bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality Improvement Project to Improve Management of Disclosed Sexual Assault in the General Adult Inpatient Population
Authors: Halton Katie , Maguire Cormac , Bruce Ailsa 
Published: July 2023

AimsThis quality improvement project aimed to improve mental health professionals' understanding and confidence in management and support of patients in the general adult inpatient setting who have disclosed sexual assault. It also aimed to improve patients' experience of support following their disclosure of sexual assault.MethodsBaseline knowledge and understanding was evaluated using an anonymous questionnaire sent to staff.Stakeholders were identified from medical, nursing, police, FME and third sector agencies and patient advocacy – their expertise was utilised to develop standardised guidance.The intervention included an education session delivered at site-wide teaching, and the creation of a procedure with associated resources for staff reference.Teaching sessions and guidance were based on this expertise to fill knowledge gaps identified in the baseline knowledge questionnaire.The questionnaire was subsequently redistributed and collected to analyse for an improvement in knowledge and confidence.ResultsInitial questionnaires presented qualitative and quantitative data suggesting lack of confidence and understanding of the processes involved in reporting and management of disclosed sexual assault.Post-intervention dataset analysis shows an improvement in staff understanding, confidence and access to appropriate resources in management of sexual assault in the general adult inpatient population.ConclusionPrior to the project there was no protocol for the management of disclosed sexual assault in the local general adult inpatient population.This left uncertainty amongst staff regarding the appropriate steps to take. This resulted in an increased risk of crucial time windows not being considered associated with a potential loss of evidence.The Quality Improvement project improved staff confidence regarding management of disclosed sexual assaults thus optimising patient outcomes and experience when reporting assault.
Meeting the Needs of Asylum Seekers & Refugees: The Norfolk Experience
Authors: Hameed Yasir , Fox Hannah , Clegg Izobel , Roupa Eirini Charami , Haq Maham , Rayala Meghana , Ahmed Ahmed 
Published: July 2023

AimsAs the number of forced migrants continues to raise every year due to conflicts, wars, climate change, and other factors, mental health services need to find innovative and new solutions to meet the needs of these vulnerable groups. We present here our experience of establishing the first mental health clinic for asylum seekers and refugees in Norwich, Norfolk (United Kingdom).MethodsThe clinic was established as part of the Advancing Mental Health Equalities QI Collaborative, which the Royal College of Psychiatrists launched to reduce barriers to accessing mental health services for disadvantaged populations. QI methodology was used to promote equality, increase access and improve outcomes over the next three years.The monthly clinic has no funding and is run by a consultant psychiatrist (Yasir Hameed) and GP (Hannah Fox). Two research assistant psychologists offered the administration support. Another assistant psychologist and two core trainees joined the small team to offer reviews and follow-ups for the patients.The monthly clinics are based away from the mental health settings (as some patients might be reluctant to attend these clinics) and are held in a friendly well-being hub run by the MIND organisation close to the city centre, which is easily accessible.The clinic receives referrals from primary care, social services, charity organisations (such as the British Red Cross), Well-being service (Psychological Therapies), and inpatient and Community Mental Health Teams.The clinic aimed to offer a person-centred, trauma-informed approach and improve the communication between services (through regular meetings with various services on a monthly basis), and enable access to appropriate treatment.In addition, the team of the clinic run drop-in session in local hotels where asylum seekers are housed to talk about mental health and access mental health services.Finally, the clinic offered training opportunities in transcultural psychiatry and working with interpreters.ResultsBetween March 2022 to January 2023, 40 referrals were received, mainly from primary care.Nearly 20% had a diagnosis of PTSD.We followed nearly half of these patients in the clinic in subsequent visits and worked closely with the psychological therapy to refer patients for appropriate therapies.ConclusionThe clinic improved the access of forced migrants to comprehensive, trauma-focused mental health assessments and improved communication and collaboration amongst services. It provided training opportunities. The drop-in sessions were a great opportunity to meet asylum seekers in their accommodation. Lessons learned and full data analysis will be shared in the poster.
A Quality Improvement Project Reviewing the Quality of Information Included in Discharge Summaries Sent to General Practitioners (GPs) From a Home Treatment Team (HTT) in an Inner London Borough
Authors: Harding Fiona , Garvey Rebecca , Constable Giles 
Published: July 2023

AimsTo improve the quality of the information included in discharge summaries to GPs from HTT. To gather the views of local GPs as to what constitutes a good discharge summary. To streamline the process for creating the discharge summaries by developing a proforma, incorporating the views of local GPs.Methods1.A cross sectional analysis of discharge summaries sent by HTT was performed.2.Each summary was assessed if they included certain information and the reader also made comments.3.A questionnaire was sent to local GPs asking for feedback on discharge summaries they had received.4.The information from the cross sectional analysis and questionnaire were used to create a discharge summary proforma.5.The findings and proforma were presented to the HTT. The team brainstormed further ideas which were incorporated in to the proforma.6.The proforma was sent to the team to begin using.7.The cross sectional analysis was repeated 6 weeks later.ResultsInitial cross sectional analysis:46 patients (2 excluded).25% of patients were discharged to the GP.Over 80% contained all the information required.Common issues included copy and pasting large amounts of irrelevant information, missing information, use of a lot of abbreviations with no explanation, unclear discharge medication, unclear discharge plans and not specifying who would prescribe.GP questionnaire:8 respondents. All GPs felt that they would want a brief summary of treatment, discharge medication (with any changes highlighted) and a plan with actions for the GP. They also felt that details of follow up with contact details for the community team would be useful. Brevity was mentioned as being of key importance, as was explaining abbreviations.Second cross sectional analysis:31 patients (6 excluded).8% of patients were discharged to the GP.12% of summaries had fully utilised the proforma and a further 16% had partially utilised it. With regards to the summaries not using the proforma the results were variable. The summaries which either fully or partially used the proforma covered all information screened for and were noted to be informative and easy to read.ConclusionA discharge summary proforma created using direct GP feedback is a useful tool to cover all the relevant information however the uptake of use of the proforma was poor. The reasons for the poor uptake would benefit from further assessment with a view to improving it further.
The Creation of a MEED Score Calculator to Aid MEED Score Completion in Patients With Eating Disorders
Authors: Hayward Simon 
Published: July 2023

AimsThe Medical Emergencies in Eating Disorders (MEED) guidelines include a scoring system, the MEED Score, which is an all-age risk assessment of the physical safety and risk to life of patients with eating disorders. Accurate MEED Scores are therefore fundamental for patient safety. However, MEED Scores can be timely and confusing for unfamiliar professionals. The MEED Score Calculator is a spreadsheet consisting of a colour-coded table with each MEED Score category. Red, Amber and Green are selected based on the described parameter and totals are automatically calculated. Additional “Background and Instructions” and “Medical Management” pages explain how to use the calculator and how to manage medical issues arising from MEED Scores. The aims of the MEED Score Calculator project are to: 1) Increase confidence amongst healthcare professionals completing MEED Scores 2) Increase efficiency of completing MEED ScoresMethods•A preliminary survey questioning MEED Score confidence and efficiency was sent to healthcare professionals who complete MEED scores•The MEED Score Calculator was created using Microsoft Excel•Upon completion of the survey, the MEED Score Calculator was distributed via email•Three months later, the secondary survey was sent to users, focusing on calculator use and the impact on MEED Scoring efficiency and confidenceResults•20 participants completed the preliminary survey•10 participants completed the secondary survey•60% of respondents now use the MEED Score Calculator when completing MEED Scores•0% prefer not using the calculator (40% haven't completed a MEED Score since having Calculator access)•60% of respondents report increased confidence completing MEED Scores•89% of respondents report reduced time spent completing MEED Scores•*Result collection ongoingConclusionThe MEED Score Calculator increases confidence and efficiency of MEED scoring amongst healthcare professionals, achieving both aims.Furthermore, due to positive feedback from eating disorder professionals, the MEED Score Calculator was included in the Kernow Local Medical Committee newsletter to raise awareness amongst Cornwall GPs. It is also due to be added to local clinical referral guidelines for GP referrals to eating disorder services. Additionally, we aim to make further improvements to the Calculator based on user feedback.We hope for knowledge of this simple tool to spread throughout relevant primary and secondary care settings, making MEED Scoring more accessible and quicker for healthcare professionals. We anticipate that with this, we will see improvement in the robustness of physical monitoring and the quality of referrals. Thus, reducing risk of adverse physical health outcomes in this vulnerable cohort.
Understanding Trainees’ Current Likelihood of Raising Concerns
Authors: Ibbett Vicki , Padda Manjinder , Thomas Katie , Harsh Rajendra , Davies Sian , Mirza Tabassum , Hubbard Katherine , Gul Ainy , Kulman Khadija , Fatima Marium , Shaw Amy , Kulman Ella , Saeed Razan , Pantall Shay-Anne , Scally Ruth 
Published: July 2023

AimsRaising concerns is a duty for all doctors. However, a scoping exercise within a large mental health Trust demonstrated that trainees experience difficulties in raising both patient safety and training concerns. As part of a trainee-led quality improvement (QI) project within this Trust, our aim was to develop a pulse survey to capture the current likelihood of trainees raising concerns and factors influencing this.MethodsAn online survey was developed using ‘plan do study act’ (PDSA) methodology. The initial draft was informed by data from the Autumn 2021 scoping exercise. The survey was refined using a collaborative trainee-led approach. It was tested by trainees involved in the QI project followed by two other trainees and was revised accordingly.Trainees across all training grades were invited to complete the survey through various communication channels. The pulse survey will be repeated monthly with a two-week response window.ResultsTen trainees out of 103 responded to the first pulse survey open from 18th to 31st January 2023 (response rate 9.7%). Seven respondents were core trainees and three were higher trainees.Respondents were more likely to raise patient safety concerns than training concerns (average score of 3.8 out of 5, where 5 equals ‘very likely’, versus 3.4 out of 5 respectively). Of the three respondents who had experienced a patient safety concern in the past 2 weeks, only two had used any existing process to raise it. These data were replicated for training concerns.No respondents were confident that effective action would be taken if they raised a training concern, while less than half of respondents were confident that effective action would be taken if it were a patient safety concern.The reasons for the low response rate are likely varied. However, there may be some similar underlying reasons for low engagement in surveys and low engagement in raising concerns. Given this, a more negative picture of trainees’ likelihood of raising concerns may have been portrayed if more trainees engaged in the survey.ConclusionEngaging trainees to provide insight into their likelihood of raising concerns is challenging. Despite the low response rate, this initial pulse survey demonstrated that trainees continue to experience barriers to raising concerns. PDSA methodology will continue to be used to optimise the monthly pulse survey response rate. The key QI outcome measures will also be integrated into pre and post intervention surveys as a pragmatic approach to evaluate specific change ideas.
Reviewing the Effectiveness of Clozapine Monitoring in Community Patients: Including the Monitoring of Physical Health Through Blood Monitoring & Reporting of Side Effects
Authors: Kahtoon Amina , Pathania Sangram 
Published: July 2023

AimsClozapine is an atypical antipsychotic used mainly in treatment resistant schizophrenia. Clozapine is known to have various side effects including neutropenia, agranulocytosis, constipation, hypersalivation, myoclonus, tachycardia, dry mouth, gastrointestinal reflux, and hypotension. Therefore, it is important that patients have regular monitoring of their physical health through blood tests and side effect monitoring. The Glasgow anti-psychotic side effect questionnaire allows patients to report side effects whilst on clozapine. This can then be used to review patients’ symptoms and treat them as required. The aim of our project was to review compliance of current blood monitoring of patients on clozapine with NICE guidelines and elucidate the effectiveness of the Glasgow anti-psychotic questionnaire in reporting of side-effects. Thirdly, we aimed to introduce a robust new monitoring system to ensure that clozapine monitoring was optimum.MethodsCompliance of the current blood monitoring was checked by reviewing the blood results for all 68 patients on clozapine. The latest blood results were compared to observe if they were within the required timeframe as per NICE. Secondly, the Glasgow antipsychotic questionnaire was distributed to patients on clozapine and then data collated. Following, this a new computer spreadsheet monitoring system was introduced to improve compliance. This allowed patients with overdue monitoring to be flagged up.ResultsThe overall compliance for the various blood parameters varied from 3% to 100% (glucose- 3%, prolactin- 19%, lipid profile- 68%, HbA1c- 69%, liver function- 72%, renal function- 74%, and full blood count- 100%). Following the introduction of a new monitoring system the overall compliance improved as follows (glucose- 8%, prolactin- 32%, lipid profile- 81%, HbA1c- 61%, liver function- 90%, renal function- 88% and full blood count- 100%). We observed a 41% uptake of the Glasgow antipsychotic questionnaire. The most common reported side effects included hypersalivation (86%), GI side effects (nausea and gastric reflux- 64%), postural hypotension (56%) and anticholinergic side effects (blurry vision and dry mouth- 46%).ConclusionThe findings show that the previous system was not effective. The introduction of a computer-based spreadsheet to flag up patients for clozapine monitoring has substantiality improved compliance with guidelines. The Glasgow anti-psychotic self-reporting questionnaire is effective in allowing patients to report the symptoms that they are experiencing. These changes continue to be utilised in our team.
Improving Patient ECG Experience Within Perinatal Mental Health and Enabling Better Antipsychotic Physical Health Monitoring
Authors: Kendall Cameron , Livesey Emma , Arnold Sally 
Published: July 2023

AimsAn ECG should be undertaken as part of physical health monitoring for newly admitted patients and as part of antipsychotic initiation and monitoring. This project compared patient experience between a traditional 12 lead ECG and a 6 lead hand held ECG device (KardiaMobile 6L device). The intention was to make ECGs within perinatal mental health better tolerated, subsequently improving physical health monitoring. On our mother and baby unit, patients were reluctant to expose the chest area to have a 12 lead ECG performed due to factors including breastfeeding and feeling self-conscious about postnatal body changes. Inability to perform 12 lead ECGs, due to lack of patient consent, increased the chance of antipsychotic prescribing without baseline monitoring. We sought to find an alternative, more acceptable way to monitor physical health in this cohort, so we could improve the safety of prescribing medications and patient care as a whole.MethodsData were gathered prospectively over a three-month period, on our eight-bed perinatal inpatient unit. Each patient had a 12 lead ECG performed on admission and then a hand held 6 lead ECG performed for monitoring purposes. Patients with pre-existing cardiac comorbidities were excluded. All ECGs were interpreted by a trained clinician, and patients provided formal feedback on their experience of having a traditional 12 lead ECG and a handheld ECG undertaken.Results14 patients were included. All preferred the hand held ECG compared to the traditional 12 lead. Patients felt the 12 lead ECG was intrusive, describing feelings of anxiety and being uncomfortable, particularly with the amount of wires and stickers required. With the hand held device patients felt more relaxed, found the procedure easier to have done, and that it was quicker to be undertaken. All agreed they would be more likely to have regular ECGs performed if it was with the hand held device.ConclusionAlthough a 12 lead ECG is gold standard, in patients who decline a traditional ECG, this handheld ECG would be a safer alternative rather than no ECG being undertaken.Patient feedback is overwhelmingly positive towards the use of the handheld ECG device, particularly as less body exposure is needed. In addition the shorter time to undertake an ECG is advantageous within the perinatal setting, as mothers are also busy caring for their infants.The greater acceptability in this cohort should lead to better physical health monitoring, both improving patient experience and prescribing safety.
Clear Records: Exploring Patient and Staff Experience of Ward Rounds to Inform and Improve Ward Round Communication and Documentation
Authors: McKnight Rebecca , Singh Neeti , Ali Imran , Hooley Robyn 
Published: July 2023

Aims1.To improve ward round efficacy and efficiency.2.To make ward rounds more patient informed and create an updated ward round patient “preparation sheet”.3.To improve collaboration and communication between the multidisciplinary team (MDT).4.To review and modify ward round/Care Programme Approach (CPA) proformas.Methods1.Quality Improvement training was delivered to the MDT.2.An anonymous Likert scale survey was completed by the MDT (n=10), to gather views on ward round experience and documentation.3.Patients: 2 interactive, breakout sessions (n=4) were facilitated to:
•Explore their experience of ward rounds through discussion and Likert scale questionnaires (n=4).•Review the existing patient preparation sheet and coproduce a revised version.4.MDT: 4 interactive, breakout sessions were facilitated with staff (n=10) to create a:
•Process map of ward rounds.•Fish bone diagram of the challenges within ward rounds.•Reverse fish bone diagram, to consider solutions.•Revised ward round and nursing proformas.5.A driver diagram was developed to generate change ideas.6.A scoping exercise was completed, comparing ward round proformas within the rehab division, to consider areas of best practice.7.A Plan Do Study Act (PDSA) cycle was initiated.Results1.Patient discussion and questionnaire feedback re: ward round experience was positive. Patients felt “respected”, “supported,” “understood team roles” and “plans” within ward rounds.2.Patients mostly agreed with the current format of the patient preparation sheet, however wanted a visual prompt, for their recovery areas. A diagram, “My recovery wheel”, was designed, to include diet, hobbies, mood, exercise, substances etc.3.Staff felt “respected”, and “listened to” and “understood their roles” in the staff survey; MDT proformas and time keeping were highlighted as requiring improvement.4.The fishbone diagram identified challenges within: staffing, procedural factors, time, resources/equipment, training and education, communication, proformas and patient engagement.5.New, succinct, MDT ward round proformas were designed, with focus on rehab goals, in order to facilitate the patient journey and discharge pathway.6.A ward round prompt sheet for the chair was created.Conclusion1.Both MDT and patients feel largely positive re: ward round experience.2.The improved patient preparation sheet is more patient centred, after being co-produced with patients.3.The MDT highlighted multifactorial challenges pertaining to ward rounds running in an efficacious and efficient manner.4.The next cycle of the project will focus on testing the new forms and change ideas.