bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Re-Audit of ECG Monitoring in Patients Admitted to the General Adult Inpatient Wards at Clock View Hospital, Liverpool, Mersey Care NHS Foundation Trust
Authors: Elagamy Yasmine , John Cherian , Dacosta Adetokunbo , Hyland Declan , Hassan Nesma , Nankoo Ryaz 
Published: July 2023

AimsThe aim of this re-audit was to analyse current practice following a previous audit of ECG monitoring in patients admitted to the general adult wards at Clock View Hospital in 2020 and determine whether recommendations made from the original audit have improved performance.The objectives of this re-audit were: screen for recording of the admission ECG; ensure clear documentation of the ECG report; identify any reason why the ECG was not performed within 24 hours of admission and identify whether inpatients with an abnormal ECG on admission had any further investigation(s) done.Methods92 inpatients discharged from the three general adult wards at Clock View Hospital between 1st of January 2022 and 31st of March 2022 was obtained. The same audit tool designed and used in the original audit in 2020 was used for this re-audit. Each inpatient's electronic record was reviewed to determine whether an ECG was performed within 24 hours of admission. In those patients who didn't have an ECG done, the reason why was recorded (if documented) and whether those patients who had an abnormal ECG were referred for further investigation. The quality of documentation of ECG reports was analysed.ResultsOf the 92 inpatients, 57 (62%) had an ECG within 24 hours of admission and 16 (17%) had one done more than 24 hours after admission. 19 (21%) inpatients never had an ECG done at any point during their admission. The reason for not performing an ECG was documented for 32 (91%) of affected inpatients. Of the 73 inpatients who had an ECG done, 16 (22%) had an abnormal ECG, but only nine had further investigation (56% vs 23% in the original audit).ConclusionThe findings from this re-audit showed that completion of an ECG within 24 hours of admission to the general adult inpatient wards at Clock View Hospital has improved from 52% to 62%. There has been improvement in quality of documentation of ECG reports. There was no documentation of the ECG report in 13% of cases compared to 35% in the original audit. In almost all affected cases, the reason for not performing an ECG was documented. The authors recommend creating an alert on the electronic record system if an ECG is not performed within 24 hours of admission and asking the ECG reporting service to copy the ECG report to the ward clerk and / or Consultant PA to ensure the report is reviewed promptly.
An Audit of Planned Follow-Up Following Discharge From Four Black Country CRHT's
Authors: Horton Gemma , Pegg Joanna , Undre Suhail , Bridgewater Peter , Odogwu Nwamaka 
Published: July 2023

AimsIt is well established in the evidence base that mortality and suicide risk increases following discharge from an inpatient admission, leading to the national implementation of ‘72 hour follow-up’. However, there is little data examining outcomes following discharge from an admission to a Crisis Resolution & Home Treatment Team. Following a number of noted Serious Untoward Incidents at a trust level, we sought to examine the standard of follow up post discharge from all four Black Country CRHT's (Dudley, Walsall, Sandwell and Wolverhampton) in order to improve policy and thus patient outcomes.MethodsThe caseloads for all four CRHT's for the period of 1st-31st December 2021 were obtained. The clinical notes system RIO was searched and scrutinised for each patient to determine when the patient's next planned follow-up following discharge from that particular spell in CRHT took place. This was compared to the audits standard: all patients discharged from CRHT should receive some form of planned follow-up in the 3 month period post discharge.ResultsAll of the patients discharged from Wolverhampton CRHT received 72 hour follow-up as conducted by members of their own team, however despite this 12% of the total caseload were either lost to long term follow-up or went into crisis before planned follow-up could take place. With regard to Dudley and Sandwell, only 51% and 47% of patients respectively were routinely followed-up within 3 months. A total of 30 patients across all 4 CRHT's went into crisis before planned follow-up took place. One patient ended their life 4 months following discharge from the CRHT; no planned follow-up took place. All of Walsall CRHT's patients were followed up on discharge unless they were discharged directly back to their GP.ConclusionTimely, regular and robust follow-up embedded in the community mental health team is paramount to the provision of safe psychiatric care. This audit has also uncovered the need for follow-up for patients discharged from CRHT to their GP, as this cohort of patients is sizeable. However we argue that a one off ’72 hour/7 day follow-up’ is insufficient when reducing morbidity and mortality, and robust long term care plans and regular follow-up should instead be a feature of longer term community mental health care.
How Satisfied Are Local General Practitioners, Who Are Part of the Brompton and South Kensington Primary Care Networks, With Communications About Patients Referred to the Mental Health Triage and Assessment Team?
Authors: Hussain Parisah , Marriott Sarah 
Published: July 2023

AimsThe Triage and Assessment Team (T&AT) at South Kensington and Chelsea Mental Health Centre have conducted a research project to assess our written communication with General Practitioners (GPs) in primary care. We are responsible for screening and assessing new patients referred by GPs to the South Kensington and Chelsea Mental Health Centre community mental health team (CMHT) department.The aim is to ensure all patients referred from primary care, receive care from the most appropriate health professional(s) in the timeliest way and that we communicate with their referrer in a timely and helpful manner. We aim to deliver a service that is safe, effective and helpful to patients, carers and their referrers. The purpose of this study is to understand the referrers’ experience of our communications with them when they refer to the T&AT.MethodsA pre-intervention survey was sent out in November 2022 to GPs who work and are part of the Brompton and South Kensington primary care networks (PCNs).We received an equal number of responses from Brompton and South Kensington GPs respectively. Quantitative and qualitative data were both collected. We had a cross section of respondents including trainees, salaried GPs and partners.ResultsFrom the quantitative data, the majority of respondents reported they were reasonably satisfied with our communication with respect to timeliness, clarity and clinical relevance of our communication.Respondents were less satisfied with the balance struck between clinical detail on the one hand and recommendations for the mental health shared care plan.A qualitative analysis of respondents all free text comments and identified three main themes: the local referral pathway, the use of SystmOne computer software programme, and recommendations for improving communications between GPs and the T&AT at CMHT.ConclusionWe have acknowledged concerns about the complex mental health referral pathway together with suggestions about improving the functionality of SystmOne across the GP and CMHT interface into the regular discussions we have with our respective PCNs.The Triage and Assessment Team are designing improvements to the consistency, timeliness and relevance of our GP communications.Once these improvements have been implemented, we will send out a post-intervention survey to GPs and reassess their satisfaction levels with our new mode of communication.
Pathways to Care at Early Intervention in Psychosis Liverpool: A Cross-Sectional Retrospective Audit Cycle
Authors: Koetsier Benjamin , Stevens John , Uffendell Chloe 
Published: July 2023

AimsEarly Intervention in Psychosis (EIP) services provide an evidence-based approach to the identification and treatment of patients experiencing a first episode of psychosis (FEP). The NICE access and waiting time standard is that 60% of people experiencing FEP are treated with an approved care package within two weeks of referral. This is defined by allocation of an EIP care coordinator, though the offer of antipsychotics is also important. The aims of this audit were to (1) Collect data on EIP referral to treatment pathways and explore delays (2) Explore the origin of EIP referrals (3) Explore timings of referrals to review with a prescriber (4) Compare two audit periods to assess recommendation efficacy and provide future recommendations to reduce delays.MethodsTwo retrospective audits were carried out on patients accepted onto the FEP pathway at EIP Liverpool in May & June 2020 (34 patients) and December 2021 (11 patients).Data were collected for each patient on time spent at stages of the referral pathway from initial referral to mental health services to first medical review with an EIP clinician. Further data included each patient's first point of contact with mental health services, the referral origin and first contact with a prescriber.Data were collected using electronic health records. Duplicate referrals and extended inpatient admissions were excluded from prescriber analysis. Initial audit results from 2020 were compared with the re-audit in 2021, assessing for changes in pathway provision and compliance with the NICE standard.ResultsThe results found that there was a 43.5% increase in wait time on the EIP referral pathway between the periods audited in 2020 and 2021, from an average of 9.8 to 22.5 days, related to the COVID-19 pandemic. The primary delays for both periods were referral assessment, care coordinator allocation and prescriber review.The type of prescriber reviewing remained consistent, with reviews being conducted by a consultant for >50% of patients in both periods.ConclusionBetween the two audited periods, the average pathway to care time increased to over the NICE standard despite implemented recommendations from the initial audit.Stages of the referral pathway facing significant delays came from within the service, due to an increase in referrals, an increase in patients experiencing FEP by 50% and a change in the origin of referrals. A framework for improvement is recommended to improve pathways to care and outcomes for patients experiencing FEP within the EIP service.
Intensive Home Treatment Team (IHTT) Antipsychotic Initiation Baseline Physical Health Investigations Audit
Authors: Okonji Deborah , Walishetty Phalaksh 
Published: July 2023

AimsThe aim of the audit is to measure performance against Bradford District Care Foundation Trusts (BDCFT's) ‘Antipsychotic Physical Health Monitoring Shared Care Guidelines’.MethodsIn September 2022, the audit project lead retrospectively reviewed the patient's electronic care record to establish their compliance to the standards.The sample was drawn from the caseload of patients managed by the Intensive Home Treatment Team (IHTT) Bradford in September 2022. All patients who were initiated on antipsychotics by the IHTT were included in the audit. Patients who were initiated on antipsychotics by other teams such as Community mental health team (CMHT), Inpatient teams, etc, were excluded. A total sample size of 25 was usedAll relevant areas of the record were checked, and data were collected on a data collection tool designed in Microsoft Excel and once collected these data were passed to the Clinical Audit team who completed the analysis using the same programme.ResultsDemographics: 15 patients (60%) were male and 10 (40%) were female. Their ages ranged from 18 years to 55 years with a mean age of 37 years.The results of the audit highlight that only 32% of patients had a full physical health check prior to the initiation of antipsychotics. A further 56% had an incomplete physical health check. None of the individual investigations were fully compliant, as identified in the table above. BMI/weight was the investigation completed the least even though all antipsychotics are known to carry a risk of weight gain. HbA1c was the least completed blood test. Only 40% of all patients had their physical health checks reviewed by a relevant professional after they had been completed.ConclusionIt is important that all patients prescribed antipsychotic medication have the necessary baseline investigations completed to ensure that the medication is safely prescribed, and the results of this audit was shared within the team for their consideration and review.In cases where antipsychotics was started without the baseline monitoring, It is assumed that this decision was taken on a balance of risks. General lifestyle factors such as diet and physical activity can have a significant impact on the patient's physical health, yet this investigation was completed less frequently than determining any illicit drug use and identifying the patient's smoking status.Following physical health checks, results of these need to be reviewed by relevant clinicians with documented evidence to this.
An Audit Looking at the Monitoring for Long-Term Antipsychotic Use on an Adult Inpatient Psychiatry Ward
Authors: Olagunju Oluwatomilola , McCarron Rionach 
Published: July 2023

AimsPatients with psychiatric disorders have been well documented to have an increased risk of cardiovascular disease and consequently a higher incidence of premature mortality. Literature has shown that many psychiatric disorders, particularly major depressive disorder, bipolar affective disorder, attention deficit hyperactivity disorder, post-traumatic stress disorder, anxiety disorders, and schizophrenia have an increased risk of metabolic syndrome. This increased prevalence of metabolic syndrome, and as a result cardiovascular disease, has been linked to factors that clinicians are involved in, such as the prescription of antipsychotic medication. it is therefore important for clinicians to be able to appropriately monitor patients on antipsychotic medications.Aim: To improve the physical health aspects of care for patients with psychiatric illnesses admitted as inpatients.Objectives:
1.To ensure appropriate monitoring of the metabolic parameters of patients on admission.2.To ensure appropriate ongoing monitoring of the metabolic parameters of patients during their hospital stay.MethodsData were collected independently by two people. The data were collected using PARIS, an online documentation program used by the Greater Manchester Mental Health (GMMH) trust, as well as the patients’ paper prescribing charts. A total of 20 patients were audited. Standards were set according to NICE guidelines on patients on long-term antipsychotics admitted to adult inpatient wards. A total of 14 standards were set. The areas audited were measurements of BMI, ECG, blood pressure, lipids, prolactin and urea and electrolytes at baseline, at prescribed time points, and at dose changes as required by guidance.ResultsOverall, five of the standards were attained, seven of the standards were not attained, one standard could only be partially analysed, and one standard (monitoring at 12 months) could not be analysed due inadequate patient length of stayConclusionPatients on long-term antipsychotics have an increased risk of cardiovascular disease and it is important that we are monitoring them frequently to avoid deterioration of their physical health and a further increase in their disease burden. This audit suggests three recommendations to ensure adequate monitoring.
1.Consideration of a comprehensive admission proforma to help standardise the admissions process.2.The development of a tool to remind clinicians to recheck metabolic parameters for ongoing monitoring at 3 months, 6 months, and 12 months.3.Regular maintenance of the ECG machines to ensure no omissions in monitoring.
Audit of Antimanic Agents Monitoring in a High Secure Hospital
Authors: Oluwaranti Oluwaseun , Wahid Nazurah , Whitehouse-Lowe Henry , Yanson Ian 
Published: July 2023

AimsAntimanic agents are effective in the management of mood disorders and other neuropsychiatric conditions such as epilepsy and aggression. These medications may cause serious side-effects and affect vital organs; hence, specific checks are recommended before initiation and for continuous use of these medications. The aim of the audit was to check compliance with monitoring of antimanic agents (lithium, valproate, and carbamazepine) and to compare with the 2018 audit.MethodsPreliminary data of all patients on the antimanic agents at Rampton Hospital from 01 December 2020 to 30 November 2021 were obtained from records.Retrospective data were collected using a modified version of the 2018 audit tool. This includes patient hospital number, ward, medication initiation date, pre-initiation and monitoring tests. The tests were, depending on the medication; full blood count (FBC), thyroid function test (TFT), liver function test (LFT), electrolytes and urea (E&U), and electrocardiograph (ECG).The audit criteria were based on the recommendation of the Maudsley Prescribing Guidelines (14th edition). A total of 16 standards were assessed overall.ResultsA total of 98 patients were prescribed antimanic medications through the review period with valproate-59, lithium -32 and carbamazepine -7. Three patients on valproate and 3 on lithium had incomplete data and were excluded. Therefore, a total of 92 patients were included in the final audit (valproate-56, lithium-29 and carbamazepine-7).Pre-initiation compliance for LFT and FBC for valproate were 35.8% and 41.5% respectively, while the monitoring compliance within 6 months were 85.7% and 87.5% respectively.For lithium, pre -initiation compliance for ECG was 73.1%; TFT and U&E had 88.5% and 96.2% pre-initiation compliance respectively. There was 100% compliance with monitoring of lithium level at 3 months, and both U&E and TFT within 6 months.For carbamazepine, the pre-initiation and monitoring compliance was 50% and 100% respectively for three tests (LFT, FBC and U&E).There was improvement in all the standards when compared with the 2018 audit compliance except FBC monitoring for valproate within 6 months which dropped from 92% to 87.5%.ConclusionOnly 6 standards had 100% compliance with the guidelines. Lithium monitoring was generally higher than for other mood stabilizers; pre-initiation monitoring was poor for both carbamazepine and valproate. There was general improvement in the standards compared with the 2018 audit.The guidelines for monitoring mood stabilizers apart from lithium needs to be made popular especially pre-initiation monitoring for valproate and carbamazepine.
Audit of DNA & Disengagement of Patients in West Essex Community MH Teams
Authors: Purakayastha Rosy 
Published: July 2023

AimsNon-attendances (DNAs) and cancellations are a very costly waste of resource within the NHS and so it is important to have a focused plan of action to proactively manage them. The Trust recognises that people may choose not to attend appointments, or discontinue contact with the services we provide for them. There will be occasions where a person's non-attendance is an indicator that :
•they may be at risk to themselves or others through deterioration in their mental health, or other issues preventing them from attending.•Therefore, any failure of planned contact should be regarded as a potentially serious matter and should lead to an assessment of potential risk. Hence we aimed this study to see if trust policy of DNA and disengagement is being followed.MethodsData were collected for 51 patients who missed their scheduled appointment between February and August 2021, using a predesigned questionnaire tool.ResultsOut of the 51 patients, 37 of them Did not attend the initial assessment whereas 14 of them did not attend follow-up appointments.18 patients had the diagnosis of depression, 9 of then had anxiety as the diagnosis and 8 had the diagnosis of personality disorder. Please see figure above for distribution of Mental Health diagnosis.98.1% patients were notified adequately and for all the patients, letter was sent to the patient and the GP.In 50.9% cases Risk Assessment was completed (although 37 patient did not attend, they were already known to our services). In 25% of cases, risk assessment was updated.Review of the Contingency plan was done in case of 26 patients.Out of the 51 patients, family was contacted for only 3 patients. Remaining 48 patients other known contacts were contacted in 4 cases.Out of the remaining 44 patients, 3 patients were referred for home visits or AHMP.Out of the remaining 41 patients, police/welfare check was done for 4 of them.The remaining 31 patients were discharged from the services after they did not respond to our multiple correspondences including phone calls and letters.ConclusionThough trust policy is being followed to a good extent in regards to adequately notifying and contacting service user, offer another appointment and informing GP, we are failing to adhere to trust policy in regards to updating risk assessments, review crisis plans or doing welfare checks.
Reflecting on Episodes of Rapid Tranquilisation in Forensic MDT Settings
Authors: Roberts Kris , Rahman Arif , Elliott Rachael 
Published: July 2023

AimsRampton Hospital is the High Secure Hospital of Nottinghamshire Healthcare NHS Foundation Trust's Forensic Service. It is one of three such hospitals in England, following Security Directions set out by the Department of Health. Patient management occurs through the implementation of strict policies and procedures. Policy requirements highlight the need for MDT post-incident discussion of restrictive interventions, and in particular, of Rapid Tranquilisation (RT). This primary audit aimed to ascertain current practice and if necessary, suggest interventions to ensure that patient-care remains safe, effective, and well-led.MethodsTo establish current practice with regards to the discussion of individual cases of RT in MDT settings, specifically in Ward Round, we commenced a retrospective data collection from electronic notes covering all directorates within the High Secure estate between May and June 2022.From these notes, we tried to ascertain whether the following policy standards were being met:
•A de-brief with the patient should take place as soon after the incident as is practicable and reasonable, ideally within 72 hours.•The MDT meeting post RT episode should explicitly discuss the episode, and consider medication and any triggers of periods of acutely disturbed behaviour.•There were 81 data sets to explore.ResultsNot all data sets were viable. Out of those analysed, less than 10% were found to have met the aforementioned ideal policy standards of having had a reflective discussion within 72 hours with both the patient and as an MDT, exploring the episode itself and its antecedents.ConclusionThere are several interesting factors to consider from the results obtained. We postulate that the frequency of episodes of RT makes meeting the policy standard problematic; pragmatically, there is a significant time barrier to exploring these incidents in detail and the various teams, operating in dynamic and high-risk environments, may find it difficult to coalesce in order to debrief appropriately.Furthermore, the reflections may actually be happening, but the burden of documentation mean that these are not being recorded formally in a way that can be measured.There are limitations to the searches of electronic notes and we did not have access to Incident Reports, often completed at the time of these episodes; further information may have been uncovered if they were available.Despite this, there is room for interventions that inform staff of this need and to provoke improvements in current practice.