bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective Analysis of a Single Centre Experience of the Pharmacological Management of Patients With Intellectual Disability & Challenging Behaviour Across Three Audit Cycles
Authors: Khodabux Nusra , Hamid Mohamed , Perry Rebecca , Cawley-Nash Bernadette , Savvopoulou Ioanna , Gumber Rohit , Barrett Mary 
Published: July 2023

AimsTo investigate adherence to NICE and STOMP guidelines for the pharmacological management of patients with intellectual disability (ID) and challenging behaviour (CB) in a large acute mental health trust over three audit cyclesMethodsThe electronic records of a purposive sample of patients with ID and CB under the care of the ID Team at a large acute mental health trust were retrospectively reviewed over three audit cycles (conducted in 2013, 2014 and 2021).ResultsThe sample sizes were 31 (2013), 17 (2014) and 35 (2021). Over the three cycles, most patients had moderate (35%, 47%, 49%) or severe ID (42%, 35%, 31%). Common co-diagnoses included autistic spectrum disorder (45%, 47%, 69%), mood disorders (23%,18%,17%) and epilepsy (16%, 24%,31%).Target behaviours for intervention were aggression (42%, 27%, 49%), agitation (10%, 40%, 40%) and self-injurious behaviour (28%, 20% and 20%).Medications used for CB were antipsychotics (61%, 24%, 62%), benzodiazepines (20%, 29%, 42%), antidepressants (13%, 35%, 42%) and mood stabilizers (6%, 12%, 9%)The number of patients on multiple medications to manage CB declined over the years, with an increasing number receiving singular drug therapy (19%, 35%, 34%).Over the three audited years, there were improvements in risk assessment (68%, 94%, 100%), descriptions of the nature of targeted behaviours (74%, 100%, 100%), metabolic monitoring (0%, 0%, 95%), documentation of successful and unsuccessful interventions (48%, 65%, 86%).Adherence to certain standards however declined over time or remained difficult to achieve: complete evaluation of mental (87%, 94%, 60%) and physical health (61%, 88%, 60%), documentation of consent (19%, 76%, 46%), documentation of discussions regarding potential side effects (32%, 47%, 50%) and 6 weeks’ review of medications’ efficacy (52%, 65%, 50%). A positive behaviour support care plan was available in 75% of cases in 2021 and had not been audited in previous cycles.ConclusionThis retrospective analysis highlights a reduction in the use of polypharmacy to manage CB in patients with ID over time. Adherence to standards remains patchy across the years with improvements in risk assessments and metabolic monitoring. Standards necessitating outpatient intervention such as review of medication efficacy, evaluation of mental and physical well-being were hard to achieve, in part explained by service changes and pressures related to the COVID-19 pandemic. Future improvements may require increased pharmacy-led reviews.
Going somewhere…?
Authors: Kumar Praveen , Ashmore Robert , Bantwal Ashwin 
Published: July 2023

AimsChallenging behaviours often results in exclusion from communities and is associated with worse outcomes for patients with Intellectual Disability (ID). Due to substantial cut backs in local community service provisions across Highland for people with ID, placements have dwindled and recent trends indicate a high demand for “crisis” inpatient admission for PWID with co-morbid mental health and/or pervasive developmental disorders. This project aims to thematically analyse the admission trends to the Intellectual Disability Assessment and Treatment Unit (IDATU) in NHS Highland over a 5 year period (2018-2022).MethodsAll patients admitted to and discharged from the IDATU over a 5 year (2018-2022) period were identified. Their case notes were reviewed and details on the primary reason for admission were manually gleaned from the admission clerking document. Data were also gathered for demographics, diagnosed mental disorder, legal status and length of admission.ResultsTotal 18 new admissions were identified. All had established ID and/or co-morbid mental illness, autism, & other organic conditions. The average age was 30.2 years. 81% of admissions were formal. Length of admission varied from 1 to 814 days.Allowing for some overlap, admission themes mainly fell into 3 categories: challenging behaviour related- Aggression, Abscond, Self-Neglect, Suicidal (50%), Decline in mental/Physical health- Psychosis, Confusion, Weight Loss (16.7%) and manageability- Vulnerability, Breakdown of social situations (33.3%).Several themes were identified amongst the stated reasons for admission in case notes. A pattern emerged whereby these fell into 3 different headings as shown by the table here.ConclusionThe above three themes identified are not surprising. A combination of behaviours grouped as “challenging” and also felt to be “unmanageable” were cited as primary reasons for admission.Notwithstanding the dwindling of community resources and workforce attrition within the ID Service in recent years, the actual numbers admitted to IDATU was roughly down by 50% comparing a 5 year analysis done from 2012-2017 (34 Vs 18).Robust scrutiny/tightening of IDATU admission criteria, along with other new service initiatives may have helped mitigate against any inappropriate use of IDATU beds.Given the established and well researched risk of institutionalisation, it is of interest to us that our findings suggest that the services employed by the State to reduce this risk were already involved in a large proportion of cases. It is our recommendation that future service development planning should focus, incentive, invest and expand robust community ID services and resources within Highland.
Audit and Re-Audit: Improving Standardised Admission Blood Tests Adherence for Psychiatric Intensive Care Unit (PICU) Patients
Authors: Lawson Joel , Zabrzycki Domenic , Satisha Shantala 
Published: July 2023

Aims1.To evaluate current adherence with the Royal College of Psychiatrists guidance “Standards for Inpatient Mental Health Services”: Were the blood tests carried out within 24-hours of admission?2.We standardised the blood test parameters that are required following admission to our PICU ward and measured if all relevant blood tests* were completed during admission.3.Re-audit after implementation of a standardised policy.*(Full blood count, urea and electrolytes, liver function tests and lipid profile, CRP, thyroid function tests, vitamin B12, folate, prolactin, vitamin D, calcium and HbA1c%).MethodsFirst cycle is an audit of electronic patient records for all admissions to the PICU ward in a two-month period by using an audit proforma to capture information to answer the questions above.After implementing a standardised guideline for PICU, second cycle was conducted over a two-month period for the re-audit.ResultsIn the first cycle, a total of 20 patient records were audited. 30% had bloods taken within 24 hours of admission to PICU. 10% of patients had bloods taken on their previous ward. 40% of patients declined/unsafe, and 20% were not done in the timeframe.69% of patients directly admitted to PICU had all the relevant admission blood tests completed and 23% had some of the blood tests done. These numbers were lower for the patients transferred to PICU from other wards.In the second cycle, a total of 16 patient records were audited. There was an improvement in number of patients having bloods done within 24 hours of admission with only 6% not done in the timeframe.Of the patients directly admitted to PICU, all the consenting patients (89%) had all the standardised blood tests. These figures remained lower for those patients transferred from other wards without an indication to retest the bloods.ConclusionThe standardised guideline for PICU that was implemented after the first cycle consisted of a pre-filled blood test request form which included all relevant parameters detailed above.This had a positive impact with a significant percentage increase in the total number of patients directly admitted to PICU having all relevant admission blood tests completed at re-audit (77% to 100%).There was also a significant percentage increase (80% to 94%) of bloods taken within 24 hours of admission to PICU.The next step will be to implement these pre-filled forms across all wards in the KMPT trust.
Assessing Recording of Allergy Status on Rio Amongst Patients in Sandwell CAMHS
Authors: Akhator-Eneka Nwaife , Maanuwa Olufikunayo 
Published: July 2023

AimsTo assess recording of allergy status for patients under the care of Sandwell CAMHSMethodsThis audit was performed at Sandwell CAMHS. The project was discussed and logged with the Trust's audit department.Medical records of all patients (516 patients) seen between January and March 2022 by the medics in Sandwell CAMHS were examined for documentation of allergy statusFor all patients the alert bar on Rio was examined to determine whether or not their allergy status was recorded.A data collection tool was devised to collect information in accordance with the standard i.e, the drug allergy recorded or not and when recorded;
•it is present•no known allergywhere present;
•substance name•reaction•severity•date recorded•Evidence and CertaintyResultsFor the Recording of Allergy Status on Rio, the audit revealed:
A.60 out of the 516 patients had their allergy status recorded.Out of these 60 patients;18 had possible allergy42 had no known allergies
B.456 had no recordings of allergy statusC.Those with possible Allergies;The substance name was documented for all in Rio for those who had allergies indicated12 of the 18 possible allergies had the allergic reaction documented13 of the 18 possible allergies had the severity documented3 of the 18 possible allergies had the date recorded1 of the 18 possible allergies had evidence and certainty recordedConclusionThe audit revealed a poor recording of the allergy statusThe following recommendations have been made:Present audit at the Specialist mental health quality improvement group.Clinicians should be made aware of the expected Nice Guidelines for documentation of allergy status.Clinicians to update allergy status of patients every 6-12 months.Develop an action plan and governance documentation with the specialist mental health quality improvement group.The results of this audit have been shared with the Rio lead for them to consider making relevant changes in Rio i.e. The systems should include prompts for annual updates of allergy status.A clear trust policy of documentation on how allergy status/adverse effects will be should be recorded Rio.If possible, it should be included in the junior doctors' handbook and the eLearning.To carry out a re- audit in 6 months to 1 year
Evaluating and Optimising the Self-Administration of Medication (SAM) in an Inpatient Psychiatric Rehabilitation Setting
Authors: Maguire Cormac 
Published: July 2023

AimsTo analyse the process of self-administration of medication (SAM) in an inpatient psychiatric rehabilitation setting in order to improve the MDT awareness and engagement with the process. The project also aims to improve the level of completion of the relevant SAM documentation in the department.MethodsThe medication prescriptions and self-administration charts (where present) for the patients on the ward were reviewed to identify errors or omissions in completion of the documentation.Thereafter a number of interventions were completed. This included informal education sessions and follow-up written correspondence to the relevant staff (via email and the ward handover book). The potential for SAM was additionally prompted at the weekly MDT meeting in order to identify additional suitable patients for the process.ResultsThree out of 18 inpatients were initially engaged to some degree with SAM at the start of the project. For the relevant patients involved, completion of attendance documentation and adherence to written instructions from 70% to 90%. Improvements in other aspects of the documentation were also observed. Following the prompted MDT discussions a further five patients were identified to commence SAM, who may otherwise have remained on traditional nurse-led medication administration.ConclusionEngagement with SAM was initially variable and therefore was improved by targeted discussions and more MDT involvement. Documentation was identified as a potential pitfall and completion improved due to the interventions above. During the project a number of medication errors were incidentally highlighted and were reported via the DATIX tool. This demonstrates the importance of risk awareness associated with the SAM process in order to improve patient safety. There should be an MDT approach when considering patients for SAM process as this can affect discharge decisions. SAM could also be considered outwith the inpatient rehabilitation setting (e.g in General Adult Psychiatry wards). SAM is important in order to promote patient autonomy and independence in a safe manner. In the future it would be useful to explore patient attitudes towards medication self-administration in order to identify barriers to concordance.
Secondary Service Communications to GPs-a Regional Audit
Authors: Mitu Tajnin , Zachariah Vinila , Ray Jason , Salmoiraghi Alberto , Singh Ramandeep , Williams Laura , Bhangu Vikram , Elsayed Asmaa , Ikuewumi Opeyemi , Gejdhar Wamiqur Rehman , Rezk Amin , Khan Mohammad , Rowley Christopher , Okhiai Lopez 
Published: July 2023

AimsThe purpose of the audit was to assess the standard of communication to GPs from secondary mental health services and to ascertain whether the information included in letters to GPs was in accordance with the recommendations of RCPsych and PRSB. The audit cycle was completed by re auditing to identify how the recommendations from the first audit has improved the quality of communication to GPs.MethodsThe audit was conducted on three psychiatric units, in three sites across Betsi Cadwaladr University Health Board and clinic letters were studied to identify whether the information was as per recommendations from: RCPsych and PRSB.The first audit used 121 letters in total from 3 sites, with the data being collected using audit proforma over a 2 week period from 04/04/22.The re audit looked at 69 letters with data collection using audit proforma over one week period from 19/12/22.ResultsMajority of letters sent to GP were lacking key information like details of Care coordinators ,medical comorbidities ,non psychiatric diagnosis, and actions for GP with this data missing in 91.7%, 61.22 %,79.59% and 71.43% respectively. Fill rates for other information like patients' details was 100% , psychiatric diagnosis was 83.47%, psychiatric medications , follow-up plan were 80.17%.The results of the re-audit most letters contained Psychiatric Diagnosis (97.1%, previous 83.5%), Psychiatric Medication (91.4%)previous 80.17%), and Follow Up Plan(98.6%, previous 80.2%). Many letters did not include information regarding Medical Comorbidity (28.6% vs 31.4% ), Non-Psychiatric Medication (65.7% vs 34.7%), Details of Care Co-ordinator (54.3% vs 8.3% ) and Action for GP (27.1%, vs 44.6%).ConclusionThe recommendations from first audit were to create local guidelines and templates with recommended headings for clinical letters, provide formal teaching for junior doctors and to re audit to see if the implemented changes has led to an improvement.The re-audit showed improvement since the introduction of the template in majority of headings in GP letters with decline in fill rate for 2 headings and these changes varied among three sites.Barriers identified affecting the overall outcome of the re audit were :template not being used, lack of training to juniors, and psychiatrist workload.In conclusion , we aim to re-distribute the template and increase awareness with informal teaching sessions, provide information on template during induction for doctors and organize training sessions on three sites.
Increased Violent Incidents During COVID-19 on Male Acute Psychiatric Ward
Authors: Esham Zaim Mohd , Harris Natasha , Lankappa Sudheer , Suarez Lori Edwards 
Published: July 2023

AimsThis is an audit evaluating the impact of inpatient COVID-19 restrictions on the frequency of recorded violent incidents on a male acute general psychiatric ward. The aim of this study is to compare the frequency of violent and disruptive behaviours between pre-COVID-19, COVID-19 and post-COVID-19 periods on the ward.MethodsInpatient adverse incidents on the ward are logged into an electronic system as ‘IR1’ (Incident Reporting) through Ulysses by healthcare professionals. Data on logged incidents between April 2019 and March 2022 were obtained by contacting the Ulysses technical team. The reported incidents were classed into ‘disruptive behaviour’, ‘violence to patient’ and ‘violence to staff’.We chose to focus on the IR1s submitted between three twelve monthly time periods: Pre-COVID-19 (April 2019–March 2020), COVID-19 (April 2020–March 2021) and Post-COVID-19 (April 2021–March 2022). We opted for these cut off periods to be in line with the local trust guidelines with respect to COVID-19 restrictions.ResultsOut of 155 incidents which occurred during pre-COVID-19 period, 38 incidents were disruptive behaviours, 24 were violence to patients and 93 were violence to staff. Of the 249 incidents during COVID-19 period, 66 incidents were disruptive behaviours, 46 were violence to patients and 137 were violence to staff. Of the 216 incidents during post COVID-19 period, 67 cases were disruptive behaviours, 53 were violence to patients and 96 were violence to staff.There was 74% increase in disruptive behaviour between pre-COVID-19 and COVID-19 phase but no increase between COVID-19 and post-COVID-19 phase.There was a 92% increase in violence to patients between pre-COVID-19 and COVID-19 phase and a 15% increase between COVID-19 and post-COVID-19 phase.There was a 47% increase in violence to staff between pre-COVID-19 and COVID-19 phase, but a 30% reduction between COVID-19 and post COVID-19 phase.Violence to staff makes up the highest proportion of violent incidents recorded, followed by disruptive behaviours and violence to patients. This trend was seen in all three time periods.ConclusionOur study showed that violent incidents in a male acute psychiatric ward increased during COVID-19 period when compared to pre-COVID-19 period. This could be explained by increased ward restrictions and difficulties in communication related to PPE use. Further studies would need to be conducted looking at trend in other services within the Trust. Our findings will be of importance in monitoring risks in similar circumstances in the future.
Documentation of Capacity Assessments for Psychiatric Inpatients
Authors: Ngwenya Keith 
Published: July 2023

AimsHow frequently and to what quality are mental capacity assessments being recorded on inpatient acute ward? Capacity is the ability to consent to a particular decision and is defined in law by the Mental Capacity Act (MCA). Capacity to make decisions is an area of particular importance in mental health care, as many mental illnesses can lead to people losing the capacity to make some decisions. Capacity assessment is a two-stage process. If a patient passes Stage 1, then they have capacity. If they fail Stage 1 then the assessment progresses to Stage 2. The person being assessed must then be competent at every step of Stage 2 to then be deemed to have capacity. Documentation of capacity assessments should demonstrate this two-stage assessment.MethodsThe sample included all people who were inpatients during the data collection window of 05 to 09 Sep 2022.For each person, their MHA status was recorded as this determined whether capacity to consent to admission was relevant. For each patient, their EPR was checked for any Mental Capacity Assessment proformas which were examined and recorded as being for admission, treatment, or something else. The cumulative case notes were then searched for any mention of ‘capacity’ and any additional capacity assessments were examined and added to the tool. All capacity assessments were reviewed against the defined standards.ResultsSample and demographics - 22 male inpatients. 21 patients subject to the MHA and 1 was an informal patient. The CTT rule applied to 7 patients.Treatment - 17 of 22 had capacity assessment for treatment at admission. All of these were recorded using the proforma and all were in line with best practice guidance. 7 had the CTT rule applied to at the time of the audit. None of the records for these people included documentation of a repeated mental capacity assessment.Something Else - 9 capacity assessments recorded for ‘something else’. Five were recorded on proforma and in line with best practice guidance. 4 capacity assessments were as case notes and didn't meet best practice criteria.ConclusionCapacity assessment for treatment is being conducted and recorded well at the time of admission, but not at the point that CTT rules apply from.Most capacity assessments were recorded on the EPR proforma and all of these met best practice guidance. 4 capacity assessments were recorded in case notes and none of these met best practice guidance.
Clinical Audit of the Quality of Care Delivered by Community Mental Health Services for Older People to People Living With Dementia and Their Carers
Authors: Ohioma Karyn Vovwero , Pearce Sarah 
Published: July 2023

AimsThis clinical audit aimed to assess how well the local Community Mental health services for Older people (MHSOP) was implementing the latest NICE and Tees, Esk and Wear Valleys (TEWV) guidelines in dementia service delivery, and to identify what impact (if any), the COVID-19 pandemic lockdown had on their service delivery. In the UK, there are over 800,000 people living with Dementia; providing sustainable individualised care for them has significant cost implications for health and social care services. In 2018, NICE published evidence-based guidelines on delivery of dementia care by professional services within a person-centred and supportive framework. These guidelines together with the TEWV guidelines on Person-centred Dementia care pathway published in 2019, set the standards for this audit.MethodsThe first cycle was performed between 7th Nov 2020 and 15th Jan 2021; we included patients who had received an initial and diagnostic assessment from the team by 12/2020.Second cycle was done from 7th Nov 2021 and 31st March 2022; inclusion criteria were patients who had initial and diagnostic assessments by Jan 2022.In each cycle, data from 20 patient records were collected using a tool designed from NICE guidelines and Trust policy on Dementia care standards.ResultsIn the first audit patients' consents for assessment and information sharing purposes was recorded in 80% of cases; this fell to 65% in the re-audit.In the first audit at diagnostic assessments, 47% of patients were given relevant information regarding their prognosis and 26% about dementia and driving; these appreciated to 80% and 53% respectively. 16% of patients were given information in readily accessible formats as leaflets, increasing to 50% in the re-audit.In both audits a carer's assessment was not offered up to the recommended standard, being (26% and 18% respectively).ConclusionThis study has demonstrated a measurable improvement in the conduct of diagnostic assessments when local and national standards guiding dementia assessments are followed, and when identified action plans on areas needing improvement are implemented. It however shows that for such improvements to be sustained, the Trust and national guidelines and all identified action plans need to be consistently applied in practice. The findings also suggest that the COVID-19 lockdown restricted opportunities for sharing readily accessible information leaflets to patients, as borne out by the relatively poorer compliance of 16% in the first audit.