bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Autism Spectrum Condition Support Within an Early Intervention Psychosis Service
Authors: Collier Karen , Singh Sashriya 
Published: August 2024

AimsTo improve the knowledge of the early intervention in psychosis team staff regarding support and referral options available for patients with suspected or confirmed autism spectrum conditions. We further aimed to develop additional knowledge within this team to help identify, assess and support people who may be neurodivergent with a primary focus on autism.MethodsStarting in September 2022 the team completed a survey to understand baseline knowledge. Plan Do Study Act (PDSA) quality improvement cycles were then used to develop resources and disseminate knowledge within the team to help target the identified staff development areas. Following implementation the team completed a further survey to reassess the changes and ongoing areas of focus and to guide ongoing skill development.Results3 PDSA cycles were completed with interventions including collecting data on local services to share within the team, collating these resources and sourcing training sessions. This demonstrated an improvement in many areas at the point of the second survey at which stage the team showed a better understanding of how to access autism assessments, the role of various local autism specific teams including admission avoidance urgent support processes and confidence in supporting people after diagnosis. Work continued following the second survey within the team with further training sessions and both medical and psychology colleagues upskilling to be able to complete autism assessments within our service in conjunction with the neurodevelopmental team. The early intervention team staff have been able to utilise the support of many of these services and often discuss these options now within team meetings.ConclusionInitially support and knowledge gaps were identified within our team and work was done to collect and share information about local services and processes to best allow us to support those within our psychosis service who also have an autism spectrum condition and this has been successfully implemented.This work has grown over the past 2–3 years since the initial quality improvement work was developed and team knowledge has since continued to grow. This has included multiple team members now also being able to complete autism assessments formally in conjunction with the neurodevelopmental service with some assessments now finalised and significant ongoing work to improve experiences of those with both autism and psychosis.
The Experience of International Medical Graduates (IMGs) at Birmingham and Solihull Mental Health Foundation Trust (BSMHFT): A Quality Improvement Project
Authors: Sohail Shahnila , Mirza Tabassum , Abiola Muhammad , Asim Anum , Adeyanju Adedamola 
Published: August 2024

AimsTo improve the overall experience of IMG Doctors at BSMHFT. To demonstrate this, we targeted an increase in percentage of doctors rating their experience as excellent in our survey.MethodsEmploying the “Model for improvement”, we co -produced all aspects of project with subject matter experts (IMGs).
•What are we trying to accomplish? We co-produced process map/aim.•How will we know that a change is an improvement? Co-produced survey, circulated monthly, data collected and analysed.•What change can we make that will result in an improvement: Co-produced change ideas from process map, survey data and weekly meetings. Commenced testing some change ideas in this phase.Other QI tools utilized include Driver diagram and family of measures.•Change strategies (PDSA cycles):These include:◦IMG specific session at Trust Induction. 15 minutes slot allocated to introduce project and encourage involvement.◦IMG whatsapp group.◦IMG Forum.◦Dedicated Email Inbox.◦Learning/career progression sessions.◦Social events.◦IMG representative.Following organised sessions number of attendees recorded and feedback obtained via survey.ResultsOutcome measure (Aim) - 5 months of survey data obtained. An average of 10 IMGs responded to monthly survey. Data presented on statistical process chart (SPC) revealed a median value of 33% of respondents (IMGs) rated their experience as excellent.Process measures –
•Trust Induction – 2 PDSA cycles completed. 15 IMGS joined the Whatsapp group following induction sessions. 24 IMGs joined the IMG mailing list.•Whatsapp group – Completed 9 PDSA cycles. Average of 3 IMGs joined per week. 69 members at present. Data indicates informal posts, planned activities, information sharing, and spontaneous queries encouraged engagement.•IMG Forum – one PDSA cycle completed. 20 IMGs attended. Feedback was obtained and 63% of respondents rated the effectiveness of the session as excellent.•Social event – one event arranged; 16 IMGs attended.ConclusionFrom this phase of the QI project, we have been able to foster an increased sense of community peer support and camaraderie amongst IMGs. This is highlighted by increased numbers in WhatsApp group, mailing list and attendance at events.The change ideas positively impacted participation, engagement, and satisfaction with the project providing a previously unavailable psychological safe space.33% of respondents rated their overall experience as excellent from the monthly surveys that were sent out.In terms of next steps, we aim to implement other change ideas and aim to increasing respondents’ rating as excellent to 50% by December 2024.
Extending the Reach of the STOMP Initiative to a Residential Nursing Home in Northern Ireland
Authors: Stirling Emily , Doris Michael 
Published: August 2024

AimsSTOMP (stopping the over-medication of people with a learning disability, autism, or both) is a national project launched by NHS England in 2016. The objective is to curb the excessive use of psychotropic medication in individuals with a learning disability, autism, or both to manage behaviour that challenges. This means ensuring that medications are prescribed at the lowest effective dose for the shortest duration of time, and aiming to discontinue if appropriate.We aim to broaden the implementation of the STOMP initiative to a relatively new residential nursing home in Northern Ireland that is home to individuals with learning disabilities and complex care needs. The residents are discussed at monthly MDT meetings attended by psychiatry, positive behaviour support (PBS) practitioners, activities coordinators, and nursing home managers.MethodsThe inclusion criteria for STOMP are 1. Diagnosis of learning disability, autism, or both, 2. Currently taking psychotropic medication primarily for behaviour that challenges and 3. No diagnosis of severe and enduring mental illness. Five patients were eligible for STOMP.Outpatient letters and medication prescriptions from the time of admission were compared with the most recent outpatient letters and medication prescriptions.ResultsThe five residents were on a range of psychotropic medications including antipsychotics, antidepressants, benzodiazepines, and antihistamines. Following STOMP implementation there was a reduction in psychotropic medication for 80% of the residents.Patient 1: Reduction in antipsychotic from 75% BNF max daily dose to 40%.Patient 2: Previously on two antipsychotics with combined use of 75% BNF max daily dose – both medications now discontinued.Patient 3: Reduction in antipsychotic from 69% max daily BNF dose to 50%, PRN antihistamine discontinued.Patient 4: PRN antipsychotic discontinued from 15% max daily BNF dose, benzodiazepine use reduced by 5%.Patient 5: Antipsychotic use increased from 25% max daily BNF dose to 33%.ConclusionThere was a reduction in psychotropic medication in 80% of the residents. This is an encouraging finding and shows that the STOMP initiative can be expanded to include residential nursing homes. Despite relatively limited resources for STOMP implementation in our local service, we have shown that by keeping the STOMP ethos at the centre of our thinking during monthly MDT meetings involving nursing home management, PBS practitioners, psychiatry, and activities coordinators, we can make sustained reductions in psychotropic prescribing.
Empowering Patients With Functional Neurological Disorders (FND) Through Information to Facilitate Informed Decision-Making and Active Condition Management
Authors: Lee Soogeun , Tamilson Bruce 
Published: August 2024

AimsThis service improvement project seeks to empower individuals diagnosed with Functional Neurological Disorders (FND) by delivering comprehensive information, facilitating informed choices about their care, and encouraging an active role in managing their health.MethodsInformation was gathered relating the concerns and expectations of FND patients upon receiving a diagnosis or attending the neuropsychiatric clinic at a regional neuroscience centre. The identification of a patient information leaflet as a valuable resource became apparent. Consequently, a meticulously designed leaflet was developed to educate patients about their condition, providing useful tips and resources. The content of the leaflets underwent a thorough series of reviews, incorporating input from various professionals within the multidisciplinary team, with additional consideration given to feedback from service users. To assess the impact of this intervention, feedback is required from both clinicians and end-users.ResultsThe patient information leaflet contains information designed to enlighten patients about their condition, incorporating psychoeducational content on self-help strategies and available treatment modalities. It also highlights support resources available to them. The leaflet can be conveniently stored in the neurology and neuropsychiatric clinic areas for easy clinician access and distribution to relevant patients. Additionally, it is available in PDF format, enabling clinicians to print it in satellite clinics, and medical secretaries can email it to patients along with clinic letters as directed by the clinicians. Initial feedback from patients and clinicians has been overwhelmingly positive, with many considering it an essential intervention.ConclusionThis service improvement, realized through a relatively modest intervention, can lead to a substantial impact on patient care and satisfaction. Providing patients with pertinent information is crucial for fostering informed decision-making and empowering them to take an active role in their care. Especially for conditions historically stigmatized and misunderstood, it is imperative to disseminate up-to-date information, establishing a reliable and endorsed source to dispel stigma for both patients and their families.
Quality Improvement Project on Standardising GP Discharge Summaries in Liaison Psychiatry Services for Older People in Nottinghamshire Healthcare NHS Trust
Authors: Tan Sue Fen , Wilson Sarah , Lander Robin 
Published: August 2024

AimsDischarge letters to general practitioners (GPs) are pertinent in summarising patients' care in secondary healthcare settings and communicating follow-up management plans for continuity of care. 26 GPs from 13 GP surgeries in the West Midlands thought that discharge letters lacked important information and standardisation. We developed a quality improvement (QI) project to standardise GP discharge summaries within the liaison psychiatry services for older people in Nottinghamshire Healthcare NHS Trust. We aimed to ensure that 100% of GP discharge letters are written in a standardised format and meet the mandatory subheadings within six months.MethodsA comprehensive literature search was performed, and we invited six GPs across Nottinghamshire to comment on the quality of anonymised discharge summaries written by our colleagues. After discussing the findings with our stakeholders, we developed a new discharge summary template with the subheadings of ‘Reason for Liaison Psychiatry Involvement’, ‘Summary’, ‘Diagnosis (if applicable)’, ‘Risk Formulation’, and ‘Treatment or Plan of Action’.We held a team meeting and distributed a guidance document with scoring criteria for each subheading for our clinical colleagues to practise for two weeks. Subsequently, 75 discharge summaries were randomly selected and independently scored across seven weeks by an internal team member and an external QI data analyst to improve inter-rater reliability. 98 discharge summaries written six weeks before the new letter template was introduced were retrospectively scored for baseline measurement.ResultsAt baseline, the discharge summary scores ranged between 6 and 20 (out of a maximum of 20), depending on the individual completing them. The mean score was 12.3.The implementation of the new discharge summary template improved the mean score to 19.0, irrespective of the author. The mean score was consistent across seven weeks.Most of our colleagues did not face significant challenges in learning a new style of writing and for some, a standardised template reduced administrative time. The same GPs reviewed the new set of anonymised discharge summaries and were satisfied with the new summary format.ConclusionFormulating a standardised discharge summary template which adhered to professional guidelines was pivotal in improving the quality of GP discharge summaries. GP involvement throughout the project convinced stakeholders and colleagues to commit to a new writing template and tremendously helped achieve our project aim.
VTE Prophylaxis Quality Improvement of Service Users Data in Older Adult Mental Health Inpatient Wards in St Charles Hospital, CNWL NHS Trust
Authors: Thakaria Shreena 
Published: August 2024

AimsTo reach the target of 100% for VTE (venous thromboembolism) prophylaxis data submitted for all St Charles Older Adult inpatients.MethodsIt was found at the start of the QI project, the service was at 63% (August 2023). I reviewed this data and discussed it with the ward managers of the older adult inpatient wards and implemented two PDSA cycles. I went through the ward list of service users and noted on the database who had an outstanding VTE prophylaxis check. From this, I then created a section for the nursing handovers to include whether each service user had their VTE prophylaxis forms filled in and whether VTE prophylaxis was appropriately prescribed. The wards have a weekly MDT meeting where this could be discussed and all staff could be reminded to document the VTE data on the trust data system. I rechecked the data two months later to see if the data had improved. Following this, I created a VTE poster to be distributed via email to ward staff and hung up in the ward doctors' offices to help educate staff on the importance of VTE prophylaxis. The statistics were rechecked two months later for further improvement.ResultsAt the start of the QI, it was found that the service was underperforming in reaching its target of 100% of the VTE prophylaxis data entry for all service users in older adult inpatient wards. After implementing the first PDSA cycle, the data increased to 84% compliance (October 2023 data). After implementing the second PDSA cycle, the data increased to 100% compliance (December 2023 data). The data showed both implementations had a significant impact on the data input and the target being reached. The new strategy has now been firmly placed into the team working pattern as a routine measurement and continues to be actively utilised.ConclusionIn an older adult inpatient ward setting with service users who have co-morbidities, reduced mobility and risk of dehydration from self neglect, it is vital they are assessed appropriately for VTE risk factors and prescribed the appropriate prophylaxis. Once this was highlighted to the ward staff and an easy system of the PDSAs were implemented, the team are now able to actively input the data and provide optimal care for the service users.
Improving Clinical Communication With the Doctor On-Call: A QI Project
Authors: Verrall Henry 
Published: August 2024

AimsClear, accurate and efficient clinical communication between wards and on-call doctors is vital for good patient care. Issues were raised locally regarding the quality and content of these calls, and a QI project devised to assess the issue and implement meaningful change.MethodsAn initial QI Audit was undertaken, using Likert scale questionnaires to rank areas of concern. These were sent to all the doctors currently manning the on-call rota, and doctors who had previously covered these on-calls. Responses were used to gauge the key concerns, and a blank space and multiple choice question on possible contributors to the issues were included.A communication prompt was designed that tackled the key issues highlighted by the audit. A clear flow-chart ensured that safe and sensible steps were taken to maximise the efficiency of a necessary call. A summary of the SBAR communication tool was also included to encourage structured handover. These prompts were cheap and easily affixed to ward telephones and were laminated and wipe-clean. Implementation was agreed with and supported by the senior nursing team.A post-QI questionnaire was then sent out one month after the intervention, getting feedback from the junior doctors covering on-call shifts in that time.ResultsQuestionnaire Likert scales measured either Frequency (1-Very Rarely – 5-Very Frequently) or Quality (1-Poor – 5-Excellent), and a mean of the scores was taken for each question.The initial audit (n = 14) included all the doctors currently on the on-call rota (n = 7). Key issues raised were Average Call Quality (2.2/5), how frequently recent NEWS scores were available (2.3/5), and how frequently key clinical information was on hand during the call (1.9/5). Many trainees were made to feel uncomfortable or like they were being difficult for requesting more information (3.2/5). And calls were often noted to not be relevant (3.9/5) or were confusing/unclear (3.9/5).A second questionnaire was completed 1 month post-intervention by the doctors working the on-call rota in that time (n = 6). 100% reported some improvement, 33.3% reported significant improvement. Improvements included average call quality (4/5), frequency of recent NEWS (3.7/5), and availability of Key clinical information (3.5/5).Blank space feedback highlighted the tool's clarity and simplicity.ConclusionThis QI project was able to highlight and address a key issue in clinical care in a simple, and very low cost manner. Improvements were demonstrated after one month of intervention, and a more in-depth trust-wide rollout of the project is being discussed.
Clinical Effectiveness and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada
Authors: Awara Mahmoud 
Published: August 2024

AimsPeople with severe and persistent mental illness (SPMI) present unique challenges in mental healthcare due to the enduring nature and complexity of their conditions. The study focuses on evaluating the clinical effectiveness and cost implications of a multidisciplinary community psychosocial rehabilitation team catering to individuals with SPMI in Nova Scotia, Canada. The investigation seeks to contribute valuable evidence to the limited literature on community psychosocial rehabilitation in the Canadian context.MethodsThe study adopts a retrospective approach, analyzing data from patients referred to community rehabilitation between 2016 and 2017. The assessment centers on the year before and after patient engagement with the community rehabilitation team. Clinical effectiveness is evaluated through measures of inpatient service use (admissions, length of stay) and emergency department (ED) visits. The Canadian billing system of Medical Service Insurance (MSI) is employed to examine the cost of acute service utilization.ResultsResults demonstrate a statistically significant reduction in mean admission rates and length of stay in the post-rehabilitation year compared with the pre-rehabilitation period. A substantial percentage of patients experienced no inpatient admissions or ED visits in the post-rehabilitation year. The analysis reveals a significant net reduction in hospital days, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation in the context of SPMI.ConclusionThe study suggests that community rehabilitation contributes positively to the clinical outcomes of individuals with SPMI, showcasing reduced inpatient service use and associated costs. The findings underscore the importance of further research into community psychosocial rehabilitation in the Canadian setting and emphasize the economic implications essential for demonstrating the efficiency of mental healthcare services.
Treatment Trajectories of Young People With Emotion Dysregulation Engaging in Dysregulated Behaviours: An Exploratory Study
Authors: Baykeens Bibire , Di Simplicio Martina 
Published: August 2024

AimsDysregulated behaviours are prevalent amongst young people worldwide. Emotional dysregulation plays a key role in these behaviours. Several psychiatric disorders have significant elements of emotional dysregulation, making it a potentially effective transdiagnostic therapeutic target. Dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and schema therapy (ST) can effectively manage emotional dysregulation, however access may be limited in clinical practice.We aimed to explore whether young people with emotional dysregulation engaging in dysregulated behaviours receive support for emotion regulation. We hypothesised that those with emotionally unstable personality disorder (EUPD) will have a higher prevalence of self-harm, disordered eating, and/or substance misuse and more referrals for DBT, MBT, or ST than those with bipolar disorder, autism, attention deficit/hyperactivity disorder (ADHD), schizophrenia, or schizoaffective disorder.MethodsDe-identified clinical records from the West London NHS Trust on 2,413 16- to 25-year-olds with an ICD–10 diagnosis of EUPD, bipolar disorder, autism, ADHD, schizophrenia, and/or schizoaffective disorder were obtained through Akrivia. Chi-squared tests were performed.ResultsYoung people with bipolar disorder had the highest prevalence of self-harm, disordered eating, and substance misuse (88.35%, n = 182), χ2 (4, N = 3138) = 39.14, p < 0.001, but the lowest number of references to DBT, MBT, or ST. Those with EUPD had the highest number of references to DBT, χ2 (4, N = 2585) = 886.75, p < 0.001, MBT, χ2 (4, N = 2585) = 81.63, p < 0.001, or ST, LR (4, N = 2585) = 21.03, p < 0.001.ConclusionThere could be an unmet need for psychological interventions for young people with bipolar disorder. A more transdiagnostic approach to offering psychotherapies that target emotional dysregulation should be applied in clinical practice.