bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Audit of Documentation Relating to a Decision-Making Capacity to Consent to Admission to the Peter Bruff Mental Health Assessment Unit
Authors: Zinchenko Oksana , Sivakanthan Sujeeththa , Rai Yugesh , Shoka Ahmed 
Published: July 2023

AimsAssessment of the capacity to consent to admission is an important legal and ethical issue in daily medical practice. Mental Capacity Assessment (MCA) should be carried out thoroughly based on all the domains mentioned in the Mental Capacity Act (2005) and be recorded in the patient's notes or admission. This audit evaluated the documentation available on the electronic database (Paris) in order to ascertain what information was and wasn't documented. The standard used: “Decision–making and mental capacity”. NICE guideline NH108 (2018) recommendations 1.4 Assessment of mental capacity were used as a standard for this audit. 100% of all admitted patients should have MCA completed during the admission clerking.MethodsThe data were examined retrospectively from the MCA on admission, available on the electronic health record database (Paris). The audit tool focuses on quantitative data collection on Mental capacity documentation.A random sample was selected of 15 patients admitted in May, June, September, and October 2022 to the Peter Bruff MH Assessment Unit (male and female). Total 60 patients.All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.ResultsAll patients who were admitted to the assessment unit were subjected to capacity assessment, consenting to informal admission and acceptance of treatment.MCA was completed and patients had capacity both on clerking and during the ward review in 85% of cases, (n=61). MCA was completed and 3 % of all patients were found to lack capacity on clerking (n=2). MCA was completed, and patients had the capacity on admission, however, they had no capacity during the review in 5% of cases (n=3). MCA was not completed, or the information was unavailable, for 7% of the cohort (n=4).Capacity to consent is specific to a decision and can vary over time; a patient is therefore competent or not with respect to a specific decision and for a given moment in time.We found that after the clerking assessment, when patients were reviewed by the unit doctor and the consultant, whether on the day of admission or shortly after (in a matter of hours), on several occasions some patients were lacking the capacity to consent to the admission.ConclusionThe missing link to be identified between the MCA capacity assessment that was carried out by the clerking doctor, compared to the MCA that was conducted by the unit doctor and consultant. This could be a restrictive environment on the unit or less attention paid to the quality of capacity assessment and further training is needed for professionals.
A Review of Unmet Needs – Making a Case for a High Dependency Rehabilitation Service
Authors: Fuller Amanda , Abdelkader Moustafa , McGill Meenaxi , Robinson Denzil , Smith Joanne , Sigfid Alice , Eyeoyibo Mo 
Published: July 2023

AimsThe Kent and Medway Partnership Trust (KMPT) Rehabilitation service strategy 2020-2025 in line with NICE guidance for Complex Psychosis 2020, sets out to deliver a complete mental health rehabilitation pathway with local provision of high dependency rehabilitation units (HDRU), open rehabilitation units and community rehabilitation provision across the county. There is a lack of HDRU provision in Kent and Medway in its rehabilitation pathway. All HDRU provision is by external providers, often out of area, dislocating people from family support and local resources essential for their recovery and integration. Kent has a relatively high number of out of area (OAT) placements based on national benchmark data (GIRFT). The proposal to develop a HDRU locally led to a review of local population needs for HDRU. The review with the existing OAT data provided information on the number of HDRU beds required in Kent and Medway.MethodsWe identified 564 patients who had had 5 or more Mental Health Act assessments, in cluster 16 and 17, more than 3 admissions to psychiatric inpatient units and with CTO recalls. Two senior clinicians reviewed these patients against the HDRU eligibility criteria. Demographics, diagnosis and comorbidities were also recorded.Results119/564 patients met the threshold for HDRU assessment. Using our conversation rate from referral to admission in our open rehab, it means about 20% (24) of this cohort would require treatment in a HDRU. Demographics, diagnosis and comorbidities were reviewed which gave important information about service provision requirements. This was compared with NICE guidance recommendations of 1 high dependency unit per 600,000 - 1,000,000. Therefore, based on this, we would be expected to have between 23 and 38 patients requiring HDRU treatment.ConclusionA high level of unmet need for HDRU exists in Kent and there is a need for further recognition of the relevance within the rehabilitation pathway. Lack of local provision of HDRUs means the use of longer, expensive and variable quality out of area or private placements. These can be not only detrimental for patients due to a loss of connection to an area and social network but a drain on resources. These results support the case for x2 12 bedded HDRUs. The lack of provision of HDRU impacts on the wider system and patient's timely access to appropriate treatment pathways.
Metabolic Syndrome Monitoring in Patients on Depot Antipsychotics
Authors: Ateem Salah 
Published: July 2023

AimsWe conducted this audit in patients attending the Community Mental Health Team (CMHT) at St Davnet's hospital in Monaghan, County Monaghan, Ireland. The British Association for Psychopharmacology (BAP) guidelines were used for this audit to assess our service compliance with standard guidelines and to consider implementing measures to enhance the service's compliance with guidelines and maintain improvement. Metabolic syndrome (MetS) is common in patients who are prescribed depot antipsychotics. Worldwide the prevalence of MetS in Schizophrenia patients is between 30 and 40%, and MetS increases the risk of CVD and mortality. Research showed that patients with severe mental illness die 10–30 years earlier due to physical illness.MethodsThe audit cycle was from the 15th of February to the 15th of June 2022. Demographic and therapeutic variables were collected from participants within the CMHT. The action plan which included psychoeducation for nursing staff regarding guidelines for monitoring and documentation was implemented following completion of the initial audit, and then re-audited.ResultsDuring initial audit the sample size was 48 patients; 77% were females and 23% were males. The mean age was 54.3 years, ranging from 24 to 90 years. 39.6% of patients had MetS monitoring charts in their files, and 29.2% had completed documentation of their MetS charts. Blood pressure, lipids, and glucose were documented in 31.3%, while BMI/girth was documented in 29.2%. Paliperidone was the most common used antipsychotic (43.8%), followed by Flupentixol (31.3%), and Aripiprazole (14.6%). In re-audit the sample size was 46 patients; 76% were females and 24% were males. The mean age was 53.7 years, with the same age range as in the audit sample. MetS monitoring charts were 100% completed in all files. Glucose documentation was 95.7%, blood pressure was documented in 91.3%, BMI/girth, and lipids were documented in 87% of files. Paliperidone, Flupenthixol, and Aripiprazole were the commonly prescribed antipsychotics.ConclusionThe implementation of the action plan resulted in recognizable improvement in MetS monitoring and documentation. To maintain this level of improvement it is essential for the CMHT to continue educating the nursing staff and other team members about the importance of MetS monitoring and documentation. Defining documentation roles and responsibilities among team members will facilitate monitoring. Identification of files that require MetS monitoring can be improved by placing colour code stickers. A MetS Clinic can be considered as a long-term plan.
Consent on Information Sharing
Authors: Jeje Jide , Ogungbayi Modupe , Binmohdzaki Mohdhafizudin , Prabhu Aishwarya 
Published: July 2023

AimsThis clinical audit is aimed at assessing the knowledge, attitude and practices of team members towards compliance regarding information sharing and consenting service users and to create awareness about existing Trust policies and national guidelines, importance of gaining consent for Information Sharing. Consent to share information should be recorded on the appropriate clinical record keeping system and/or paper. Service users also have the right to request that information is not shared – and staff must record these decisions in the clinical record. Team members work with other agencies and at times need to share patient information. Hence, there should be discussion about who information is going to be shared with, and why. A recorded consent is useful in instances when patient data may need to be shared in court.MethodsThe 1st cycle of the audit was conducted from 15th of December 2022 to 4th of January 2023. Clients that met the inclusion criteria were checked to see if the form was filled in by the relevant practitioner/ ever filled in. This was done for both the Community Mental Health Team (CMHT) and Memory assessment Services (MAS). A survey with 7 questions was sent out to team members to assess their knowledge of the Trust policy as well as national guidelines on consent on information sharing.ResultsA total of 238 service user records were assessed. 119 each under CMHT and MAS. Combined results of 37% of the 238 services users had consent documented while 63% did not have consent documented. 27% of services users under MAS had consent obtained and documented. 56% of service users under CMHT had consent obtained. 100% of team members that responded to the survey knew to discuss personal and confidential information sharing with patients. 91% of staff knew that the discussion on consent and information sharing should be documented. 23.5% of staff were not aware of trainings on information sharing and 35.3% of staff were unaware of where to document the consent.ConclusionAlthough rare, unrecorded discussion/consent on Information sharing can cause serious implications. This audit highlights the need to create awareness about the importance of recording Information Sharing consent. Possible reasons for results include team members not being aware of where to document in client records, Trust has not properly educated staff on Information sharing and the way to record it in electronic health records and the Concept of implied consent.
Audit of Physical Health Monitoring in Long-Stay Psychiatric Inpatients on Clozapine in NHS Ayrshire & Arran
Authors: Carson Chris 
Published: July 2023

AimsThere is a body of evidence showing the health inequalities faced by people with schizophrenia, with some studies indicating that their life expectancy is approximately 20 years less than that of the general population. The vast majority of patients with schizophrenia require long-term treatment with antipsychotic medications, such as Clozapine. These can lessen disease burden significantly however can be accompanied by adverse effects, including metabolic syndrome. This audit aimed to determine whether the local physical health monitoring guidelines for those on Clozapine are being carried out for long-stay patients in inpatient forensic and rehabilitation psychiatry services in NHS Ayrshire & Arran.MethodsThe guideline “National Standard for Monitoring the Physical Health of People Being Treated with Clozapine” was issued by the Scottish Government in 2017. This guideline advises on physical health parameters which benefit from monitoring during Clozapine titration and on-going therapy. This audit reviewed whether the parameters with specified frequencies, such as annual LFT monitoring, were being monitored within the recommended timeframes.ResultsIn our group of 18 patients on long-term Clozapine therapy, 10 had undergone a serum fasting blood glucose and 12 had a lipid profile checked in the preceding 6 months. Meanwhile, all 18 had liver function tests done within the last year prior to data collection. All patients had a BMI, heart rate and blood pressure reading documented in the last year, while 12 out of 18 had an ECG carried out in the same time period.ConclusionThis audit has revealed a mixed picture in terms of the adherence to guidelines for physical health monitoring for our long-stay forensic and rehabilitation patients on Clozapine therapy. A need for more fastidious blood test monitoring within the forensic service has been identified, with a particular focus on the measuring of serum fasting blood glucose and lipid panels. It was noted that a physical health monitoring checklist incorporating the above guidelines had previously been introduced into the rehabilitation ward, and the benefit of this was demonstrated in the 100% adherence they achieved. We have therefore decided to introduce a similar checklist to the forensic wards as our intervention, with a plan to re-audit in 6 months' time.
An Audit on Physical Health Assessment and Medical Review for Service Users Under the South Cambridgeshire Crisis Resolution and Home Treatment Team
Authors: Chougule Amitkumar , Balasubramanian Saravanan 
Published: July 2023

AimsAccording to the Home Treatment Accreditation Scheme (HTAS) Standards for Home Treatment and Crisis Resolution Teams, the physical health assessment and medical review are type-1 criteria. These standards must be met for all service users since failure to meet them would constitute a significant threat to patient safety, rights, or dignity. This audit aimed to measure the compliance of the south Cambridgeshire crisis resolution and home treatment team (CRHTT) with the HTAS standards for physical health assessment and medical reviews.MethodsThis audit was registered with Audit & Service Evaluation Registration services at the Cambridgeshire and Peterborough NHS foundation trust (CPFT). The necessary permissions to access patient records on the trust's electronic patient record (EPR) system were obtained from appropriate authorities in the CPFT IT department. From August 2021 to July 2022, all referrals to South Cambridgeshire CRHTT were screened for inclusion and exclusion criteria, and clinical records of 77 service users who met these criteria were analysed. The required data were collected on an excel sheet and analysed using descriptive statistics to measure the percentage of service users who satisfied the audit criteria. The audit was conducted between May 2022 and July 2022.ResultsA total of 1232 referrals were screened, and 77 (6.25 %) service users (n=77) satisfied the inclusion criteria. The average age of service users was 37, with 54.55% of the subjects being females and 45.45% being males. 70.12% of the CRHTT reviews met the Physical health assessment criteria as set by HTAS while 94.80% of the CRHTT reviews met the medical review criteria set by HTAS. The expectations were 100% of the CRHTT reviews should meet the HTAS standards for physical health assessment and medical review. The HTAS standards were not met in 30 percent of service users for the physical health assessment criteria and in 5% of service users for the medical review criteria for the CRHTT assessments done by the south Cambridgeshire CRHTT team for the period between August 2021 and July 2022.ConclusionThis audit suggests that the south Cambridgeshire CRHTT is currently not meeting the standards laid down by HTAS and there is room for improvement in the physical health assessment and medical review process. The recommendations were made and additional audits may be necessary to ensure that all service users receive HTAS-compliant care.
An Audit of PPI Cover in Those Taking SSRIs Within an Older Adult Community Mental Health Team
Authors: Cooper Michael , Langan Clare , Haxton Christopher 
Published: July 2023

AimsSerotonin in platelets has a major role in promoting vasoconstriction and platelet aggregation. Selective serotonin reuptake inhibitors (SSRIs), which are widely used clinically, inhibit the serotonin transporter responsible for serotonin uptake into platelets. This serotonin depletion reduces clot formation, thus increasing bleeding risk. This risk is particularly elevated in older adults who are also more likely to have co-morbid physical health conditions. The Maudsley Guidelines recommend that if SSRIs cannot be avoided in those assessed as high bleeding risk, then gastro-protective proton pump inhibitors (PPIs) should be prescribed. The aim of this full cycle audit was to evaluate all patients in an older adult community health team (OACMHT) to assess how many were prescribed an SSRI and whether PPI cover had been considered in those deemed to be at higher risk of a GI bleed due to either age or concomitant medication use.MethodsAll patients open to the OACMHT prescribed an SSRI were identified. Their electronic notes were checked to see if they were either prescribed medications or had comorbidities which increased bleeding risk. Electronic notes were reviewed to assess if bleeding risk had been considered at the time of prescribing SSRI, in addition to whether a PPI had been prescribed.This was repeated 6 months later following the results being presented to prescribers within the OACMHT.ResultsPatient age ranged from 60 – 101 years. 23% of patients were prescribed SSRI medication. There was an improvement in the proportion of patients on SSRIs prescribed PPIs in the second cycle compared to the first cycle of this audit (64.7% vs 56.5%). We also found that the majority of patients prescribed an SSRI and medications known to increase bleeding risk were prescribed a PPI in both audit cycles. We found only 1 patient in our cohort had bleeding risk explicitly documented in electronic notes.ConclusionSSRI use is common within the OACMHT. The majority of patients were prescribed a PPI alongside their SSRI. This improved in the second cycle of this audit. A significant number of those prescribed a PPI had their PPI prescription commenced prior to an SSRI being prescribed which may have artificially inflated our results.However, a significant proportion of patients prescribed SSRIs were not prescribed PPI cover which is not in line with current Maudsley guidelines. Therefore there is still work to be done in minimising bleeding risk in patients taking an SSRI within the OACMHT.
Identifying and Advising on the Menopause in Secondary Mental Health
Authors: Dugard Rebecca 
Published: July 2023

AimsWomen aged 45 to 55 years can suffer psychological symptoms during the menopause including low mood, increased anxiety and poor memory. NICE guidelines recommend that hormonal replacement therapy (HRT) is considered to alleviate low mood symptoms that arises as a result of the menopause. It is not currently routine for perimenopausal symptoms to be explored during consultations and physical health checks with female patients in the community. Additionally, in secondary mental health settings the option of HRT is not routinely discussed. The aims of my completed initial audit are to improve the psychological symptoms in women experiencing the menopause or perimenopause. I aim to encourage doctors and nurses to routinely screen for perimenopausal symptoms of women aged 45 to 55 years. I aim to encourage doctors and nurses to routinely ask if women in this age category have used HRT or would consider discussing HRT options with their GP.MethodsI performed retrospective data collection of 30 women aged 45 to 55 years in an Outpatient Clinic setting. I referred to the clinic letters of these women over the past 12 months and recorded if there was any documentation of HRT or perimenopausal symptoms. I used the progress note search feature to screen for any further documentation of the discussion of HRT or perimenopausal symptoms. I referred to the most recent completed PHIT (physical health) questionnaire for these women. I recorded if the sexual health section of the PHIT questionnaire had been completed and if any discussion of HRT or perimenopausal symptoms had been documented.ResultsI found that 3 out of the 30 women had discussions regarding HRT and/or perimenopausal symptoms documented in their clinic letter or progress notes. I found that 17 out of the 30 women had the sexual health section of their PHIT questionnaire completed in full. I found that 0 out of the 30 women had documentation of the discussion of HRT or perimenopausal symptoms in their PHIT questionnaire.ConclusionMy results displayed that only a small percentage of women aged 45 to 55 years are having discussions in secondary mental health setting regarding HRT and perimenopausal symptoms. Therefore, there is a clear need for the further education and training on the menopause for doctors and nurses working in these settings. This will encourage the routine screening of perimenopausal symptoms in women of this age category so that HRT can be considered.
Compliance Audit on Diagnosis and Treatment of Folate and Cobalamin (Vitamin B12) Levels in CAMHS Transition Service at Oldham, a Full Cycle Audit
Authors: Elisseou Antigoni , Darwin Genevieve , Ramkisson Roshelle 
Published: July 2023

AimsTo investigate compliance with British Society of Haematology (BSH) guidelines and NICE clinical summarieson diagnosis and treatment of folate and cobalamin deficiencies in CAMHS Transition service, Oldham.MethodsThe standards used were based on BSH guidelines and Nice clinical summaries, with targets for all 100%:
1.Haemoglobin concentration and mean corpuscular volume (MCV) checked at the same time as assay for serum cobalamin and folate.2.Cobalamin and folate assays should be assessed concurrently due to the close relationship in metabolism.3.Treatment of established cobalamin deficiency should follow the schedules in the BNF.4.All patients with anaemia, neuropathy or glossitis, and suspected of having pernicious anaemia, should be tested for anti-IFAB regardless of cobalamin levels.5.Patients found to have a low serum cobalamin level in the absence of anaemia and who do not have food malabsorption or other causes of deficiency, should be tested for IFAB to clarify whether they have an early/latent presentation of pernicious anaemia.6.Treatment of folate disorders should follow the schedule in the BNF.7.We reviewed all open cases to Transition service in Oldham. Their NHS number was checked through the pathology laboratory portal. In addition, notes on Paris electronic system and digital letters were checked to see if results were acknowledged. The initial audit period run from February 2021 to April 2021.The results were shared with the Multidisciplinary Team and an algorithm was created and shared in an attempt to improve the practice. The re-audit run from May 2022 to July 2022. A total of 80 patients were included in the audit and 25 patients in the re-audit. We entered and analysed our data using Microsoft excel.ResultsCompliance levels for the standards for the audit were as following: standard number 1, 2 and 5 were 100%, number 3 and 6 were 0%, and number 4 was not applicable.Compliance levels for all the standards were 100% for the re-audit.ConclusionThe results of the initial audit indicate that not all standards were met. However, results of the re-audit indicate all standards were met. It appears implemented changes may have affected the outcome of results. However, as the sample of patient was small might need to repeat this audit cycle in the future to see if the results remain the same.The physical health protocols are relevant to psychiatric practice and the algorithm can be disseminated for further use.