bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is ADHD Medication Monitoring Being Completed in CAMHS?
Authors: Johnston Benjamin , McFerran Helen 
Published: August 2024

Aims•To determine the demographics of the patients prescribed medications for ADHD under the CAMHS teams within Southern Trust (NI).•To assess whether the physical health monitoring guidelines (as outlined by NICE – nice.org.uk/guidance/ng87) have been followed.•If monitoring is not up to date, to determine why not.MethodsWe reviewed records from clinical notes and NIECR (Northern Ireland Electronic Care Record) to collect demographic details.Following NICE guidelines, we used the clinical notes to determine which patients had physical health monitoring up to date, including heart rate (HR), blood pressure (BP), weight and height.For any patient with monitoring not up to date, we reviewed the notes or contacted the practitioners to determine why this was the case.Results96 patients were found to be prescribed ADHD medications. Full demographic details were obtained and collated for these patients, including age, sex, diagnosis, co-morbidities, and medication information (e.g. preparation, dose, polypharmacy).Of the 96 patients, 1 was excluded as their monitoring was carried out by paediatrics.71 out of the remaining 95 had their monitoring up to date, leaving 24 patients with monitoring not up to date. Of these 24:
•8 were due to non-attendance•4 were due to equipment issues (e.g. faulty/unavailable)•3 only had partially completed monitoring (e.g. BP, weight, height but no HR recorded)•1 was only reviewed virtually•1 had documented completion of monitoring, but no figures documented•7 unknown – no reason given.ConclusionAfter 1 patient was excluded, 71/95 patients had monitoring up to date (~75%).Of the remaining 24, some were due to systemic issues affecting all services, e.g. non-attendance or faulty equipment. However, some were due to issues more easily addressed.This led to a discussion at a trust-wide patient safety meeting, with the following outcomes:
1.Staff were given a presentation on NICE guidelines for ADHD medication monitoring to ensure knowledge is up to date.2.The importance of completing all aspects of monitoring and documenting these each time was highlighted.3.If monitoring could not be completed, the reason must be documented, to avoid further “unknowns”.4.An agreed plan to schedule monitoring appointments following virtual reviews.5.Annual re-audit using the same data template, with the aim of improving each year.
Prescribing Practice of Citalopram and Escitalopram in Older Adults Following the 2014 MHRA Guidance of Associated QTc Prolongation: A Clinical Audit
Authors: Kar Shreyan , Prasanna Aparna 
Published: August 2024

AimsCitalopram and escitalopram are commonly used serotonin-specific reuptake inhibitors (SSRIs) for the treatment of depression and anxiety. These medications are known to cause corrected QT interval (QTc) prolongation, with risks of further arrhythmias. In 2014, the Medicines Healthcare Regulatory Agency (MHRA) published guidance outlining this risk and advised decreased maximum daily doses of citalopram 20mg and escitalopram 10mg in the elderly population. The aim of this audit was to explore the prescribing patterns of citalopram and escitalopram in a community sample of older adults with psychiatric disorders, against MHRA guidance.MethodsOlder adults (aged >65 years) in the community mental health services in Wolverhampton, who were prescribed citalopram or escitalopram, were identified through a search of clinic letters in June 2023. We checked the medications, doses, history of QTc prolongation, concurrent medications that may prolong QTc, electrocardiogram (ECG) reviews, and any discussion about the risk. The data was collected by accessing the electronic patient record and related health records. In total 17 patients were included, with no exclusions.ResultsMost of the patients (94.1%, n = 16) were on citalopram and only one patient was on escitalopram. The most common dose of citalopram was 20 mg (62.5%, 10/16), with one patient having a higher than the recommended dose (30 mg). Escitalopram was within the recommended dose. There was no history of QTc prolongation in any patient. Concurrent medications that could prolong QTc were identified in 35.3% (n = 6) of the patient population; all of these were antipsychotics. A small proportion (11.8%, n = 2) of the patients had documentation stating about QTc prolongation and arrhythmia risks for citalopram or escitalopram. A review of ECG when initiating or adjusting treatment was noted in only one patient.ConclusionMost of the older adults had citalopram and escitalopram within recommended limits. A considerable proportion of patients had concurrent medications with an additional risk of prolonging QTc and subsequent arrhythmia. It is essential to consider ECG in all elderly patients before starting medications with a risk of QTc prolongation. There is a need to discuss the cardiac risk associated with citalopram and escitalopram with the patients and improve documentation. It may be better to provide written information to the patients and caregivers regarding this.
A Clinical Audit on the Monitoring and Management of Antipsychotic-Induced Hyper Prolactinaemia
Authors: Khan Noman 
Published: August 2024

AimsAntipsychotic medications are one of the major iatrogenic causes of hyperprolactinaemia with the attendant short- and long-term effects and risks associated with it.
•The audit sought to answer the question: Are we monitoring and managing hyper prolactinemia caused by anti psychotic medications appropriately?Methods•A literature search for relevant data and standards with regards to monitoring and management of hyperprolactinaemia was conducted.•The audit was based on the standards derived from South West Yorkshire NHS Partnership Foundation Trust’s (SWYPFT) standards, NICE guidelines, and the Maudsley Prescribing Guidelines in Psychiatry (14th edition), focusing on the Trust's standards.•The total population under consideration included every patient under the care of the North Kirklees, Community mental health team (CMHT), Old age psychiatry services (OPS) that was using antipsychotic medication in the time period between 16 June 2022 and 15th July 2023.Results•Total patients 61•Female 30•Male 31•Age: 65 and above•Already on antipsychotic: 49•Started on antipsychotic: 12•Two or more antipsychotic: 2•Switch from one antipsychotic to other: 4•Prolactin monitoring not required: 27 because were already using olanzapine, quetiapine and aripiprazoleMonitoring required: 34•Initiation: 12•Prolactin level done 2/12•Prolactin level not done 10/12•LAI (long acting antipsychotic) 11Prolactin level done 7/11Prolactin level not done 4/12Not done: 75% were with Care coordinator25% Wellbeing team•On oral antipsychotic that require prolactin level monitoring: 11•Prolactin level done 5/11•Prolactin level not done 6/11ConclusionPatients who were on antipsychotics in community required prolactin monitoring. In more than 50% of patients prolactin were not monitored regularly because of communication gap between Psychiatrist and GPs as no clear instructions were mentioned from Psychiatrist to GPs, patients and care coordinators.A small number of patients in whom prolactin was raised were highlighted to their respective medics and managed accordingly.
Audit of Non-Pharmacological and Rapid Tranquilisation Practices in Managing Distress Among Older Adults: A Comparative Study in Inverness Hospitals
Authors: Kumar Praveen , Wild Adam , Howells Fiona , Kumar Tharini , Williams Phoebe 
Published: August 2024

AimsThis audit evaluates the adherence of nursing and medical staff to local protocols for managing distress in older adults (aged >65 years) using non-pharmacological approaches and rapid tranquilisation (RT) in a psychiatric hospital's dementia ward, an acute medical unit, and a geriatric ward in a general hospital. We hypothesize that operational differences between these wards significantly influence the management of older adult patients.MethodsConducted from September 17 to October 8, 2022, in hospitals in Inverness, Scotland, this study reviewed 322 case notes and drug charts from patients who underwent RT in three wards: the Old Age Psychiatric Ward, Acute Medical Unit (AMU), and Geriatric Ward. Focus groups and informal discussions with ward nurses and junior doctors were organized to understand their perspectives on handling distress in dementia patients, with an emphasis on de-escalation techniques.Data focused on key parameters:
•Patient Diagnosis and Legal Status.•Administration Details: including initiation time, de-escalation techniques, consultation with senior doctors, and details of drugs administered (route, drug, and dosage).ResultsStaff nurses in all wards prioritized non-pharmacological de-escalation techniques, such as recognizing early signs of agitation, employing distraction and calming tactics, and acknowledging the importance of personal space, even in the face of staffing challenges and high patient loads. These measures were consistently employed prior to considering RT, adhering to the local protocol. Physical restraint was employed only in scenarios where there was a risk to the patient or others, executed by personnel trained in managing violence and aggression.Conversations with junior doctors, particularly in the AMU, revealed a limited understanding of the RT protocol, suggesting a need for enhanced training and awareness. Overall, the study indicates that while RT is regarded as a last resort after the failure of psychological and behavioral approaches, there is a clear necessity for further education and training to ensure the safe and effective administration of RT.ConclusionThis audit demonstrates that despite the varying environments and pressures in the three wards, adherence to the local protocol for managing distress in older adults is largely effective, with a strong preference for non-pharmacological methods. The findings highlight the need for ongoing education and reinforcement of RT protocols, particularly among junior doctors, to ensure patient safety and adherence to best practices. The results suggest that with proper support and training, the use of RT can be a carefully controlled and beneficial tool in managing distress in older adult patients.
Audit of Risk Assessment Tool in Adolescent Eating Disorders
Authors: Punukollu Mallika , Mulligan Camilla 
Published: August 2024

AimsAim:To develop better prioritisation and assessment of high-risk patients.Standard:RCPsych Junior MARSIPAN guidelines advise that reasonable aims for a first presentation to primary care involve physical examination and referral to the appropriate CAMHS or paediatric service depending on the level of risk. The framework set out within the guidelines can be used to highlight areas useful to assess and grade concern.NICE guidelines also state that in primary care, when assessing for an eating disorder or deciding whether to refer people for assessment, the following should be considered: BMI or body weight for their age, rapid weight loss, restrictive eating practices, mental health problems, physical signs of malnutrition, poor circulation and behaviours such as excessive exercise, unexplained electrolyte imbalance or hypoglycaemia.Indicator and target: Proportion of GP referrals which contain information to allow risk assessment and prioritisation of referrals within CAMHS.MethodsEating disorder referrals were reviewed over a three month period. Using EMIS, SCI store referrals were reviewed to check the source of referral and information included.Referrals were checked against the following criteria: weight, degree of weight loss, fluid intake, calorie intake, heart rate, blood pressure, mental health screening, compensatory behaviours and blood analysis.ResultsFirst cycle Results: from period from May–July 2021, comprising 8 referrals. The percentage of referrals which included information on the following were: weight 25%; weight loss 50%; calorie intake 37.5%; fluid intake 12.5%; heart rate 0%, blood pressure 12%, mental health 62%, compensatory behaviours 12.5%, bloods analysis 25%.Action plan: Pro forma was developed to increase awareness of the information that is useful to CAMHS to prioritise and assess risk as per standards expected from NICE and Junior MARSIPAN guidelines.This was circulated to East Renfrewshire GP practices in August 2021.Second cycle Results: Referrals were reviewed in the period after the pro forma was circulated from Sept–Dec 2021. This comprised of 4 referrals. Upon review results showed that the percentage of referrals which included information on the following were: weight 100%; weight loss 50%; calorie intake 25%; fluid intake 25%; heart rate 25%, blood pressure 50%, mental health 100%, compensatory behaviours 75%, bloods analysis 50%.ConclusionThe audit showed, that following the pro forma being circulated, there was an improvement in proportion of referrals which contained appropriate information (26% compared with 55% cumulative percentage of information included).
Anticholinergic Burden in People With Learning Disability and Mental Health Difficulties: A Baseline Audit
Authors: Sahadevan Sreeja , Hicks Melissa , Tharian Reena , Patteril Elizabeth , Alexander Regi 
Published: August 2024

AimsBackground:The cumulative effect of having one or more prescription drugs with anticholinergic properties is known as the Anticholinergic Burden (ACB). ACB can increase mortality and morbidity. Adults with learning disability are a high-risk group for this.Aims:To evaluate Anticholinergic Burden (ACB) for adults with learning disability and co-existing mental health conditions and make practice recommendations.MethodsA baseline audit was carried out over a period of 1 month on those treated within two specialist in-patient units in England. Routinely collected information including diagnosis, prescribed medication, clinical outcomes (Clinical Global Impression – CGI) and side-effect scales (ACB calculator, Anticholinergic Effect on Cognition – AEC, Liverpool University Neuroleptic Side-effect Rating Scale – LUNSERS, Glasgow Antipsychotic Side-effect Scale – GASS) were collated and analyzed using quantitative methods.Results19 patients were included. Mean age was 37 years, 89% (n = 17) were male and 95% (n = 18) of white British ethnicity. The clinical diagnoses included 74% (n = 14) with mild learning disability, 68% (n = 13) with a major mental illness (psychosis or affective disorder), 53% (n = 10) with autism and 32 (n = 6) with a personality disorder. 89% (n = 17) were on antipsychotics, 63% (n = 12) on mood stabilizers, 58% (n = 11) on antimuscarinic drugs for antipsychotic side effects, 58% (n = 11) on anxiolytics, 32% (n = 6) on antidepressants and 89% (n = 17) on medication for physical conditions. Including pro re nata (prn) medication, the mean ACB calculator score was 6.68 and 4.21 on the AEC scale. On LUNSERS, the mean score was 23.13 (medium side effects), on GASS 8.87 (mild or absent side effects), on CGI efficacy index 6 (decided clinical improvement with side-effects not significantly interfering with functioning) and on CGI global improvement 2.37 (much improved).ConclusionThe ACB in people with learning disability and mental health problems is high. While an ACB calculator score of 3+ is described as associated with increased mortality and morbidity in the general population, the mean score in this sample was double that if prescribed prn medication was included. Medication prescribed for both mental and physical health reasons. Despite the high ACB, they show good clinical improvement and functioning regarding their mental health. The scores on other side effect scales are not exceedingly high either. There is a need for more research to set the specific practice standards regarding ACB measurement and monitoring in this group. Adequate health education for patients and staff should be a priority to maintain vigilance regarding ACB effects.
Adherence of Baseline Physical Health Monitoring for Patients Receiving Antipsychotic Medications in a Psychiatry Ward, Lahore
Authors: Suleman Asma , Madeeh Hashmi Ali 
Published: August 2024

Aims•To identify current practices regarding baseline tests monitoring for antipsychotic medications.•To identify potential causes for not adhering to the standard guidelines.•To ensure all the baseline tests have been documented and reviewed properly.MethodsIn a retrospective analysis, a cohort of 28 patient case notes was examined in June 2023 to assess the baseline physical health parameters within the Psychiatry department at Punjab Institute of Mental Health, Lahore, in accordance with the guidelines outlined in “The Maudsley Prescribing Guidelines in Psychiatry 13th edition.” The data was analyzed to fulfill the audit objectives, and significant trends were subsequently identified.ResultsThe baseline assessments encompassed a comprehensive blood count, urea and electrolyte analysis, liver function testing, blood glucose measurement, and blood pressure monitoring, all of which were conducted in 100% of the cases. Nevertheless, electrocardiography (ECG) was only carried out in 71% of the cases prior to the initiation of antipsychotic treatment. Regrettably, there was a lack of documentation regarding baseline weight/BMI monitoring, serum prolactin level assessment, and creatinine phosphokinase level measurement.ConclusionThe audit revealed several areas of concern that warrant immediate attention and improvement. These include:
•Protocols and Guidelines: The absence of defined protocols poses a significant challenge to maintaining consistent and standardized practices within the department.•Awareness and Training: There is a noticeable lack of awareness among medical staff, including doctors and nurses, regarding the importance and proper procedures for baseline assessments.•Sampling Errors: The occurrence of sampling errors during the data collection process has impacted the reliability and accuracy of the obtained results.•Administrative Challenges: Administrative issues have been identified as a barrier to the seamless implementation of baseline assessment protocols.•Resource Allocation: Insufficient funding for laboratory resources has hindered the comprehensive and timely conduct of essential tests.•Test Availability: The limitations in the availability of certain required tests have impeded the thoroughness of baseline assessments for patients.Addressing these areas of improvement is critical to enhancing the quality of care and ensuring the holistic well-being of our patients. It is imperative to implement robust protocols, enhance staff awareness and training, rectify administrative challenges, secure adequate funding for resources, and ensure the availability of essential tests. These measures will contribute to the delivery of comprehensive and effective healthcare services within the Psychiatry department at Punjab Institute of Mental Health, Lahore.
Assessment of Compliance With NICE Guidelines on Safety Planning Following Self-Harm in Elderly Patients in a Mental Health Trust
Authors: Tariq Safyan , Prasanna Aparna , Lau Ryan 
Published: August 2024

AimsOur aim was to evaluate the extent to which the risk assessment protocol post self-harm incidents for patients aged over 65 at the Black Country Healthcare Trust is aligned with the recommendations set forth in the NICE Guideline (NG225). We specifically sought to determine whether safety plans are incorporated as recommended by the NICE Guideline (NG225), and in the absence of a distinct safety plan, whether essential components of such a plan are integrated within the risk assessment framework utilised following episodes of self-harm.MethodsA retrospective audit was conducted utilizing data from the trust on self-harm incidents over a six-month duration. Of the 1,408 recorded incidents, 68 involved individuals aged 65 years or older. A sample of 30 incidents was randomly selected from this cohort to constitute the target sample for this study. Each case was anonymized with a unique identifier and subjected to a comprehensive review employing a bespoke data collection instrument, expressly developed for this audit. The review process was facilitated by the trust's digital record system (RIO). Data collated for analysis encompassed a range of variables, including demographic details, diagnostic classifications, geographical location, care setting, self-harm methodologies, the severity of the self-harm events, the origin of data, and compliance with the stipulated criteria of the NICE Guidance (NG225).ResultsComprehensive safety plans were present in a minority of cases, specifically 6.7% (2 out of 30 patients). The documentation of individual components of the safety plan, analysed separately, yielded the following results:
1.Documentation of self-harm mechanisms was achieved in 70% of cases (21/30).2. Identification of precipitants or triggers was noted in 56.7% of cases (17/30).3. The formulation of coping strategies was documented in 20% of the sample (6/30).4. The enumeration of essential contacts was completed in 33.3% of cases (10/30).5. The identification of family members pertinent to the patient’s support network was noted in 33.3% of cases (10/30).6. The inclusion of contact details for these identified individuals was present in 30% of cases (9/30).7. Guidelines to ensure a safe environment were applicable and recorded in 38.9% of the relevant cases (7/18).ConclusionThe majority of patients did not have a safety plan post self-harm incidents. Notwithstanding the absence of a comprehensive safety plan, critical elements prescribed by NICE Guidance (NG225) were insufficiently addressed within the risk assessment and subsequent management planning post self-harm.