bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing a Pathway for Referrals of Patients With Dementia Within a Mental Health Liaison Team
Authors: Burns Alex , Imran Nadia 
Published: August 2024

AimsAssessment and management of the mental health needs of patients with dementia has been identified as a key role for a mental health liaison team (MHLT). The existing practice for referrals of patients with dementia made to Barnsley Hospital's MHLT was for them to be redirected to the memory team for assessment, who have limited scope for in-reach work into hospital, rather than being assessed by MHLT who are based on the hospital site.This project aimed to clarify the pathway for dementia referrals presenting with psychiatric issues at Barnsley Hospital and determine which patients should be seen by either MHLT or the memory team. It also aimed for MHLT to increase the number of dementia referrals assessed compared with existing practice and increase the proportion of face-to-face reviews for these patients.Methods2 periods of data collection took place within MHLT, where the outcome of referrals made from Barnsley Hospital for patients with diagnosed or suspected dementia requiring assessment was recorded. The first period recorded existing practice and the second period recorded practice following the implementation of a new pathway for referrals.The new referral pathway was created in collaboration between MHLT, memory team and Barnsley Hospital's dementia nursing staff. MHLT would review cases of suspected dementia not currently open to memory team whilst referrals made for patients open to memory team would be referred to memory team initially, with the option of MHLT input subsequently being requested.ResultsFirst data collection period 3–28 April 2023:4 referrals in total.2 were assessed by MHLT, 1 seen face-to-face, 1 by telephone. 2 were redirected to memory team.Second data collection period 17 July–17 September 2023 following implementation of the pathway:10 referrals in total.7 were assessed by MHLT, 7 seen face-to-face. 3 were redirected to memory team.ConclusionThe implementation of the pathway led to improved outcomes, with absolute increases of 20% in the proportion of referrals assessed by MHLT and of 45% in the proportion of patients assessed face-to-face. Undertaking the project also helped to identify that there was a training need for MHLT practitioners regarding dementia assessment and management. The next aim is for MHLT to assess 100% of dementia referrals following dementia training being delivered to the MHLT practitioners, and to continue regular MDT meetings to monitor the efficacy of the pathway and maintain collaboration between MHLT and the memory team.
Improving Health Literacy for Individuals With Intellectual and Developmental Disability and Their Carers
Authors: Dhooper Jesmine , Omokanye Mariam 
Published: August 2024

AimsThe aim of our project is to support health literacy in patients and carers under the Nottinghamshire Intellectual and Developmental Disabilities (IDD) service. To achieve this aim, we will produce a 20 page newsletter, containing updated and accessible research on mental health disorders that are common in the IDD population. We will also utilise a Trust webpage to publish the newsletter and produce a video/ podcast for the webpage, showcasing individuals with intellectual disabilities discussing and interacting with the articles.MethodsResearch into the relevant articles included a search on Google Scholar and PubMed, and a list was written up. Final research articles to be included in the newsletter were selected after consultation with the consultant peer group within the Intellectual and Developmental Disability team within Nottinghamshire Healthcare NHS Foundation Trust. Easy read forms of all the articles were drafted by researchers, which will be sent to relevant authors to verify that this is an accurate representation of their research. An accessible 20-page newsletter will be produced, and an IDD focus group will review the content of the newsletter, discuss the articles and relevant videos/ podcasts will be made of these interactions. A webpage on the trust website will be created to publish the newsletter and allow users to interact with the articles electronically (using the standard electronic accessibility tools) and this will also contain the videos/podcasts produced. Feedback will be obtained electronically via a QR code and via traditional means e.g. an easy read reply slip.ResultsThe key outcomes of our project are producing 10 easy read articles within our newsletter. These articles need to be useful and accessible to the IDD population, which will be verified by small focus groups consisting of patients with IDD, carers and staff to review literature before publication as well as the feedback after publication. Another key outcome is the use of coproduction to involve people with IDD in production of the newsletter and webpage, in order to recognise the value of their lived experience, improve the quality of the project and drive success.ConclusionSuccessful publication and feedback will pave a way for exploring a second edition the following year for printing via Trust communications. If successful, this project could be used as a template for an effective way to share research findings that contribute to the understanding of assessment and treatment pathways for people with an Intellectual and Developmental Disability.
Improving the Quality of Junior Doctor Handover in Tyrone and Fermanagh Hospital, Northern Ireland
Authors: Fulton Jill , Sreekumar Archana C. , Sheridan Aisling 
Published: August 2024

AimsTo improve the quality of junior doctor handover in the Tyrone and Fermanagh hospital. The hospital is spread across a number of inpatient sites making it difficult to complete an in-person handover. Each day the handover is completed on a Word document and sent via trust email to relevant staff. Issues were identified with the quality of information shared and how the outstanding tasks were handed over.MethodsA PDSA cycle was implemented to explore outstanding issues with the handover and consider how change might be implemented. Junior doctors identified various issues including the lack of a common format, the amounts and relevancy of information shared and identifying an individual or team to conduct the outstanding tasks.A baseline audit for a 3 month period (July–September 2023) was completed. Results were reviewed and a driver diagram was established. Suggestions identified for improvement included the use of new template and an in-person handover.A new template for recording information was drawn up and agreed by the group. It included basic demographic prompts such as staff member on shift and the date of handover. The template included prompts for key patient information identified from initial audit as frequently forgotten.The template was emailed to doctors on the rota and was also highlighted to new staff at junior doctor changeover points. This new template was the intervention chosen for re-audit between November 2023 and January 2024.ResultsFollowing the application of our intervention, completion of the handover improved. From an information governance perspective the identification of staff and shift dates improved (to 98% & 99% respectively). The security of information shared improved through use of password (69% to 91%).The quality of information sharing also improved with the percentage improvement of key demographics increasing, such as patient initials (29.4%), Healthcare number (9.2%), MHO status (15.46%), patient summary (19.76%) and working diagnosis (34.91%) and finally an increase of 88.74% in identifying the person for following up outstanding tasks.ConclusionThe use of a handover template has improved the quality of information shared across a number of key areas. The identification of person for handover has improved significantly with this tool and is felt to represent an improvement in patient safety. Following re-audit cycle, other areas were identified for further changes such as adjusting prompts on the template and a secure folder for storing the handover. These changes could be easily implemented in a subsequent audit cycle.
A Retrospective Assessment of Referrals Between the Mental Health Liaison Team and Memory Assessment Service; Does Delayed Referral Due to Delirium Lead to Some Patients Being Lost to Follow-Up?
Authors: Fyall Thomas , Thompson Bethany , Overshott Ross 
Published: August 2024

AimsThe assessment, diagnosis, and management of memory problems in older adults are routinely undertaken by memory assessment services (MAS) typically following referral from a GP. Mental health liaison teams (MHLT) newly identify many older people in acute hospitals with memory problems. Delirium is often diagnosed acutely and should be managed prior to any consideration of dementia diagnoses, however many of these people still have histories which also suggest underlying undiagnosed dementia. Referral policies advise of 3 months delay between delirium and MAS review to avoid misdiagnosis of dementia. MHLT therefore often request GP to refer at 3 months if still indicated. It is felt that some patients may be lost to follow-up via this route; our aim was to explore this further with a view to establishing a more robust direct referral pathway if indicated.MethodsElectronic records of patients under the care of MHLT aged over 65 from June 2022 to June 2023 were reviewed. This excluded patients who were referred and discharged from MHLT after a single assessment. We collected retrospective data for 8 months during this 12-month period. For any patients with memory concerns, we recorded where MAS referral was recommended and whether they were subsequently referred and seen.Results108 patients over the age of 65 under the care of MHLT were identified. 69 patients had memory problems, 28 of whom already had established diagnoses or were already under MAS and 41 had newly identified memory problems. Of these 41 patients, 15 were felt to need MAS referral due to possible dementia. 3 were referred directly to MAS by MHLT and were seen. 5 were later referred to MAS by GP on MHLT recommendation and were seen. 7 were not later referred to MAS despite it being recommended.ConclusionAll 3 patients whom MHLT were able to refer directly to MAS were seen, whereas 7 out of 12 (58%) patients for whom 3-month delayed referral by GP was requested were not seen. The policy of 3-month delay avoids misdiagnosis due to delirium, but in practice also leaves some patients with missed opportunities for diagnosis and management of dementia. There is a need for a more robust delayed referral pathway to memory assessment services from mental health liaison teams. We hope to use these findings to improve our local referral pathways and share this information to support other localities.
Assessing Clinical Coding Compliance in a Mental Health Inpatient Unit: An Audit and Intervention Study
Authors: Golchinheydari Sirous 
Published: August 2024

AimsClinical coding (CC) is the translation of medical terminology into a coded format that is recognised both nationally and internationally. NHS trusts must record the clinical care given to inpatients and the resources used for inpatients while they are in hospital care. CC ensures accurate patient records, communication and data exchange between providers and can aid in epidemiological research, healthcare planning and quality as well as cost control. An audit was carried out in a mental health inpatient unit to assess whether CC was completed as per the local and national CC guidelines, followed by an intervention to improve compliance.Methods2 inpatient wards were identified, 1 male and 1 female, and 10 patients from each ward were selected at random on the 15th of December 2023. Their notes were assessed to determine whether: the CC has been updated during their current admission, CC has been updated if new diagnosis, CC had been completed on last discharge, physical health conditions were included in the CC and the number of physical health diagnosis changes and their documentation. Intervention was carried out and a re-audit completed on the 31st of January 2024.ResultsOut of 20 patients: 5 (25%) had a completed CC during their admission and 4 had a diagnosis change but only 1 (25%) CC was updated. 9 had a physical health diagnosis but only 3 (33%) were included on CC. 16 (89%) had a completed CC on last discharge and 2 were admitted for the first time.Doctors on the wards were informed about CC, how to access the form on the system and the importance of updating CC. This was communicated in teaching sessions and doctor communication groups.The re-audit showed some improvement. Out of 20 patients: 10 (50%) had a completed CC during their admission, 4 had a diagnosis change and 3 (75%) CC were updated. 7 had a physical health condition and only 2 (29%) were included on CC. 12 (75%) had a completed CC on last discharge and 4 were admitted for the first time.ConclusionThe audit showed a lack of awareness of CC and its importance. The intervention helped to improve compliance of CC in current inpatients. Further intervention and improvement is required for physical health CC and can be attempted with posters in the doctor's rooms and regular reminding during group sessions.
Implementation of a Formal Medical Handover in an Acute Mental Health Unit
Authors: Hagan Jonathan , Lamont Victoria , McCormick Lauren 
Published: August 2024

AimsTo implement a robust and reliable medical handover process in the Bluestone Unit, Craigavon Area Hospital, Southern Health and Social Care Trust. Following discussion with Junior Medical Staff, Doctors did not feel confident that they were always aware of outstanding physical investigations or any acutely unwell patients on the inpatient wards. This could lead to patient safety issues which we aimed to address using the PDSA model for effective change management.MethodsA) Twice daily face to face handover was introduced at 09:00 and 16:45 in the Junior Doctor's office, easily accessible to staff. A standardised handover template was already in existence. The outgoing Doctor On-Call overnight would complete this to handover any outstanding tasks. The Doctor carrying the On-Call bleep during the day would then use this template to lead a formal, face to face handover with a team of Junior Doctors covering each of the inpatient wards. This helped to clarify which wards were covered and ensure timely, effective allocation of tasks.B) A formal, face to face “weekend handover” was introduced at 15:30 in the Conference Room every Friday afternoon.A survey was sent to twelve Junior Doctors to gather formal feedback both before and after these interventions.ResultsFollowing these two interventions:
1.91.67% feel there is now a structured and comprehensive daily handover. 91.67% felt this was not the case before.2.63.64% feel there is now always a successfully completed morning handover. 0% felt this was the case before.3.83.33% feel there is now always a successfully completed weekend handover. 41.67% felt this was not the case before.4.75% feel they are always aware of sick patients when On-Call. 25% felt they were not at all aware before and 66.67% felt they were only occasionally aware before.5.91.67% feel they are always aware of outstanding bloods to chase. 8.33% felt always confident before.6.83.33% feel they are always aware of outstanding investigations to chase. 16.67% felt always confident before.7.90.9% feel they know which wards are covered and uncovered when carrying On-Call bleep. 9.09% felt they knew before.ConclusionThe implementation of a formal handover process has significantly improved Doctors' awareness of outstanding tasks and ward cover, which is likely to benefit patient safety moving forward. Further action is necessary to improve communication between medical and nursing colleagues regarding physical investigations performed and appropriate, timely follow up.
Complex PTSD Pathway for Kingfisher Mother and Baby Unit
Authors: Jackson Jemima 
Published: August 2024

AimsWhen Kingfisher Mother and Baby Unit (MBU) opened in 2019 personality disorder and severe self-harming behaviours were exclusion criteria for admission. Complex Post Traumatic Stress Disorder (C-PTSD) with its emotional dysregulation, interpersonal difficulties and common presence of self-harm was similarly categorised.Currently, C-PTSD presentations are frequently admitted to the MBU, making up around 45.9% of admissions. There is increasing understanding of the importance of effective and trauma informed treatment in admission outcomes, particularly in reducing trans-generational trauma. This requires appropriate skills and training in staff.MethodsService users were identified retrospectively over a 24-month period and categorised into C-PTSD traits (trait) and non-C-PTSD traits (non-trait). Comparisons of routine outcome measures (ROMs) identified higher distress in the C-PTSD group and reduced satisfaction. Staff survey highlighted areas of anxiety and low confidence in working with service users with C-PTSD traits.Actions were divided into three streams – Admission, Transitions and Communication. Staff training needs were identified and training given. Admission processes were reviewed with a focus group including past service users and changes based on DBT principles were implemented. A leaflet was developed to aid communication with service users considering MBU admission via Outreach and Community Perinatal teams.ResultsSurveys were the primary source of data before and after changes. As of September 2023 the majority of training had been rolled out but numbers completing the training survey were too small to draw conclusions. Anecdotal feedback was predominantly positive and the survey will be repeated at the same time as other data in March 2024.Ward process changes started in late August 2023 and routine outcome measure data will be compared at 6 months (March 2024). Again anecdotal feedback is positive.The leaflet was rolled out for use by community teams and service users in November 2023 and feedback via survey will be collected in March 2024.ConclusionEvaluation of routine outcome measures showed poorer outcomes and experiences for patients with traits of Complex-PTSD. Staff survey highlighted lack of confidence in managing the same. Consultation with a range of staff and past service users led to changes in admission practices, communication prior to admission via a leaflet, and staff training. Anecdotal feedback since implementation has been positive but we hope to see this confirmed in the Routine Outcome Measures and surveys 6 months after the changes were implemented.
Safe Medication Prescribing in Halton Memory Services
Authors: Jain Divya , Marya Archisha 
Published: August 2024

Aims•To improve safe medication prescribing by achieving a 25% improvement in the number of cases reported in the practice within six months.•To reduce human factors contributing to medication errors to improve patient safety and quality of care.Methods•Retrospective data collection was done for Halton and Widnes patients from March 2022 to April 2023;•Retrospective data collection for Re-audit was done for a period between June 2023 to January 2024 to complete the audit cycle;•Liaised with medicine management team for local practices/policies;•Reviewed and verified Trust standardised local policies on medicine management;•Reviewed incident data and checked processes in other teams;•The findings were presented at the Medicine Management meeting in May 2023;•Training on safe prescribing was delivered to the Memory team in June 2023.Results•During the first data collection period, 14 incident forms were reported.•During the second data collection period, 1 incident form was reported which was an administrative error.•Prescribing errors for the first cycle accounted for 28.6%, administrative errors for 35.7%, dispensing errors for 21.4%, and other errors for 14.3%.•Specific error types included prescribing the wrong dose/medication, medication not prescribed, medication unavailable and double prescribing.•No incidents of restraint, seclusion, rapid tranquillisation, ambulance calls, or RIDDOR were reported.Conclusion•Administrative errors accounted for the majority of the total reported incidents (35.7%).•Recommendations include safe clinical practice of prescribing medication (MDT lead to update medication card and inform GP promptly).•Other recommendations were medication card updates, aligning clinical systems, avoiding email requests and introducing Community EPMA (Trust objective to introduce EPMA to community teams in 2024/25) and to standardise procedures.•An improvement of 92.9% in the incident reporting was found in the re-audit following a training session to the team with improved practice of no email requests or chains.•The audit identified communication difficulties within memory services, primary care and care home.•It also highlighted challenges related to new staff, post-MDT meetings medication card updates, prescriber preferences, geographical disparities, and doctors’ availability.
Let's Talk About Sex: Breaking Down Barriers to Care in a Community Learning Disability Team
Authors: Embliss Liam , Melrose Zoe , Dunn Laura 
Published: August 2024

AimsWe aimed to improve the care for people with intellectual disabilities (PWID) presenting to a community learning disability service (CLDT) with health needs relating to sexual wellbeing, sexuality, and/or gender identity (SSGI). A QI framework was used, focussing on staff education and service development.We hypothesised that there would be a lack of confidence and staff knowledge around SSGI issues in PWID. We suggested that challenges exist because discussing sex in PWID still feels taboo.PWID have the same sexual needs as those without any disability. Historically, this population have been discouraged from expressing their sexuality due to certain attitudes, fears, and prejudices. Stigmatising views have included PWID being viewed as asexual or conversely posing a risk of sexual violence, despite evidence showing that they are more vulnerable to sexual abuse. Important issues around capacity and understanding consent highlight the importance of psychosexual education for patients and carers.Carers and health care professionals are key in educating and supporting PWID, however, our disinclination towards discussing SSGI openly can have unintended negative effects on the wellbeing of our patients. These issues are therefore paramount to understand and address.MethodsPatient-facing staff in a London CLDT were surveyed, and staff focus groups held, to understand attitudes towards SSGI in PWID. Staff knowledge of local services was also explored. Using thematic analysis, we identified both staff and service development needs and devised a set of interventions to address these.Four educational interventions for staff were developed and evaluated using QI methodology. Interventions included bitesize teaching, externally commissioned training, and resource packs.ResultsThematic analysis identified a number of barriers to delivering SSGI care, particularly staff's low confidence and a lack of training. Following the four educational interventions, average staff confidence to discuss SSGI increased from 55% to 77%.Staff responses indicated a lack of SSGI services for PWID locally. In response to this, the QI team, service leads and management agreed upon various service development ideas. These include upskilling specific staff to become SSGI leads; auditing the CLDT caseload to understand the SSGI issues in our population; and trialling a clinical sexology service for a small subset of patients.ConclusionA QI approach to staff education demonstrated clear benefit, with staff more confident to address the SSGI needs of PWID. Combined with sustainable service improvement ideas, this can improve patient care.