bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Survey on Additional Health Risk Factors for Heroin Users Presenting in Emergency Department (ED) of Chesterfield, North Derbyshire
Authors: Rauf Adeel , Sirur Deepak , Smith Martin 
Published: August 2024

Aims1. To identify various physical and social health characteristics of heroin users to reduce further risks presenting to ED in Chesterfield, North Derbyshire.2.To consider whether any characteristics identified could develop a targeted screening tool for enhanced interventions.MethodsA retrospective review of ED notes was conducted from Chesterfield Royal Hospital using electronic patient records of heroin users who are under the care of Drug and Recovery Partnership (DRP) in Chesterfield, North Derbyshire. We developed a proforma for data collection analysis using Microsoft Excel.100 patients were chosen over a time interval of one year in which they have had at least one ED presentation.We looked into Body mass index (BMI), physical health diagnoses, number of presentations to the ED in one year, psychotropic medications, dose of opioid substitution therapy and living circumstances of the attendees. These characteristics were identified in a previous study of local mortality data.Results46% of the attendees only presented once in the study interval.83% of the attendees presented to ED due to a medical reason.41% of the attendees had raised BMI.73% of the attendees who attended were on Opioid Substitution therapy (OST). 51% of the attendees were using a dose between 70–100 ml of methadone.27% of the attendees had co-morbid COPD and Asthma.47% of the attendees were on prescribed psychotropic agents. 56% of them were prescribed mirtazapine.44% of the attendees lived alone, 33% with a partner.Conclusion1.Based on the sample, 83% of the heroin users presenting to ED in this period of study attended due to physical health concerns.2.As half of the sample were not serial attenders (46%), it is important that opportunities of assessment for this high-risk group of people are not missed.3.Nearly three quarters (73%) of the attendees were on prescribed OST, half of those were within optimised dose. This suggests for tighter links between liaison to local drug services to alert presentations with specific consideration of harm reduction interventions, dose optimisation or re-titration onto OST.4.The data collected over this period supports the development of a pilot screening tool to prioritise enhanced care interventions with a specific focus on harm reduction for a specific group of high-risk heroin users.
Audit on PRN Prescriptions in Adult Inpatient Female Ward
Authors: Adhikari Alka , Shah Syeda , Dhaliwal Maya , Chalaby Ayesha 
Published: August 2024

AimsPro re Nata (PRN) psychotropic medication prescription and administration play a crucial role in addressing patients’ immediate needs and medical care plans in acute mental health services. However, regarding the appropriate indication, use, and documentation of PRN medication prescription, review, and administration practices should be as per NICE guidelines to ensure patient safety and care quality.This audit will encompass an evaluation of PRN medication prescription in acute inpatient psychiatry as per NICE guidelines and a reaudit after recommendations implementation.MethodsWe made 8 sets of questionnaires based on The National Institute for Health and Care Excellence (NICE) guidelines recommendation for PRN prescription as per local trust policy. We collected data from 28 patients in the acute inpatient mental health unit for the first cycle. Data was collected from patients' records which included medicine charts, progress notes, and MDT reviews. We analyzed data from the first cycle and implemented changes in Clinical practice. This includes including these guidelines in junior doctor induction, weekly discussion with team pharmacist, adding prompts in medication chart, and weekly review of PRN medication in ward MDT. After 2 months we collected data of 25 patients for reaudit.ResultsWe analyzed first-cycle data, which required improvement as per AUDIT standard compliance. We implemented recommendations before reaudit. We found there were significant improvements in some areas of concern, although this was not 100 percent audit standard. This area includes a review of PRN medication prescriptions in the last 7 days (25 percent in the first cycle, 56 percent in reaudit), grouping them if both oral and intramuscular formulations were prescribed to avoid overdose (7.2 percent, 28 percent), documentation of minimum (10.7 percent, 24 percent) and maximum dose (100 percent, 100 percent) of PRN within 24 hours, documentation of indication (100 percent, 96 percent).ConclusionThe findings of this audit and recommendations after the first cycle of audit contribute to enhancing quality of PRN medication prescription practice in acute inpatient mental health services for health care professionals. Addressing potential areas of prescription, administration, and review and providing valuable recommendations and insight for improvement of patient safety and best clinical practice.
An Audit to Assess Nicotine Management on a Mental Health Rehabilitation Unit in Mersey Care NHS Foundation Trust
Authors: Baruah Ranjan , Popoola Olusegun , Gilbey Sion , Pentz Oliver 
Published: August 2024

AimsResearch has found that having a mental health condition is associated with smoking, and difficulties remaining abstinent. It is also evidenced that there is desire to reduce the amount smoked and cease smoking altogether by those with mental health conditions. Smoking can also affect some medications used to treat mental health conditions.To assess nicotine replacement management in inpatients at Rathbone Rehabilitation Centre (RRC) against Mersey Care NHS foundation Trust (MCFT) Nicotine Management Guidelines (SA20).MethodsData of all discharged patients from RRC over a 12-month period was collected following a standardised process and assessed for 6 parameters.A total of 51 discharges were identified and the whole sample of 51 patients were audited.Results47 (92%) were asked and recorded of their smoking status and 4 (8%) were not at the point of first contact on patient electronic records (Rio).Of the 28 smokers who were identified on admission, 26 (93%) were offered support to stop smoking at that point. 3 other patients started smoking during admission.Of the 31 patients who were identified as smokers (including 3 who began smoking during admission), 24 (77%) were offered support to stop smoking at regular intervals throughout their admission and 7(23%) were not.Of the 28 smokers who did not wish to permanently stop smoking, there was documented evidence that 20 (71%) of these individuals were offered nicotine replacement treatment (NRT) in some form to manage temporary abstinence from smoking.5 out of 31 smokers were referred to a Nicotine Dependence Treatment Advisor for counselling and support during their inpatient stay.ConclusionBelow action plan was designed to improve compliance with MCFT Nicotine Management Guidelines (SA20):Audit leads to communicate with every team member at RRC (Team meetings and emails) to remind them of the following:
◦To offer smokers support to stop smoking at regular intervals and document on Rio; via named nurse sessions or opportunistically.◦To offer NRT where appropriate and document on Rio if accepted or declined during MDT reviews/named nurse session.◦Ensure Physical Health Nursing Proforma is always completed on Rio, and if the service user is a smoker, to ensure referral status (referred/declined) to Nicotine management team is documented.◦Increase awareness of referral pathway by putting up posters in relevant clinical areas.
Monitoring of Antipsychotics in CAMHS Intellectual Disability Service in Lancashire and South Cumbria NHS Foundation Trust
Authors: Batool Sadia , Abbas Wala Kamal , Oyedokun Abimbola , Oyed Mischa 
Published: August 2024

AimsTo ascertain the service performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of children and adolescents prescribed antipsychotics.MethodsInitial audit: April–June 2021.Re-audit: January–February 2024.Registered with the Lancashire and South Cumbria NHS Foundation Trust audit department. An audit tool was developed by the investigators. The investigators carried out a review of patient electronic records and clinical letters to gather information pertaining to initiation of antipsychotics and physical health monitoring.ResultsAmongst other variables in this trust-wide audit, we considered age, ethnic background, reason of initiation of anti-psychotic, comorbid conditions among which most common is epilepsy, dose of antipsychotic used and distributions across various CCGs. Were they regularly reviewed by medic reviews and side effects monitored? We also looked at choice of antipsychotic used, which was largely aripiprazole and risperidone. Were antipsychotic bloods done or not and were we able to complete children's height and weight measurements whilst they were on antipsychotics? It was important that these are documented as being considered or ‘offered' even if could not be successfully completed due to e.g. challenging behaviour from the child. Detailed and comparative results can be shown in final submission along with charts.ConclusionThe recommendations from initial audit were compared with the second audit, and whilst some of them were completed such as incorporating growth chart in the electronic records system, some ongoing challenges were identified. Positive and negative findings were both noted although the final conclusions lies in favour of good changes been made to service including the caseload becoming more ID specific in this age group.
Quality of Adult Inpatient Discharge Planning and 3 Day Follow Up – a Regional Audit
Authors: Mitu Tajnin , Pierce Anita , Seddiq Nehad , Elsayed Asmaa , Elahi Ishraq 
Published: August 2024

AimsThis study aimed to assess the post-discharge follow-up processes for psychiatric patients, specifically focusing on a 72-hour follow-up with documented Mental State Examination (MSE) and the presence of a comprehensive care plan, including up-to-date risk assessments and handover documentation.MethodsConducted across three psychiatric units – Heddfan, Ablett, and Hergest – and associated Community Mental Health Team (CMHT) sites within Betsi Cadwaladr University Health Board, the audit spanned eight weeks (14/08/2023 to 16/10/2023). Adhering to NICE guidelines (NG-53) and CCQI Standards for Community-Based Mental Health Services-2017, data collection focused on the specified criteria.ResultsAnalysis revealed that 23% of patients did not receive a 72-hour follow-up post-discharge, attributed to reasons such as patient refusal or missed appointments. Only 74% of patients had documented risk assessments, posing challenges to follow-up teams. Despite the hospital's controlled environment, transitioning patients into the community demands updated risk assessments. While 87% of patients had documented mental state examinations during follow-ups, there's room for improvement in this crucial activity.ConclusionIn summary, the study emphasizes the importance of meticulous documentation and communication in the transition from inpatient psychiatric care to community settings. Challenges in achieving comprehensive follow-up documentation, with only 67% meeting criteria, were identified. The presence of an online Medication Therapy and Electronic Discharge system faced obstacles in printout availability. Designating a responsible individual for care plans pre-discharge and commendable adherence to thorough assessments during inpatient stays (83%) underscore efforts for a holistic approach. Future enhancements should target improving medication information integration and fortifying collaboration between inpatient and community teams. Addressing these aspects not only prevents medication-related errors but also ensures a seamless and patient-focused transition, enhancing the overall quality of mental health care delivery.Additional Authors: Dr Minahil Junaid, Betsi Cadwaladr University Health Board, Rhyl; Dr Moheet Rahal, Betsi Cadwaladr University Health Board, Rhyl; Dr Aanika Nawr Hoque, Betsi Cadwaladr University Health Board, Wrexham; Raghdah Faisal, Betsi Cadwaladr University Health Board, Bangor, Amin Rezk, Betsi Cadwaladr University Health Board, Wrexham; Mostafa Negm, Betsi Cadwaladr University Health Board, Wrexham.
A Complete Audit Cycle of the Recording of the Baby's and Their Siblings' Age, Date of Births and Due Dates of Pregnant Mothers During the Initial Assessment Process for Patients Presenting to a Community Perinatal Mental Health Services
Authors: Eze Chinenyenwa , Brotchie Emma 
Published: August 2024

Aims•To find out the proportion of patients for whom the dates of births of their children, age and their due date were recorded during their initial assessment as a means of reducing risks through safeguarding.•According to the Royal College of Psychiatrists: Standards for Community Perinatal Mental Health Services 5th Edition (2020), Under Section 5 – Rights, Infant Welfare and Safeguarding: during the initial assessment, the baby's age and date of birth and mother's due date should be recorded as part of the infants' physical and emotional care needs assessment.Methods•All new patients discussed during multidisciplinary team meetings within a 2 month period from 01/08/2023 to 30/09/2023 were identified•Their clinical records were audited.•This information was cross-checked with the information provided on their referral letters.•Patients attending preconception counselling were excluded.•The initial results were presented in one of the multidisciplinary team meetings.•The recording of the children's ages, date of birth or due dates of their mothers was re-audited two months later.ResultsAudit
•A total of 70 new patients were discussed within the initial two months period.•25 out of the 70 (36%) did not attend their appointments and two patients (3%) cancelled their appointment.•1 patient who attended for preconception counselling was excluded.•Of the remaining 42 patients that were assessed, 6 (14%) were primigravida while 36 (86%) patients were multiparous patients.•15 out of the 42 (36%) had their children's age, dates of birth and due date recorded while 27 out of the 42 (64%) lacked this record.Re-audit
•A total of 65 patients were identified during the re-audit period•18 out of the 65 patients (28%) did not attend their appointment and one patient cancelled her appointment.•One patient that attended for preconception counselling was excluded from the re-audit process.•Of the remaining 45 patients that were assessed, 2 (4%) were primigravida and the remaining 43 (96%) were multiparous women.•The age, dates of birth and the due date were recorded for 26 (58%) out of 45 patients while 19 out of the 45 patients (42%) did not have this record.Conclusion•The children's ages were commonly recorded compared with their date of birth.•Gestational ages of the pregnant mothers were commonly recorded compared with their due dates.•Date of birth is needed for a quick check on a child for safeguarding reasons and this is useful during the admission of mothers onto a mother and baby unit.•The re-audit showed a significant improvement in the documentation of this information in the patients' records.
Identifying Perimenopausal Symptoms in Women Diagnosed With Depression: A Focused Audit at a Tertiary Care Hospital
Authors: Gul Naima 
Published: August 2024

AimsThis audit aimed to assess the recognition and management of perimenopausal symptoms in women diagnosed with depression at the Psychiatry Outpatient Department (OPD) of Benazir Bhutto Hospital, Pakistan. It focused on identifying gaps in screening for perimenopausal symptoms among these patients.MethodsConducted over a year, this retrospective audit included 250 women aged 45–55 years, previously diagnosed with depression. Post-diagnosis screening for perimenopausal symptoms was performed using the Menopause-Specific Quality of Life Questionnaire (MENQOL) and the Greene Climacteric Scale. Data on initial diagnostic criteria, treatment modalities, and patient outcomes were reviewed. Follow-up interviews provided insights into ongoing symptom management and treatment satisfaction.ResultsThe retrospective screening revealed that 78% of these women had significant perimenopausal symptoms per the Greene Climacteric Scale, which were initially overlooked. MENQOL results showed 65% experiencing a substantial impact on quality of life due to menopausal symptoms. Treatment primarily consisted of antidepressants (used by 82% of patients), while 8% received psychological counseling, and 10% were advised on lifestyle adjustments and non-hormonal therapies. Only 45% of the patients reported satisfactory symptom management, indicating a potential discrepancy between the treatments for depression and the underlying perimenopausal condition.ConclusionThe audit at Benazir Bhutto Hospital demonstrates a high incidence of undiagnosed perimenopausal symptoms in women treated for depression, suggesting a critical need for improved screening protocols. The results indicate that integrating perimenopausal symptom assessment into the initial diagnostic process for depression could lead to more effective, individualized treatment strategies. This approach may enhance the overall treatment satisfaction and quality of life for perimenopausal women, underscoring the importance of holistic patient care in psychiatric settings.
An Evaluation of the High Dose Antipsychotic Therapy Patients on the General Adult Inpatient Wards and the Psychiatric Intensive Care Unit in Mersey Care NHS Foundation Trust – Is Clozapine Being Considered in Each Case?
Authors: Hyland Declan , Singh Roopa , Dainton Kerry 
Published: August 2024

AimsHigh Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.This audit aimed to determine whether the option of clozapine is being considered in those patients on the 16 general adult inpatient wards and Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust who are prescribed HDAT.MethodsA list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether there was documentation in the patient's electronic record that the option of treatment with clozapine was considered. The authors also wished to determine whether, in those HDAT patients in whom clozapine was considered, the rationale for it not being pursued as a treatment option was documented.Results29 inpatients on the 16 general adult wards and on the PICU were prescribed HDAT. In 9 (39%) of the HDAT patients, the option of treatment with clozapine was considered. It was documented for 6 of the HDAT patients that the option of clozapine was not applicable. Of the 9 HDAT patients that had a trial of clozapine considered, all of them had documented evidence of the decision in their electronic record. Four of the 9 patients accepted the trial of clozapine, 5 did not accept/it was deemed not appropriate. Of the 5 patients who did not accept the trial of clozapine or were deemed not appropriate, the rationale was documented for each patient.ConclusionGiven the lack of recommendation and evidence base to prescribe HDAT, the option of clozapine, if appropriate, should always be considered in any patients in whom HDAT is being considered or required. There may be barriers to clozapine being chosen – both patient-related and clinician-related. Any such barriers should be explored and addressed to ensure that treatment-resistant patients are commenced on clozapine without unnecessary delay.
Food for Thought: Evaluating Dietary Documentation in Psychiatric Settings
Authors: Kumar Praveen , Northrup Apryl , Carroll Lorna , Ireland Heather 
Published: August 2024

AimsThis study aims to evaluate dietary history documentation by junior doctors in a psychiatric hospital setting in Scotland. With emerging evidence in nutrition psychiatry highlighting diet's impact on mental health, especially ultra-processed foods, this aspect often receives insufficient attention in clinical assessments. The audit benchmarks current documentation against UK Public Health nutritional guidelines and UK Parenteral & Enteral Nutrition Guidelines on Malnutrition, assessing adequacy and consistency across psychiatric diagnoses.MethodsThis audit conducted a systematic review of medical records in psychiatric wards, focusing on patients newly admitted over six months. The data collection examined admission sheets by junior doctors, covering patient identifiers, admission time, diagnosis, doctor's grade, and comprehensive details on dietary habits, eating behaviours, BMI, and substance use. The review incorporated a dietitian's input to align dietary assessments with UK Public Health Nutritional expectations and the prevention of Malnutrition Guidelines. The goal was to assess the regularity, quantity, variety, and documented changes in patients' dietary behaviours, screening for potential nutrient deficits, impacts of psychotropic medications, and eating disorder psychopathology.ResultsThe results showed significant deficiency in the detail and consistency of dietary history documentation across all wards, regardless of the doctors' grade or the patients' psychiatric diagnoses. Most entries were inadequately documented or entirely missing. A particular discrepancy was noted in documenting dietary habits in patients with low BMI or those on metabolic altering antipsychotics, which should necessitate health behavior change dietary interventions. Furthermore, even in severe psychiatric conditions, there was a gap in dietary documentation indicating a widespread oversight in recognising the potential relevance of nutrition in the overall health and treatment planning of psychiatric patients, regardless of the severity or type of their condition.ConclusionThe audit reveals a gap in psychiatric patient care concerning detailed dietary relevance history documentation. While Scotland's wards routinely use the Malnutrition Universal Screening Tool (MUST) for identifying malnutrition, this tool often overlooks key dietary elements like variety, quantity, and regularity, which are vital for linking diet content to mental health. This oversight is significant given the burgeoning field of nutritional psychiatry. Our findings suggest the necessity for systemic changes to improve dietary history documentation in psychiatric settings. This includes a more structured and systematic approach, integrating insights into the harmful effects of ultra-processed foods on mental health, to provide holistic care.