer a meeting with the carer.To discuss the outcomes with the Carer Champions on each unit, to review what form their support currently takes, and consider how this could link in with the requirements of Standard 5.2.To re-audit in 1 year.
Prescribing and Monitoring of Pychotropic Medications in a CAMHS Inpatient Service
Authors: Erunkulu Olorunleke , Imran Shermin , Ashraf Wasim 
Published: August 2024

AimsTo ensure that there is a clear rationale for commencing service users on psychotropic medications.To ensure that the prescription of psychotropic medications is evidence-based and that they are in line with the Trusts and NICE guidelines.Ensure that psychotropic medications are regularly reviewed by the managing team.To ensure that information about medications is adequately shared with patients and carers.To ensure that service users are well-monitored for side effects.MethodsA 2-week retrospective audit on Phoenix ward.Clinical information from all the current service users on psychotropic medication was reviewed.The clinical information was collated from all 8 service users’ medication cards, ward round documents, MDT reviews, and electronic notes (PARIS), and these were analyzed by the inpatient specialty registrar.Results1.We attained a 100% mark in some areas of our prescribing such as indicating the rationale, the maximum dose for medication, and also prescribing within BNF limits.2.We however could not evidence proper information sharing with patients (only 40% documented).3.We could not evidence sufficient information sharing with carers (only 20% documented).4.PRN medication was mostly prescribed as a range rather than a clear dose, which gave rise to subjective dispensing bias.5.Side effect monitoring was documented for 85% of patients, meanwhile, the standard for this is 100%.ConclusionClinicians are to ensure that medication information is always shared with service users, and their carers, and this is documented.Clinicians are to also ensure that PRN medications are prescribed as a single dose rather than as a dose range.Ward staff are to ensure that they are monitoring side effects and documenting these clearly on electronic notes and ward round documents.The MDT is to ensure that all regular and PRN medications are reviewed regularly during ward rounds.Present this audit, share relevant findings with the clinical team, and monitor the implementation of the action plans by doing a reaudit in 6 months.
An Audit of Physical Health and Blood Test Monitoring in Patients Under the Care of Mersey Care NHS Foundation Trust Who Are Prescribed 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, bipolar disorder, recurrent depressive disorder and aggressive of self-harming behaviour. In patients who are prescribed lithium, several physical health checks and blood tests must be completed on a regular basis to ensure lithium remains safe and appropriate to continue. Lithium has a narrow therapeutic index and so close monitoring of serum lithium level is required.This audit aimed to establish whether Mersey Care NHS Foundation Trust’s physical health check and blood test monitoring of patients prescribed lithium is in keeping with NICE guidelines and determine 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 were identified. The POMH lithium audit tool was used to capture data for each patient as Mersey Care NHS Foundation Trust was participating in the POMH lithium audit. Each patient's electronic record was scrutinised to determine whether the following were measured every six months during maintenance treatment – Thyroid Function Tests (TFTs), serum calcium level, estimated Glomerular Filtration Rate (eGFR) and serum lithium level, and whether the patient had a weight/body mass index (BMI)/waist circumference within the last 12 months.ResultsOf the 127 lithium patients included in the audit, 64% had a serum calcium level done every six months, 78% had TFTs done every six months, 83% had an eGFR done every six months, and 87% had a serum lithium level done every six months. 71% of patients had a weight/BMI/waist circumference within the last 12 months.ConclusionTrust performance for TFT monitoring and weight/BMI/waist circumference was above the national compliance level reported in the POMH lithium audit; Trust performance for serum lithium level, eGFR and serum calcium level was below the national compliance level. There is a need to ensure that medical and nursing staff are aware of the physical health checks and blood test monitoring required for patients maintained on lithium. A Quality Performance Alert will be sent to medical and nursing staff in the Trust to raise awareness and lithium monitoring will be included in the junior doctor Trust induction. Future auditing of Trust performance on physical health check and blood test monitoring for patients maintained on lithium will be conducted.
Driving Status in Patients Admitted to Acute Psychiatric Ward and DVLA Advice
Authors: MacDaid Kerenza , Rana Faryal , Tagoe Reuben 
Published: August 2024

AimsDVLA guidance is very clear about patients not driving during or shortly after episodes of acute mental illness. There is an obligation for patients to inform the DVLA if they are unwell. The obligation for doctors to inform the DVLA if the patient chooses not to, and continues to drive when they should not, is also well known.This audit aims:
1. To identify the number of patients whose driving status was recorded following their admission to an acute psychiatric ward.2. To identify the number of patients discharged with correct DVLA compliant advice.3. To identify the number of patients whose notes reflected correct driving status information on discharge.MethodsPatient ward notes and discharge summary documents relating to their admission on to the PICU ward were examined retrospectively for recorded evidence of patient's driving status and any documented DVLA advice given. Patients admitted from November 2022 and April 2023 were reviewed. 68 patients were identified and systematic sampling techniques identified a sample of 30 patients.Keyword search included “Driving”, “License”, “Car”, “Driving license”, “DVLA”.Results30 patients were reviewed in total.40% of sample patients had no driving status recorded on their notes.Of the 60% of sample patients who were confirmed to be driving/held license, nearly half (47%) had no recorded advice documented regarding the DVLA or driving after an acute MH illness on discharge.A third (33%) of sample patients were recorded as having been given generic advice regarding driving only.Only 20% of sample patients recorded to be driving, were documented as having been given correct advice as per DVLA guidance on discharge.ConclusionThis audit demonstrated that driving status is currently poorly recorded in patients admitted to PICU and documentation of correct DVLA-compliant driving advice being given on discharge to relevant patients is also poor. Patients may not be receiving important information that they need.Providing correct and accurate advice to patients regarding the DVLA rules and psychiatric illness should be part of a safe and robust discharge plan, and forms part of the clinical teams obligations to the patient. Identifying patients as drivers and improved documentation of driving status and evidencing appropriate advice being given is key.A number of interventions were implemented and a re-audit will be undertaken in Spring 2024. If successful at improving rates of DVLA compliant advice being given, it would be hoped these interventions could be shared across the trust.
Patient-Led Lifestyle Questionnaire to Help Improve Lifestyle Interventions Offered to Patients
Authors: Mandair Kuljit , James Louisa 
Published: August 2024

AimsMaintaining a healthy lifestyle plays a vital role in the prevention and management of many mental conditions. There is also evidence that these patients have a lesser standard of health promotion and physical care and despite national awareness and guidelines early mortality rates have not improved.The aim of this audit cycle was to firstly establish whether lifestyle interventions are being offered to patients (in a Home Treatment Team) and secondly how could this be further improved. A patient-led lifestyle intervention was introduced whereby the aim was to help patients feel empowered by being able to select an area of lifestyle they would like to improve. A coaching style framework was used and the patient was assisted in setting a lifestyle related goal to help with their mental health recovery.MethodsAn audit was carried out on 20 Physical Health Forms in January 2023 looking at the documentation of lifestyle interventions offered in the following lifestyle domains: smoking, alcohol, substance misuse, diet, exercise and the measuring of waist circumference and weight. This is a form that is usually completed by Psychiatric nurses based in the Worcester South Home Treatment Team during initial patient assessments.The audit showed low levels of interventions offered to patients for lifestyle domains and therefore staff education on the importance of lifestyle and the importance of measuring waist circumference was delivered within a team meeting setting. A patient led lifestyle questionnaire was also initiated. After implementing this for 3 months, a re-audit was completed of 20 physical health forms in May 2023.ResultsThe re-audit results showed an increase in lifestyle interventions offered to patients in all lifestyle domains. There was a 30% increase in patients being offered interventions in exercise, a 40% increase in patients being offered interventions in diet, 20% increase in patients having waist circumference measured, 5% increase in patients being offered substance misuse interventions, 10% increase in patients being offered interventions for alcohol misuse and a 30% increase in patients being offered interventions for smoking.ConclusionThere is growing evidence that by addressing lifestyle factors we can improve overall patient care outcomes by raising awareness and including lifestyle modification to be a part of the treatment plan. Using a coaching framework can be an effective part of the management plan by helping patients to feel empowered and future focused to improve their lifestyle and therefore their own health.
Consideration of Clozapine in Patients With Treatment Resistant Schizophrenia
Authors: Moazzami Niema , Devereux Aimee 
Published: August 2024

AimsThe aim of the audit is to measure the performance of Bradford District Care Trust (BDCT) against the NICE guideline's quality standard: ‘Adults with schizophrenia that has not responded adequately to treatment with at least 2 antipsychotic drugs are offered clozapine.’MethodsWe identified the 273 patients prescribed clozapine in BDCT as of January 2023. 202 had been prescribed clozapine for more than 5 years and these were excluded. Of the remaining 71, 34 were excluded for reasons such as their diagnosis i.e. Parkinson's or personality disorder or inadequate information within the clinical record. The final sample consisted of 37 patients prescribed clozapine within the last 5 years with a diagnosis of treatment resistant schizophrenia (TRS).To define an ‘adequate trial’ of an antipsychotic, an adequate duration and adequate dose was determined. It is widely recommended in literature that an adequate trial of antipsychotic should last at least 6 weeks and this time constraint was utilised for the audit. The Maudsley Guidelines minimum effective dose table was utilised for establishing adequate doses. For antipsychotics not included in this list the British National Formulary (BNF) maintenance doses were used. A data collection tool was then developed that allowed for retrospective collection of key information relating to the objectives outlined above.ResultsClozapine was offered at the appropriate time [this includes where clozapine was considered but was not felt to be suitable/was contraindicated/declined by the patient] in 13 cases (35%). In 24 cases (65%) clozapine was not offered at the appropriate time. For 21 patients there was a delay in offering clozapine after 2 adequate trials of antipsychotic medication had been given. Delays ranged between 9 days and 15 years, with the average [mean] delay being 3.7 years. There were 3 patients who were initiated on clozapine without the completion of 2 adequate trials of other antipsychotic medication.ConclusionIn summary, this audit measured BDCT's adherence to the NICE guideline on clozapine for TRS. Of the 37 patients in the final sample, 35% received clozapine at the appropriate time, while 57% experienced delays with an average delay of 3.7 years. Notably, 8% commenced clozapine without completing the recommended antipsychotic trials. These results emphasize the importance of improving adherence to the guideline, as delays in offering clozapine pose potential risks for patients with TRS. Ensuring timely access to this treatment is crucial, as it has the potential to significantly enhance patient outcomes.