bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Service Evaluation of Workload Monitoring for the Psychiatric Resident On-Call Rota
Authors: O'Neill James , Taylor Anna , Nightingale Sharon 
Published: July 2023

AimsThe Psychiatric Resident On-Call (PROC) rota provides medical cover for all inpatients across Leeds and York Partnership NHS Foundation Trust outside normal working hours. With the introduction of a new regional inpatient CAMHS unit in August 2021, a service evaluation project was undertaken to establish if the current medical provision was sufficient to meet the increased demand of expanding services.MethodsWorkload monitoring was undertaken for 28 days during August and September 2022 for all evening, weekend, night and bank holiday shifts. Data collection documents in the form of Microsoft Excel spreadsheets were sent to one doctor to co-ordinate for all PROC doctors on each shift. For each 30-minute period, the number of doctors engaged in clinical activity was documented and the average number working at that time, as well as standard deviation, was calculated.Results51 out of 56 on-call shifts were accounted for during the workload monitoring period by returning of a completed data collection document. Workforce demand for the remaining five shifts was estimated from reviewing handover document with listed times of call-out and expected duration for each job.Data showed that workload was consistent throughout weekend shifts, but slowed around the time of handover. This is likely due to the end of shift being used to complete documentation, and the start of shift being used to assign roles and plan the shift ahead. In addition, lengthy non-urgent tasks may not have been appropriate to undertake if a PROC was due to shortly end their shift.Patterns of night-shift working suggested a steady demand during the early hours of the shift, but a reduction during early hours of the morning, with trough levels being observed between 04:00 and 05:00 in the morning. No significant differences were observed between evening and night shifts across weekdays or weekends.ConclusionAssessing the above data led the authors to conclude two changes to workforce provision which may increase efficiency of workload. The first was to implement a cross-over role which could bridge periods of handover and ensure that a medic is still available to respond to tasks despite the change in workforce around these times. The second was to rebalance allocated provisions so that less medics were on shift during early hours of the morning, when demand was lowest, and re-allocated to evenings or weekends where demand appeared to be greater.
Social Capital for Caregivers of Children With Neurodevelopmental Disorders in Kumasi, Ghana; a Multidisciplinary Approach to Patient and Caregiver Wellness
Authors: Sackey Ruth Charlotte , Adu-Nyako Pearl , Ratner Leah , Osei-Bonsu Angela 
Published: July 2023

AimsTo demonstrate the role of psychosocial support groups in providing social capital for caregivers of children with neurodevelopmental disorders as an integral part of service delivery.MethodsA descriptive prospective pilot study was conducted at the child neuropsychiatric joint clinic of the Komfo Anokye Teaching Hospital. A support group was initiated for caregivers of children attending the clinic, with the support of a multidisciplinary team of two psychiatrists, a paediatric neurologist, nurses, a clinical psychologist, an occupational, art, and speech therapists. Fifty (50) caregivers enrolled in the support group. A total of three face-to-face psychoeducational sessions, monthly Whatsapp discussions on topical issues of interest to caregivers and an outdoor social event were conducted over a period of one year. During sessions, healthcare providers provided psycho-education about illness management and coping skills for caregivers. Caregivers shared their experiences for the purposes of peer-peer learning and peer support. Information was gathered from caregivers on their psychosocial needs through open forum discussions and a questionnaire administered needs assessment. A retrospective evaluation of the support group intervention among caregivers was carried out using a mixed method, after a year's participation in the support group.ResultsFrom pilot observations of 30 of the caregivers who completed the evaluation, 85% rated the support group as highly beneficial, 10% rated as beneficial, and more than 95% of them will recommend the service to other caregivers. Caregivers perceive support groups as providing a forum to empower providers to educate caregivers about their well-being, de-stigmatize mental health, and strengthen the trust between caregivers and providers. They may also provide increased opportunities for respite and relaxation.ConclusionThere must be improved social capital for caregivers of patients with chronic illnesses, with emphasis on coping during periods of stress and change. Caregiver and peer support groups are critical to improved psycho-social well-being and smooth service delivery for children with neurodevelopmental disorders and their families.
Knowledge of Service Users’ Voting Rights Amongst Mental Health Professionals in Haringey
Authors: Wright Jessica , Oppenheimer Melina Bergson , Thomas Rhianne 
Published: July 2023

AimsVoting is an intrinsic part of being a member of society and promotes social inclusion. The vast majority of mental health service users have the same right to vote as the general population but are a disenfranchised group and inpatients are half as likely to vote. Service users experience many barriers to voting including knowledge of their eligibility and the accessibility of the registration and voting process. Mental health staff need to understand service users’ voting rights so they can offer appropriate support. This project aimed to explore staff knowledge of service users’ voting rights.Methods77 multidisciplinary team members from inpatient and community settings in Haringey were surveyed about voting rights.Questions focussed on staff knowledge of service users’ right to vote (whether or not subject to various civil or forensic sections), if capacity to vote was required and if those with certain diagnoses were legally disenfranchised.27 Care Coordinators were asked if they discussed voting with service users and whether support around voting and registration was in care plans.ResultsThe response rate was 96%. No respondents answered completely correctly. Staff knowledge was similar across all groups and settings.The majority of staff believed community service users (89%) and informal inpatients (93%) were able to vote.63% of respondents knew inpatients on civil sections could vote. 81% knew those on a Community Treatment Order could vote. 40% of responses regarding the forensic sections were correct.56% believed service users needed to have capacity in order to vote.Certain diagnoses were believed to legally prevent service users from voting, including dementia (19%) and schizophrenia (13%).44% of Care Coordinators discussed voting with service users and 26% included voting in care plans.ConclusionDespite a national campaign, the level of staff knowledge is disappointingly low throughout all groups and settings, risking service users being given wrong information. This further disenfranchises a group that already experiences significant barriers to vote.It is of particular concern that a significant minority of staff believed certain diagnoses legally prevent voting.It was poorly understood that capacity is not relevant to the right to vote.Voting rights and available support is not widely discussed by care coordinators with service users.Clearly, education and training on voting rights is necessary for mental health professionals. We are planning staff education sessions and service user workshops as a quality improvement project.
Physical Health Assessment and Monitoring for Adults Receiving Pharmacological Treatment for ADHD in an Adult CMHT:Clinical Audit
Authors: Shankar Nikhil Gauri , Turner Chloe , Klenka Lucie 
Published: July 2023

AimsADHD diagnoses have skyrocketed in the recent times resulting in a lot of the patients being on stimulant medications. NICE guidelines recommends a baseline review of physical health which should include height, weight ,baseline pulse and blood pressure and a cardiovascular assessment before starting these medications. It also recommends 6 monthly monitoring of weight, blood pressure and pulse. We aimed to assess the current practice of baseline and 6 monthly physical health monitoring against the standards set by NICE guidelines.Methods33 random case notes were identified from the adult CMHT who had a diagnosis of ADHD and were receiving stimulant medications. An audit pro-forma was designed to collect data on baseline blood pressure, pulse, weight ,cardiovascular assessment before commencing treatment and 6 monthly monitoring of Blood pressure, Pulse and weight. The data were collected over a period of 3 months between October 2022 and December 2022.The results were presented in the local CMHT meeting and a new proforma was designed for baseline and follow-up physical health assessment which will be incorporated in the case notes. A re-audit is planned in March 2023.ResultsThere were 16 females and 17 males in the identified cases.19 patients were on different Methylphenidate formulations,8 patients were on Lisdexamfetamine and 6 were on Atomoxetine.19 patients (57%) had documentation of baseline blood pressure, 13 patients (39%) had documentation of baseline pulse,17 patients (51%) had documentation baseline weight and 2 patients (6%) had documented baseline cardiovascular assessment in the case notes.10 out 33 patients had 6 month follow-up visits and monitoring data were collected from them. None of the patients (0%) had documentation of blood pressure, pulse or weight in the case notes.ConclusionThe adherence to NICE guidelines was low in physical health monitoring as hypothesized by the team. A new proforma for baseline and 6 monthly physical health monitoring is developed by the audit team which is aimed to increase awareness about the physical health monitoring amongst the clinicians. The need for improving this practice is crucial due to increasing number of patients on these medications and the risk of serious side effects.
Audit on Baseline Physical and Metabolic Investigations Before Prescribing Antipsychotics in Children and Adolescent With Psychosis and Schizophrenia
Authors: Javaid Sadia Tabassum , Latif Lubna 
Published: July 2023

AimsINTRODUCTION: The term ‘psychosis’ is used in NICE guidelines to refer to the group of psychotic disorders that includes schizophrenia, schizoaffective disorder, schizophreniform disorder, and delusional disorder as identified by the International Classification of Diseases – 10th revision (ICD 10; World Health Organization, 1992).BACKGROUND: Children and young people with psychosis and schizophrenia have poorer physical health than the general population as get older. Life expectancy is reduced by 16 to 25 years (Brown et al., 2010; Parks et al 2006).AIMS & OBJECTIVES: To compare the west-midlands child psychiatrist practice with the standard NICE clinical guidelines on baseline physical and metabolic investigations before prescribing antipsychotics in children and adolescents. To compare if fulfilling criteria. Early detection and intervention in order to delay or possibly prevent the onset of psychosis and schizophrenia. To improve the services.Methods•The sample was collected via ‘WEST MIDLANDS CAMHS CONSULTANT SURVEY’.•Information collection through the questionnaire.•Nine members of the west midlands CAMHS Consultant CLENT group participated in 2019.Results•Indications to use antipsychotics, Record keeping and Assessment of nutritional status & level of physical activity: 100%.•Pulse and B.P check: 88.9% yes, 11% not always.•Weight and Height plotted on growth chart: 77.8% yes, 22% not always.•Antipsychotics (must be initiated by suitably qualified health care professional with expertise in prescribing: 33% consultant, 55% doctor, 11.1% doctor or nurse.•Assessment of movement disorders was done by 44.4%always, 11.1% never and 44.4% sometimes.•Lipid Profile was checked by 44.4% always, 11.1% never and 44.4% sometimes.•Fasting blood Glucose and Hb1ac check: 33.3% yes, 66.7% never and 33.3% sometimes.ConclusionData collected suggest meeting the set standards for indications of antipsychotics, record keeping and physical activity checks but not in other domains.Recommendations:
•To create a checklist Performa for physical / metabolic Health Checks for children and adolescent initiated on antipsychotic medications under the care of CAMHS.•Clinicians to stay up to date with NICE guidelines.•To regularly monitor physical health and blood test before prescribing antipsychotics.•To re-audit after introducing Performa in our CAMHS centre, if effective to introduce it in other local CAMHS centres after negotiation with them.
Clozapine: How Well Are We Monitoring Patients?
Authors: Johnson Stephanie , Perera Samantha , Isaac Mokhtar , Heasman Sally-Anne , Payne Laura 
Published: July 2023

AimsAims and auditable outcomes: We aim to ensure 100% patients on clozapine have annual physical health checks. By ensuring all patients prescribed clozapine therapy receive an annual physical health check and medic review, we aim to improve patient safety and prevent serious harm from occurring in cases that could be avoided.MethodsAll patients aged over 18 years prescribed Clozapine, who were under the assessment and treatment service in Eastbourne, were identified using Carenotes, our electronic patient records system.Results78% of patients on clozapine had been reviewed by a doctor in the past 12 months. 32% of patients had attended a physical health review within the past 12 months. One patient had not had a medical review for several years.ConclusionOur audit has shown that there are no clear guidelines on the long term monitoring of clozapine in regards to physical health reviews and psychiatric assessment. Using best practice it appears annual review should be the minimal standard, however further evaluation of this is recommended at trust level.In response to these results and the current guidance, we would like to implement the following:
•Create a database for all patients on Clozapine under the care of Eastbourne ATS.•Create a spreadsheet looked after by one member of admin staff to be updated regularly•The physical health lead nurse to be informed of physical health checks due by admin
Prescription of High Dose of Antipsychotics in Two Rehabilitation Wards of Chronically Unwell Patients
Authors: Liolitsa Danae , Khan Azmathulla 
Published: July 2023

AimsThe Royal College of Psychiatry (RCPsych) Consensus and the NICE guidelines have set out quality standards for the prescription of antipsychotics. There are concerns, however, regarding the over prescription across different psychiatric units: doses above BNF limits, multiple antipsychotics prescribed, lack of adequate monitoring of physical health and lack of availability of a clear rationale when high dose antipsychotic therapy (HDAT) is used. In the current audit, we sought to review the frequency HDAT is used in a female rehabilitation ward of patients with psychosis and a male rehabilitation ward of patients with dual diagnosis psychosis and/or autism. We also examined whether appropriate considerations are taken prior to prescribing HDAT and if the mandatory monitoring is in place when someone is on HDAT.MethodsA set of standards was set out and an audit tool was formulated that took the format of a table for data collection. Data were collected and anonymised, by looking at the medication charts and patients’ records, to identify if essential steps prior to/during HDAT prescribing are followed. All service users, 10 in each ward, that were in admission during the period between 7th and 13th November 2022, where included in the study.Data were compared directly with standards set out based on NICE guidelines and the RCPsych consensus. The data were input into Excel spreadsheet, then analysed and presented in tabular and graphs’ format.ResultsA total of 20 medication charts were reviewed over the five-day period. Only one out of ten individuals with ASD in Springs Centre was treated on HDAT and a clear rationale was documented to justify its use. All patients in both wards had the HDAT form and side effects scale form completed and filed. All patients had documentation of HDAT use on T2/T3 forms.40% of patients at Kenton Lodge were on HDAT. These patients required use of at least one depot due to lack of compliance. There was four patients overall treated on combination of antipsychotics. One patient did not have physical health monitoring at baseline due to refusing consent.ConclusionIn a small proportion of cases, HDAT may be justified, as long as the safety implications are considered and monitoring requirements observed.We recommend that audits of high dose antipsychotic prescribing can be performed periodically as a matter of routine practice. Also, to introduce a formal psychosis assessment scale to identify whether improvement has been accomplished since HDAT initiation.
Audit on the Adherence to Guidelines for the Management of Alcohol Withdrawal Syndrome in a General Hospital
Authors: Simiyon Manjula , Connah Rob , Proffitt Rhian , Downes Sharon , Jarvis Jennifer , Baker Catherine 
Published: July 2023

AimsProblematic drinking of alcohol is a common problem in the United Kingdom. As alcohol is a central nervous system (CNS) suppressant, when a chronic user abruptly stops drinking alcohol, the alcohol-mediated CNS inhibition is withdrawn and the glutamate-mediated CNS excitation is left unchecked leading to a total excitation of the CNS. This results in alcohol withdrawal syndrome (AWS). The aim of this audit was to assess the compliance to the health board's policy for management of AWS available in the intranet as NU16 which was developed based on the NICE guidelines, across the wards in the General hospital. We aimed to assess compliance concerning four aspects:
1.Initial clinical and laboratory assessment2.Prescribing for alcohol detoxification (benzodiazepines and vitamins)3.Scoring of and adherence to CIWA-Ar4.Specialist advice during the admissionMethodsWe requested for the case records of patients admitted to the Wrexham Maelor Hospital during May 2022 with problematic alcohol consumption. We have received 56 case notes from the medical records department among which, 50 fulfilled the inclusion criteria. A case report form was prepared based on the NU16 and anonymized data were collected.ResultsAverage age of the participants was 56 years ranging from 21 to 95.There were 29 males and 21 females. Mean days in the hospital was 3.25(+0.88). Only 4% of the records had complete documentation of drinking history, 84% had documentation of physical examination, and 20% had the documentation of signs of Wernicke's encephalopathy. CIWA-Ar was applied in 44% with correct scoring only in 24%. Compliance to laboratory investigations varied from 16% for gamma glutamyl transferase (GGT) to 84% for full blood count. Benzodiazepines were prescribed for 38%, oral thiamine was prescribed for 58%, 42% had two pairs of intravenous pabrinex three times a day and 6% had received 1 pair once a day. Benzodiazepine regimen was completed in 75% and alcohol liaison opinion was obtained only in 16%ConclusionWe could find that there were omissions in multiple areas of adherence to the guidelines in all the four domains. Alcohol liaison team is conducting special training programs for the management of AWS for all the clinical staff in the general hospital with the aim that compliance should improve in the near future.
Improving Medical Handover in the Tyrone and Fermanagh Psychiatric Inpatient Unit
Authors: Rafferty Mark , Sheridan Aisling , McNamara Laura 
Published: July 2023

AimsThis project was undertaken in the Tyrone and Fermanagh Hospital, an inpatient Psychiatric Unit in Omagh, Northern Ireland. It was recognised that the previous method of medical handover via anonymised WhatsApp messages had several issues including patient data on personal phones, over-reliance on phone apps which have the potential to crash and short messages with limited details were included. The aim of our project was to improve patient safety by improving communication between medical staff members.MethodsThe previous method of medical handover was via text message on messaging platform WhatsApp. A message was sent the morning of handover, to the WhatsApp group.We continued to use a digital platform, but used Microsoft word, and Western Trust email addresses to record and send the handover. At the start of this project, we allowed free space recording, resulting in variation in the handovers.We agreed a minimum number of details to be included to ensure quality of handover, and audited the word documents, to assess the adherence to this.This change, still does not require face to face handover. There have been pros and cons to the change, which will be discussed in this presentation.We reviewed four months’ worth of handovers. They were reviewed for specific elements of essential handover criteria. The areas included Patient Name, H&C, detained or voluntary, admission or review, presenting complaint, patient's history, risks, physical issues, and handover to specific person.It should be noted that the doctors involved were aware of the changes made, and standards being introduced, and therefore were aware that they would be auditing their own handovers. This might have created bias in the subsequent handovers.We then analysed each month to see what percentage of handovers had been concordant with the standards. These data were then represented in graphs, as we will show.ResultsWe identified areas which were performed well when completing handover. The areas which were consistently 100% included the date of handover and patient name or initials. Outstanding jobs were performed in 97.5% of handovers.Areas for improvement identified when collecting results were the status of admission (i.e. voluntary or detained), the main patient risks and use of the document password.100% of the shifts used the new digitalised format for handover using Microsoft word and trust email system.ConclusionWe reviewed the results of the data, which highlighted areas for improvementWe hope to implement a standard performa for handovers, reducing the chance of key information being missed, thereby improving patient safety. We aim to collect data following this 2nd intervention in the next rotation and continue to examine handover processes using PDSA cycles.