bluuebunny/crossref_metadata_2025_split huggingface dataset:
Getting a Handle on Handover: Improving the E-Handover Process for Duty Doctors in Psychiatry
Authors: Ong Emily , Docherty Emma , Cuthbertson Gillian , Wong Eugene 
Published: July 2023

AimsEffective handover is a vital aspect of patient safety and continuity of care. On-call junior doctors (the Duty Doctor) in psychiatry inpatient wards in University Hospital Hairmyres (UHH) and University Hospital Wishaw (UHW) use an electronic handover tool (e-handover) to supplement handover. This lists outstanding jobs and information to be aware of. This project aimed to improve the handover process by making amendments to the e-handover.MethodsA Plan, Do, See, Act (PDSA) cycle structured the project. An electronic survey was sent to all 30 Duty Doctors. This contained a Likert scale, 1 being negative and 10 being positive, to rate the handover process, alongside space for free text comments to be given. Thematic analysis identified common themes within these comments.Changes were implemented in response to the survey findings. Space was added to the e-handover for each patient's care team (parent team), as well as their contact details. The Duty Doctors were informed of the changes and a post-intervention survey was sent six weeks later.ResultsThere was a total of 22 responses (73.3%) to the pre-intervention survey. Themes identified from the free text comments included: Organisation of tasks; Ease of use; Reliability; Inappropriate use; Technical issues; Handover update; Task information and Ward information. The most common theme was inappropriate use of e-handover. It was identified that tasks were being added to the e-handover that would be more appropriately actioned by the parent team.There was a total of 12 responses (40%) to the post-intervention survey. A demonstrable improvement in the rating of the handover process was found. Free text comments showed that the changes made were helpful. Common themes were identified from the comments. One theme was ‘Missing information’, which included a lack of clarity on the date a job was added to the e-handover. Future changes could include adding space to the e-handover for this information.ConclusionFollowing the adjustments made to the e-handover there was an improvement in the satisfaction amongst the Duty Doctors.One limitation identified was the lower response rate for the post intervention survey. We postulated that this was due to the survey being distributed when junior doctors changed clinical rotations and left the Duty Doctor role. This could be considered for future improvement cycles.Additionally, free text comments from the post intervention survey could be utilised to inform future improvements.
Assessment of Cardiovascular Disease Risk in Adults With Severe Mental Illness Admitted to Acute Psychiatric Unit Using QRISK-3 Assessment Tool: A Quality Improvement Project
Authors: Elbadrmany Ibrahim , Sakhuja Divya 
Published: July 2023

AimsThe purpose of this QI project was to assess risk of CVD (cardiovascular disease) in adults with SMI (severe mental illness) admitted to acute psychiatric ward as risk can be reduced by relevant changes in lifestyle, optimizing treatment of relevant comorbidities, and by drug treatment, if appropriate. Nice guidelines for CVD risk assessment and management were followed for those with CVD risk of 10% or more.MethodsThis QI project focused on patients with a diagnosis of severe mental illness admitted to ward Ty Cyfannol, YYF hospital, ABUHB in South Wales from 1st April 2021 to 30th November 2021. QRISK®3-2018 risk calculator used to estimate risk of cardiovascular disease. Patients younger than 25 years old at the time of QI project were excluded as QRISK tool is only valid for patients aged 25–84 years. Patients who already had a diagnosis of Ischaemic heart disease or stroke/transient ischaemic attack were also excluded as per criteria of QRISK3. Total number of patients included in this project was 43 patients. Data were collected from patients’ medical records including their weights, heights, routine physical examinations and laboratory investigations requested during their admission. In order to maintain anonymity, patients were assigned to their hospital number. This information was saved in a password protected Excel Spreadsheet.ResultsThe mean age of patients was 43.3 ± 11.06 years ranging from 25-69 years. Most patients were males (65.1 %). Schizophrenia was the most prevalent diagnosis (32.5%) followed by emotionally unstable personality disorder (18.6%). 72% out of total 43 patients were smokers. The mean BMI was 23.6 ranging from 17 to 31. 41.9% had their BMI ≥ 25, 8 patients out of those with BMI equal to or higher than 25 scored 10 or more on QRISK3. 13 (30.2%) patients were estimated to have high CVD risk using QRISK3 assessment tool, of whom 76.7% (n=10) aged 55 years or more. 69.2% (n=9) were current smokers, 23% (n=3) were diabetic and 15.2% (n=2) had hypertension.ConclusionThe findings of this project conform the consensus that people with SMI are at a higher risk of having CVD. Therefore, this should emphasize the importance to assess CVD risk in patients with SMI and to manage modifiable risk factors accordingly and to incorporate the assessment of cardiovascular risk in patients with severe mental illness in day-to-day practice in mental health inpatient units.
RCPsych Leadership and Management Fellowship Scheme (Lmfs): An Lypft Project on Equity, Transcultural Intelligence and Inclusion
Authors: Elisha-Aboh Christiana , Nightingale Sharon 
Published: July 2023

AimsThe Royal College of Psychiatrists (RCPsych) Leadership and Management Fellowship Scheme (LMFS) is aimed at accelerating a fellows’ leadership and management development using a combination of structured leadership development programmes and a local apprenticeship model. It is open to all higher trainees, utilising special interest time over 12 months.In most establishments, certain groups are more prone to prejudice; whether due to age, gender, ethnic origin, sexual orientation, religion, career progression or disability. Leeds and York Partnership Foundation Trust (LYPFT) values diversity and strives to foster growth within a multicultural workforce and patient group. Equity accepts the difference between persons and ensures everyone reaches full potential, using individualised support. The aim was to create a culturally aware, inclusive and dynamic workforce. This project set out to achieve its objectives through four pillars.MethodsPillar 1-Initiating the local Medical Workforce Race Equality Standards (MWRES) LYPFT action plan: Appointment of the MWRES lead through advertisement and interviews. Pillar 2-Raising awareness on patient, carer and community involvement through a transcultural workshop: A virtual workshop anchored by four professionals and three patients, with lived experience was held, after which survey results were analysed. Pillar 3-Supporting International Medical Graduates (IMGs): Supporting IMGs through raising awareness on challenges and completing the regional handbook. Pillar 4-Interdisciplinary Undergraduate Education: Raising awareness on diversity and inclusion through undergraduate interdisciplinary education.ResultsPillar 1: An MWRES lead was appointed after interviews and is now in office. Pillar 2: Results of survey questions from the workshop around awareness of barriers minority groups experience, available transcultural resources, transcultural issues, local protocols and resources, and likelihood to intervene against discrimination; showed an improvement of 41.2%; with average pre-workshop scores of 55% and average post-workshop scores of 96.2%. Pillar 3: The Health Education England, Yorkshire & Humber IMG handbook has been completed and results from the survey included. Pillar 4: Students reported an improvement in their learning following the session. The weighted improvement on equity and transcultural issues for the pre and post teaching intervention improved from 5.391 to 7.126.ConclusionOverall, the aims of the four pillars of the project were successful achieved, with positive feedback received. LMFS encourages trainees to develop their leadership and management skills through local mentoring structures and should be encouraged. This is a clarion call to all professionals to adopt a culturally informed approach in all aspects of their practice; related to the workforce and patient care.
NHS Ayrshire and Arran Sustainability and Well-being Committee - Assessing and Improving Trainee Well-being
Authors: Fraser Sam , Barrett Megan , Clark Sophie , Pulley Racheal 
Published: July 2023

AimsTo promote the Royal College's core principles of sustainable psychiatry, Junior Doctors at Ayrshire Central Hospital formed the Sustainability and Well-being Committee. The principle aim through 2022, following the COVID-19 pandemic, was to maximise junior well-being - knowing a sustainable workforce is one that feels supported and fulfilled by work and working conditions.MethodsThrough meetings with junior doctors, qualitative information on factors impacting well-being in the work place was gathered, and three targets for improvement were identified.The following domains and interventions were implemented:
1.Improve working environment: The doctor's office was sized for 2 staff maximum - despite staffing levels consistently in excess of 20 junior doctors. Additionally, there was no natural light. We obtained a new significantly larger office space, with natural light.2.Comfort break area – Doctors identified that having an area with comfort seating to take breaks and socialise away from patients and visitors would be beneficial. We obtained a seating area and a coffee machine, maintained by the junior doctors.3.Access technology – Absence of desktops and IT issues with older laptops was impairing productivity and morale. We obtained 4 new desktop computers, and personal laptops for core trainees.A digital questionnaire was used to collect quantitative data retrospectively, from doctors currently working in the department, or who had done so in the last 6 months.Likert scales were used to assess pre and post-intervention levels of well-being, and ranking intervention impact on this. Doctors also identified future areas of intervention going forward into 2023.ResultsA total of 16 responses were obtained, and 100% of these agreed that feeling supported and good working conditions was important to maintaining wellness and productivity. Pre-intervention average wellness was rated 5.2 (with 1 being extremely poor, and 10 being extremely good), this increased to 8.1 post-intervention. Improved working environment had the most significant impact on well-being.Respondents identified environmental sustainability as target for improvement in 2023, potentially through improved recycling, reducing meat consumption and car sharing. Further well-being interventions e.g., walks, promotion of Balint group and social events were also suggested.ConclusionInterventions from the trainee-led Sustainability and Well-being Committee through 2022 improved working environment and subjective well-being. This demonstrates that junior staff can successfully initiate and lead projects to promote and improve sustainability in psychiatry. Results indicate that junior staff are willing to actively participate in interventions to improve well-being, and environmental sustainability in 2023.
Implementing ‘Train 2 Retain’ Simulation Training Programme for the Mental Health Liaison Practitioners: A 6 Month Pilot Project
Authors: Javed Qaiser , Easwaran Sruthi , Shamim Aamer 
Published: July 2023

AimsThe authors designed a unique simulation training programme exclusively for the liaison practitioners based in Aintree University Hospital Mental Health Liaison Team (MHLT). The simulation training aimed to improve the knowledge, confidence and competence of liaison practitioners through exposing them to realistic mental health related scenarios in an Accident and Emergency department (AED) and teaching them clinical skills in a safe environment.MethodsThe programme had been delivered by a Liaison Psychiatrist, core and higher trainees in once-monthly session lasting 45 minutes. Six clinical scenarios were picked based on the most common AED presentations. Scripts for all six scenarios were prepared in advance and both content and quality were checked with a liaison consultant psychiatrist. The scenarios depicted the journey of a patient being referred by the AED doctor to MHLT. Various clinical skills were embedded in the training programme including history taking, risk assessment, eliciting psychopathology, brief physical examination, managing co-morbid physical and mental health conditions, use of Mental capacity and Mental Health Act, and collaborative working with AED colleagues. Each station lasted 10-15 minutes and was accompanied by pre-briefing and debriefing with a higher trainee and experienced liaison psychiatrist for a further 30 minutes.Liaison practitioners rated their confidence managing common but complex scenarios on Likert scales from 1 to 5 immediately before and after the session. Free-text questions explored practitioner's favourite aspects of the training, areas of further improvement and topics they would like the authors to include in the future training. Feedback had guided subsequent programme development and topic selection.ResultsThe strength of the target audience was between 6 and 15 nurses per session, with increasing attendance at each session. Dropouts were mainly related to their busy shifts in AED. On average, Likert scale scores were between 1-2 before and 5 after sessions (100% in all feedback forms), indicating a statistically significant improvement in overall confidence and competence. Participants highlighted the format, real-life performance, quality of clinical scenarios and power point slides including group discussions as the most useful aspects of the training. 100% of respondents felt that the content covered was useful and the session content was pitched at the appropriate level.ConclusionOverall, 'Train 2 Retain' Simulation training was well-received amongst liaison practitioners. Embedding simulation training can improve the confidence and skills of liaison practitioners working in a busy AED setting which will improve well-being and staff retention. The next phase in the development of the training will be to include competence-based assessment and involving practitioners from other liaison services within the trust.
Improving Physical Health Recording in Brent Early Intervention Service (EIS)
Authors: Kessab Selim , Bahia Sukh , Mohammed Merfet , Fleet Jake 
Published: July 2023

AimsBy July 2021, we will increase the percentage of full recording of physical health data for 90% of patientsMethods-Completion of recording (green results) was measured using Tableau Software for a 10 week period from Jan- March 2021 (baseline), then monthly during the study
•PDSA cycles were conducted between April and July 2021 with analysis and changes tested monthly as per PDSA methodology. This informed future interventions.•We involved staff in designing a flowchart/protocol of how to book patients into the well-being clinic and sought opinions on how recordings could be improved.Results•In March, prior to any changes being implemented, staff were reminded to complete recording of physical health data. This improved percentage of recordings up to 62% by 1 st April.•Following this, a training session about the well-being clinic was arranged for all EIS staff.•A further session was arranged for staff to devise a flowchart of how the process will operate and generate further ideas.•A reminder system was put in place with the team leader emailing care co-ordinators monthly.•By 1 st July, percentage of complete recordings were 73%.•We decided to continue with the project and to increase the frequency of reminders to fortnightly. This helped to improve the percentage of complete recordings to 90% by September 2021.Conclusion•We learnt that education and training amongst all staff was needed to improve the recording of physical health data.•Improved utilisation of the physical health well-being clinic helped to streamline physical health assessments and helped to reduce the workload of EIS staff (also promotes sustainability).•Involving staff in designing and implementing changes leads to better adherence in improving physical health recording.•More time was needed for the interventions to be implemented in our service (target reached later than original timeframe), but this should now be sustainable.•Reminder systems will need to continue to ensure that performance is maintained, with further training provided as required.
An Evaluation of Core Trainees’ Views on Clinical Rotations in the West Yorkshire Psychiatry Training Scheme
Authors: Laud Rose , Isaacs Terrence , Elisha-Aboh Christiana , Leung David 
Published: July 2023

AimsGathering honest feedback on experiences of clinical rotations is vital to allow improvement of training. However, our current local systems lack anonymity, which may lead to reduced confidence in providing honest views. Aim: To provide trainees with a method of giving honest and protected feedback to improve future training posts.MethodsA Survey Monkey feedback form which was sent to core trainees across West Yorkshire in July 2022. This allowed feedback for up to 6 rotations, meaning those finishing CT3 could retrospectively review all their placements. The data were analysed by the project leads, grouped into themes, and anonymised.ResultsWe received responses for a total of 57 posts from 23 core trainees (total trainees July 2022 = 71), some of whom responded for multiple posts. Types of posts reviewed included: General Adult (40.4%), Older Adult (24.6%), Child and Adolescent Mental Health (8.8%), Forensics (7%), Learning Disability (5.3%) and Psychotherapy/Liaison (3.5%). 10.5% of responses did not specify the speciality.Overall, respondents strongly recommended 51.8% (n=29) and recommended 12.5% (n=7) of posts to other trainees. Respondents strongly did not recommend 5.3% (n=3) and did not recommend 1.8% (n=1) of posts to other trainees. Positive themes included having a range of experiences and a supportive team. Trainees valued having a range of cases with appropriate autonomy. They liked having a job that was busy enough to gain the required experience but not too busy to impede training and learning opportunities. An accessible and supportive supervisor who provided regular supervision with completion of work based placed assessments was also important.Negative themes included lack of regular supervision and heavy workload, which impacted a trainee's ability to attend teaching and participate in other aspects of professional development. Feedback for inpatient posts suggested that physical health obligations sometimes limited training opportunities.ConclusionOur results have shown that training needs are varied between trainees. It is therefore important that trainees have honest discussions with their supervisors about their needs and areas for development. Overall, trainees would recommend the majority (64.3%) of posts reviewed, however areas for improvement were highlighted. These may include extra training opportunities and increased physical health support. The main limitation of our evaluation was the low survey uptake (32.4%) in comparison to total trainee numbers. We hope that sharing our findings with both trainers and trainees will improve future responses.
Improving Education Around High-Risk Psychotropic Medication in Supported Living Facilities
Authors: Madhusudanan Shweta , Fapohunda Mosun , Rickard Joy , Best Christine , Loothfaully Sanaa 
Published: July 2023

AimsOf the medication-related incidents that have been reported in supported living placements, many involved high-risk psychotropic medications such as Clozapine, Lithium and Sodium Valproate. An evaluation of these incidents found problems with administration and inadequate monitoring. Consequently, a virtual education programme was commissioned to educate support staff in living placements in South West Hertfordshire which showed strong positive evidence that the training session improved learning and management surrounding psychotropic medication. This education programme has now been expanded to supported living facilities in the North of the trust to further ameliorate safe medication management and care provision within these placements. The aim of this teaching programme is to provide an educational platform to improve the knowledge and risks associated with Clozapine, Lithium and Sodium Valproate in an effort to reduce medication-related incidents within the placements.MethodsVirtual training was developed and delivered for support staff across supported living facilities in the Northern directory of the trust. This teaching was collaboratively designed and delivered by a multidisciplinary team including pharmacists, doctors and nurses. The virtual nature of the session lent increased accessibility to staff members from various regions.Results28 staff members from 6 support living facilities covering a resident population of over 65,000 people attended the 3-hour virtual education programme. Quantitative studies run on the pilot lecture in the high-risk psychotropic learning programme found strong evidence that this training leads to increased understanding of the administration, management and risk profiling of the aforementioned high-risk medication.ConclusionEducation surrounding high-risk medication will reduce long-term incidences of medication-related adverse events. The expansion of this learning programme to the entirety of the Hertfordshire trust is a step further in improving patient care within local mental health services.