bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Survey Into Child and Adolescent Mental Health (CAMH) Staff Wellbeing Within a Trust in England
Authors: Shamim Iqra , Sundhar Reka Ajay , Panesar Kiran 
Published: August 2024

AimsSickness absences within the NHS have been on the rise with 27 million days across 2022, 22% of which were due to mental health and wellbeing related issues. The 2022–23 report on progress in improving NHS mental health services found that increased workload and staff shortages within the mental health sector was leading to concerns of staff ‘burnout’ and higher rate of staff turnover. There is an indication that CAMHs staff are at higher risk of poor wellbeing despite limited research in the UK. The audit aimed to gain insight into the wellbeing of staff working in CAMHs within the trust according to NICE Mental Wellbeing at Work (NG212) and highlight areas of concern and propose recommendations to improve staff wellbeing.MethodsAnonymous self-report questionnaire, based on a validated tool recommended in the NICE NG212 guidance, was disseminated across four boroughs within the trust to measure wellbeing in the workplace. The survey had 19 questions, 17 requiring scores on Likert scales and 2 descriptive questions, aimed to gain information on the five drivers of wellbeing in the workplace (health, relationships, environment, security, and purpose).ResultsA total of 123 responses were analysed. Across all four boroughs, physical health scored worse than mental health. 44.7% of respondents felt they had inadequate facilities in the workplace to support their health and wellbeing. Further, 32.5% of responses disagreed/strongly disagreed that change was managed well in their organisation compared with 25% who agree/strongly agree. Key words such as staff-appreciation and team-building days recurred in qualitative responses across the trust. There were further site-specific differences. Research shows that provision of workplace exercises can be safely used for the promotion of employees' physical and mental health. Cost-effective strategies such as staff-appreciation and gratitude can improve job satisfaction thereby promoting staff retention. To consider elements of face-to-face contact with colleagues could also have a positive impact on psychological wellbeing due to more productive meetings; increased networking; increase of engagement and job satisfaction.ConclusionThe CAMHS staff wellbeing survey provided useful insight into staff perception of their wellbeing at work. Repeating the survey, after implementing recommendations, would help identify important determinants. Despite the survey being limited to the specific trust, further research into CAMHs staff wellbeing across the UK could help facilitate improvements and help with staff retention.
Follow Up After Hospital Discharge in Older Adult Psychiatric Patients
Authors: Sunderland Kay , Rhodes Nicholas , Donaldson Andrew , Dillon Shaina , Otaniyen Patience 
Published: August 2024

AimsTo identify if patients discharged from an older adult psychiatric ward were followed up in line with national recommended guidelines. Current National Institute for Clinical Excellence (NICE) guidelines recommend follow up and final discharge letters (FDLs) being available within 7 days of discharge.MethodsA record search was conducted to identify all patients discharged from one ward during a one year period.Each patient's notes were reviewed to identify what follow up they had in place and how long it took for this to be implemented. We also examined the time taken for a final discharge letter (FDL) to be made available to their General Practitioner (GP).ResultsWe identified 99 patients who were discharged from the ward within the specified period.The mean time taken for patients to be followed up after discharge was 9.72 days. In 63.16% of cases this follow up was provided by Community Psychiatric Nurses (CPNs), with 51.58% being reviewed in medical clinic. A further 9.47% had their initial follow up with an occupational therapist, 4.21% with a psychologist, 4.21% with the addictions team, 4.21% with care home liaison, 2.11% with social work, 2.11% with continuing care and 1.05% with rehab.FDLs were sent to GPs, on average, 13.6 days after patients were discharged.ConclusionWithin our data set a few outlier values markedly increased the mean for both outcomes. Using median figures, average follow up time fell to 6 days, meeting national guidelines, and FDL time fell to 8 days, exceeding recommendations by just 1 day.Within our department, measures have since been put in place to ensure secretaries are reminding medical staff of the recommended time frames for final discharge letters and it should be noted that an immediate discharge letter (IDL) is routinely sent to GPs containing key clinical information prior to patients being discharged.The results show that our current practice does fall somewhat short of matching national guidelines and further work should be done to investigate how we can improve standards.
Audit for Patients Who Are Discharged on Community Treatment order (CTO) in North East Part of Essex: Exploring the Section Paperwork and the Readmissions in 2 Year Period
Authors: Ahmed Bushra , Pal Hem Raj , Alhadi Rashed 
Published: August 2024

Aims•To find out discrepancies around community treatment order section paperwork and renewal hearings.•Explore if CTO is helpful in delaying relapse of mental illness.MethodsAll inpatients from general adult male and female wards in the North East Essex area in the last 3–5 years who were detained under section 3 of the Mental Health Act and were discharged on a Community treatment order were included. All included patients were followed up for a period of two years and data was reviewed to know if the standard guidelines regarding the CTO paperwork completion and renewal hearings were followed.Data about episodes of further recalls to hospital, further revocation or discharges on CTO during that two year period for these patients is included.Information about the timely filling of the CTO forms and uploading on the system upon readmission is explored wherever applicable.Finally, the time duration between discharges and each readmission is explored.ResultsTotal no. of patients: 13, Male: 10, Female: 3Out of the 13 patients,One had 4 readmissions in the consequent two year period (Days since last discharge – 158, 80, 14, 365 days), duration of each admission: (39, 9, 71, 53) days.Two had 2 readmissions (on days 623 and 80: On day 65 and 9), Duration of each stay (6 and 90 days; 80 and 164 days).Four patients had 1 readmission (on days 683, 133, 30, 723) and duration of stay is (14, 33, 1510 and 1460 days).Six patients never had any admission.As for the tribunal hearing, one patient's tribunal hearing was missed, one of them did not attend, one had his CTO rescinded and one was admitted soon after. Rest of the patients had their regular timely hearings and were regularly reviewed in the community.Out of 13, only 3 patients had appealed against the CTO, had tribunal hearing.Out of 13 patients, only one patient had his CTO lapsed and he had two readmissions during the 2 years follow up.Delay in admission following recall was due to section 135 being issued.CTO3 paperwork was missing in two cases.A second CTO3 or recall notice was issued in 4 cases, in 1 case, reason was not documented, in 2 cases, patient agreed for informal stay but later did not comply with care plan. In one case, reason was not documented.ConclusionCTO paperwork are missed in rare cases and could be avoided by reminders from Mental Health Act Office.CTO renewal hearings take place regularly as per mental health act guidelines, though in rare cases, meeting is missed. This could be avoided by having patients discharged on CTO to be booked for timely reviews beforehand.The audit is too small and is inconclusive to indicate if CTOs prevent readmissions and relapses and hence future study with more sample size is called for.
Audit of High Dose Antipsychotic Therapy (HDAT) Prescribing Among Inpatients in East Suffolk
Authors: Ruhi Shamim , Alase Anne , Aregbesola Motolani , Khan Quratulain , Rizvi Fariha 
Published: August 2024

AimsHigh doses of antipsychotic therapy (HDAT) are often prescribed in secondary mental health services and has been the subject of many audits and service improvements. This interest is largely due to the increased morbidity and mortality related to HDAT, and strong advocacy for clear rationales to guide this decision. There is a need for continuous review and monitoring to prevent unnecessary prescribing.Our audit was used to determine the prevalence of HDAT in East Suffolk inpatient settings and assess whether review planning and monitoring of HDAT was practiced.Standards for antipsychotic dosage were established using British National Formulary and Maudsley Prescribing Guidelines for Psychiatry.MethodsRetrospective data was collected using electronic records of patients 18 years and above who were discharged from inpatient psychiatric wards located in East Suffolk between 1st July and 31st December 2021.Data available included discharge medication letters, discharge summaries and inpatient clinical notes.ResultsA total of 256 patients were discharged from East Suffolk wards in the 6-month period between 1st July and 31st December 2021.Majority of the patients (80%) were above 65 years of age with more than half of patients being male 114 (56.3%).Ninety-seven (37.9%) patients had a diagnosis of schizophrenia or schizophrenia-like and delusional disorders, while approximately 25% of the audited population had a mood disorder.9% had a singular diagnosis of personality disorder.One hundred and sixty-six (64.6%) patients were on antipsychotic medications and two (1.2%) patients were discharged on HDAT.ConclusionHigh dose antipsychotic prescribing was not as prevalent as initially assumed. This audit noted only one of the two patients on HDAT did not have the appropriate monitoring form completed.Good clinical practice recommends the need for the completion of a high dose antipsychotic therapy (HDAT) form for each patient, which would allow proper monitoring.
High Dose Antipsychotic Therapy Prescription Amongst Patients Admitted to the Psychiatric Intensive Care Unit (PICU), Mill View Hospital, Hove
Authors: Awolaran Dorcas , Monir Samina 
Published: August 2024

AimsAcutely ill patients on PICU are likely to be on High dose antipsychotic treatment (HDAT), which poses a risk to their physical health. Current guidelines require that appropriate criteria be met before prescription, and close physical health monitoring after prescription of HDAT. This audit aims to assess practices regarding prescription of HDAT to patients on PICU, Mill View Hospital, Hove according to standard guidelines.MethodsTen of the 38 patients admitted to PICU at Mill View Hospital between January and June 2023 were on HDAT and thus were eligible for this audit. The revised prescribing observatory for mental health topic 1h 3e audit tool was used to collect data regarding the patients. Data was collected from the clinical records including electronic, paper notes and uploaded drug charts and forms.ResultsThe age range was between 21–56 with an average age of 35. Eight of the 10 patients were white British, 2 were of another ethnic group or ethnicity unknown. All the 10 patients had clinical reasons for HDAT prescription clearly documented at the start of the treatment which ranged from cross titration of antipsychotics to treatment resistance to standard treatments.Of the 10 patients on HDAT, 6 of them had documented clinical review in the 3 months, 1 had documented clinical review in last 3 to 6 months, 3 had no clearly documented review of clinical response in the last year.Only 7 out of 10 had their temperature, pulse, blood pressure, body mass index and electrocardiogram (ECG) clearly documented. Seven of the 10 patients had their full blood count, urea and electrolytes, liver function tests, blood glucose, plasma lipid tests done and clearly documented in last year. Eight of the 10 patients had their serum prolactin checked while none of the patients had their creatinine phosphokinase checked and clearly documented in the last year. Only 2 of the patients had clearly documented examination of extrapyramidal side effects (EPSE) in the last one year.ConclusionThis audit demonstrates that although clinical reasons for HDAT prescription were documented for all patients, current standard guidelines for HDAT prescription regarding regular review and physical health monitoring were either not being met, or not clearly documented.
Compliance With a Biopsychosocial Assessment Template When Assessing Presentations of Self-Harm or Suicidal Ideation by Liaison Psychiatry Practitioners in Dorset Healthcare: A Clinical Audit
Authors: Azlan Aryn , Gale Kirstie 
Published: August 2024

AimsTo evaluate whether a comprehensive biopsychosocial assessment is performed for patients presenting with self-harm or suicidal ideation in clinical practice, following National Institute for Health and Clinical Excellence guidelines 225 (NG225). We assessed Dorset Healthcare Liaison Psychiatry practitioners' compliance with a standardized biopsychosocial assessment template.MethodsA standardized biopsychosocial assessment template, aligned with NG225, is utilised in all Dorset Healthcare Liaison Psychiatry services for conducting initial assessments. Included data were the initial assessments of adult patients presenting from 01/08/2023 to 30/09/2023 for the following indications: 1) a suicide attempt, 2) a self-harm incident, or 3) suicidal ideation. Any initial assessment that did not use the standardised template was excluded. Retrospective analysis of Rio records assessed compliance with each heading on the biopsychosocial assessment template.ResultsA total of 60 records were included from Dorset Healthcare Psychiatry Liaison Services. Only one heading, the “Presenting Situation”, was documented in all assessments (100%). Psychiatric headings on the template showed high compliance: “Mental State Examination” and “Risk Summary” were each documented in 98% of assessments, and “Psychiatric Formulation” in 92%. The “Carer/Parent's Understanding of the Assessment” was the least assessed (40%). Other significant headings that showed moderate compliance were, “Safeguarding Concerns” (71%), “Physical Health History” (75%) and “Social Situation” (81%).ConclusionOur findings emphasize the need for more comprehensive biopsychosocial assessments in Dorset Healthcare Liaison Psychiatry services. While Liaison Psychiatry practitioners exhibit proficiency in evaluating psychiatric aspects, there is reduced compliance in assessing social aspects, notably in assessing family understanding. Future qualitative analyses will evaluate practical barriers and human factors affecting compliance with specific headings. Moreover, data collection can expand to encompass additional Mental Health services in a wider catchment area, including settings such as community and inpatient facilities.
A Clinical Audit of ECT Documentation in NHS Grampian
Authors: Ball Rachel , Smith Murray 
Published: August 2024

AimsElectroconvulsive Therapy (ECT) is a treatment used for patients with severe depression, mania, catatonia, and schizophrenia. National Institute for Clinical Excellence (NICE) guidance for the use of ECT advises that for all patients, a risk/benefit assessment for the treatment should be made and documented with particular reference to anaesthetic risk and the adverse effect of cognitive impairment.For patients who can consent to treatment, NICE recommends the use of patient information leaflets to help people to make an informed decision about their ECT treatment.For patients who cannot consent to treatment, psychiatrists can authorise the use of ECT using the Mental Health Act. However, NICE recommends that any advance directive should be fully taken into account, and someone who speaks on behalf of the patient should be consulted.This project aimed to audit whether the documentation of the consent process of patients undergoing ECT in NHS Grampian was in line with the above NICE Guidance.MethodsThe clinical notes and ECT folders of the six patients undergoing ECT treatment in NHS Grampian in January 2023 were reviewed in reference of the following domains:
1)The clinical indication for ECT.2)If the patient (or their family/advocate) had the opportunity to receive the RCPsych Patient Information Leaflet for ECT.3)If a discussion about the risks/benefits of ECT had taken place with a patient, their family or advocate.4)If specific risks and side effects – namely anaesthetic risk and cognitive impairment – had been discussed with the patient, their family or advocate.The project had been registered with the NHS Grampian Quality Improvement & Assurance Team prior to data collection beginning.ResultsAll of the notes reviewed (100%) had the clinical indication for ECT clearly documented.Three (50%) of the patients had received the RCPsych Patient Information Leaflet for ECT.A clear risk/benefit assessment discussion was documented in three (50%) of the patients' notes.Specific discussion of side effects including cognitive impairment and anaesthetic risk was documented in three (50%) of the patients' notes.ConclusionThere is a clear need for improvement in the documentation of the consent process for ECT in NHS Grampian. While the indication for receiving ECT is being clearly recorded, documentation of the risk/benefit assessment, discussion of specific side effects, and involvement of family or advocacy is less consistent. The introduction of the NHS Grampian standardised consent form is being considered as an option to improve this documentation. The documentation of the consent process for ECT can be re-audited once this form has been introduced.
Audit of the Use of Outcome Measures Within Child and Adolescent Mental Health Outpatient Services in Rotherham, Doncaster and South Humber NHS Foundation Trust
Authors: Bell Lydia , Thomas Mohan 
Published: August 2024

AimsRotherham, Doncaster and South Humber NHS Foundation Trust (RDaSH) has 28 Promises as part of its Strategy.Promise 16 is to: Focus on collating, assessing and comparing the outcomes that our services deliver, which matter to local people, and investing in improving those outcomes year on year.This audit in November 2023 looked at the practice of using outcome measures for CAMHS patients in order to highlight areas of development for the service to work toward achieving the promise.MethodsWe wanted to understand if young people were having outcome measures completed and if so, when, what and how often. We achieved this by using a dip sample of five patients each across the three different localities (Rotherham, Doncaster and Scunthorpe).A report was generated to include all patients discharged from CAMHS in the preceding three months to September 2023. Young people who had been with the service less than six months were excluded from the audit. Five patients were chosen randomly from each locality and their electronic patient record on System One was studied.Information in the patient records was compared against the audit standards and recorded in Excel so the data could be analysed.ResultsThe results showed that 11 of 15 young people had an outcome measure completed at some point during their episode of care. All five young people in Scunthorpe had an outcome measure recorded in their clinical records however this tended to only happen at the very start, meaning there was no basis for comparison. Four out of five patients in Doncaster had outcome measures in the clinical record and these were undertaken throughout the episodes of care. In Rotherham, two of five young people had outcome measures recorded in the clinical records.The most frequently used outcome measure was the RCADS but the SDQ was also used.ConclusionThere is work to be done to ensure the use of outcome measures becomes routine, and also to standardise both the type and frequency of use. The Trust is aiming to increase their use by utilising SystmOne's capabilities to interface with service user mobile devices to send out outcome measures to patients. There is also a plan to inform staff within the service about the expected use of outcome measures. This audit will be repeated in 2024 to see if the Trust are moving closer to delivering their promise.
Introduction of the DUNDRUM Triage Urgency Tool to a Medium Secure Unit in Bed Crisis
Authors: Duthie Leanne , Morris Alistair 
Published: August 2024

AimsAt a time of increased pressures across the whole forensic estate, The Orchard Clinic Medium Secure Unit faced the additional challenge of having to close multiple acute admission beds.This led to challenges in determining how to triage patients in the face of multiple external pressures, frustrations for clinicians managing severely ill patients in prison and human rights concerns for those unfit to stand trial but remanded to custody to await a bed.The need for an objective tool to aid triage decisions became apparent. We therefore piloted the use of the DUNDRUM triage urgency manual, a structured professional judgement tool to aid triage decisions for forensic units.The aims of introducing this tool were to ensure decisions are more consistent and reliable, ensure scientifically valid items are not forgotten, make decision making processes more transparent, demonstrate equality of access to services and reduce chance of serious error.MethodsThis audit reviewed all acute admissions to The Orchard Clinic between Aug 22–Aug 23. This covered a period 6 months prior to the introduction of the tool and 6 months after.In order to determine if the use of the tool improved our triage making decisions the Dundrum score was retrospectively calculated for admissions and those on the waiting list during the first 6 month period of the audit. The same information was recorded for those following the introduction of the tool in the second 6-month period.ResultsPrior to introduction of the DUNDRUM, the team's triage decisions were not in line with validated tools, those with lower DUNDRUM scores were prioritised over those with higher scores. Following introduction of the tool our triage decisions improved. Common themes emerged when we analysed the reasons why our triage decisions were out of line with validated tools. These included patients in hospital settings taking precedence over those in prison, patients admitted without prior discussion at bed management meetings, legal urgency taking precedence over clinical and lack of available HDU space.ConclusionPrior to the introduction of the DUNDRUM triage urgency manual the audit demonstrates that the team's triage decisions were not in line with validated tools. This improved following training and use of the tool at bed management meetings. The Orchard Clinic has now formalised use of this tool within bed management meetings. We are currently in the process of re-auditing over a 12-month period.