bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Quality of Old Age Inpatient Ward Rounds During COVID-19 in NHS Lanarkshire, Scotland
Authors: Ambardar Prerna , Chatterji Indrajit 
Published: June 2022

AimsTo provide a structured Multidisciplinary team (MDT) checklist to improve the quality of ward rounds in Ward 3, Wishaw General hospital. Ward rounds normally involved patient and electronic documentation review during MDT. Feedback from medical and nursing staff indicated inconsistencies in finding up to date Do not resuscitate cardiopulmonary resuscitation (DNACPR)forms/Treatment escalation plans, treatment forms, care plans, thromboembolism prophylaxis during ward rounds. Discussions about who will update the family, make social work referrals needed clear documentation in order to follow up efficiently post MDT. Food, fluid, and weight charts although done regularly there was no single place to keep them together. These charts to be kept in a separate folder for finding easily during ward rounds. The Royal College of Psychiatrists sets standards that managers and practitioners have agreed standards for ward rounds. Structured ward rounds and check lists have shown to prevent omissions in care and improve patient safety.MethodsDiscussions with Ward 3 team, nursing colleagues and ward Quality improvement group were held. A Standard MDT Quality improvement Checklist was devised and used as a Pilot in W3, WGH.This was first introduced in August 2021. Plan, do, study, act (PDSA) cycle was carried out.Plan: Trial MDT checklist at Ward 3 ward RoundDo: Use Initially for two Consultant ward roundsStudy: Ask all MDT staff members for feedback on the formAct: Reformat the checklist for the following ward rounds and distribute among all consultants.Repeated Revisions of MDT checklist done after feedback from ward staff and final version devised and results audited in Nov 2021 and Jan 2022.Food, Fluid, and weight charts were put in separate folders.ResultsBefore MDT Checklist nil up to date MDT checklist information available, 10% individual food and fluid charts and 0% folders.After MDT checklist in November 2021, 73% increase in up-to-date checklist items, 100% increase in finding charts in folders.In January 2022 decrease to 44% of up-to-date MDT checklist items, 100% food and fluid charts in folders.ConclusionMDT Checklist provided robust structure to our Ward rounds along with the regular electronic record and has been incorporated in our shared drive. The results in January for up-to-date checklist were down because of staff sickness due to new Omicron variant and less people available to keep documentation up-to-date.
Antipsychotic Monitoring Within the Home Treatment Team in the Southern Trust, a Quality Improvement Project
Authors: Andress Cedar , Coulter Paul , Watson Leah 
Published: June 2022

AimsThe Royal College of Psychiatrists has a specialist group called the Home Treatment Accreditation Scheme (HTAS) that has published a set of best practice recommendations for Home Treatment Crisis Response (HTCR) teams across the UK. As of yet, the HTCR team in the Southern Trust is not accredited. We decided to focus our project on antipsychotic monitoring. SMART aim: All patients (100%) within the HTCR team commenced on antipsychotics are receiving an appropriate level of blood and physical monitoring as recommended by guidelines and these are being documented correctly within 10 days of discharge.MethodsPLANHTAS standards were reviewed alongside NICE guidelines on antipsychotic monitoring and a pro forma created. We collected baseline data on patients commenced on treatment dose antipsychotics in the HTCR team and assessed completion of bloods/ECGs/physical parameters and documentation.DOOur intervention for PSDA cycle 1 was to educate members of the multi- disciplinary team (MDT) via a presentation after the baseline data were analysed. We looked at correct documentation and how to fix common mistakes identified. We asked staff for their input on how to improve outcomes. Posters were printed off for guidance. We collected data after this intervention using the same pro forma.STUDYWe analysed the results from PSDA cycle 1, comparing them to baseline results.ACTOur next step in PDSA cycle 2 would be to focus on continuing to improve poorer results such as prolactin levels and ECGs, with input from the MDT.ResultsBaseline data showed between a 14% and 59% completion rate for various baseline bloods, 68–72% completion rate for heart rate (HR)/blood pressure (BP)/weight and a 36% completion rate for ECGs.Following PDSA cycle 1, this improved to between a 55–100% completion rate for baseline bloods, a 91% completion rate for HR/BP/weight and a 64% completion rate for ECGs.Baseline documentation of these parameters was correctly recorded between 9–68% of the time. This overall improved after PSDA cycle 1 to 18–73%.ConclusionOur intervention from PDSA cycle 1 improved completion of bloods, physical parameters and ECGs in the HTCR team. Documentation also improved in all domains.Our next step in PDSA cycle 2 would be to focus on continuing to improve poorer results, looking at altering practicalities that may have affected those areas.
Audit Reviewing Consent for Electro Convulsive Therapy
Authors: Ansari Saba , Maiya Sujatha 
Published: June 2022

AimsThe National Institute for Health and Clinical Excellence (NICE) recommends that valid consent be sought for Electro Convulsive Therapy (ECT) in all instances where the individual has the capacity to provide or deny consent. Individuals should get comprehensive information on the general risks and potential advantages of ECT. When informed consent and decision-making are not possible, advance directives are fully considered, and the individual's advocate and caregiver are consulted. Additionally, patients should be informed that they can discontinue treatment at any moment. The purpose of this audit is to determine whether we are adhering to the NICE-recommended standards and recommendations.MethodsThis is a retrospective audit looking at case notes from the last 30 individuals who received ECT at University Hospital Wishaw. Individuals' electronic and paper light notes were analysed for data.In informal patients, the aspects reviewed were:
1.Documentation about adequate information given.2.Documentation of risks and benefits explained.3.Documentation of information given about withdrawing consent.In Formal patients the aspects reviewed were:
1.Number of cases who received urgent ECT under Mental Health Act (Scotland) with Record of notification on T4 form.2.Number of cases who received ECT under Mental Health Act (Scotland) with Certificate of the designated medical practitioner completing T3A form.3.Number of cases who regained capacity to consent for ECT during the course of treatment and had appropriate informed consent with Certificate of consent to treatment completed on T2 form.4.Did any of the cases have Advance Statement either for or against having ECT as a treatment option for them?ResultsObservations of the data collected revealed that over 30% of cases lacked the documentation proposed by NICE standards. Only 25% of cases with complete documentation were informal patients, whereas the remaining 75% received ECT under the Mental Health Act Scotland.ConclusionBased on the observations, this audit establishes that our results do not meet generally accepted standards. The full results will be disseminated with appropriate recommendations to the prescribing Consultant Psychiatrists. This Audit process has also prompted us to redesign the ECT booklet to include the required documents in accordance with standards.
Improving Continuity of Care of Patients Transferred Between Medical and Psychiatry Wards During the COVID-19 Pandemic and the Increasing Demands on Core Trainees to Manage Medical CoMorbidity
Authors: Beaumont Paula 
Published: June 2022

AimsAn existing transfer document at FVRH recognised that patients presenting to one specialty may require transfer to another depending on the changing needs of that patient. This document was not often used prior to the COVID-19 pandemic however demands for medical beds resulting in prompt return of patients to psychiatry highlighted the need to adhere to a safe transfer process. Unlike many psychiatry units where physically unwell patients are taken to ED, the MHU for Forth Valley is attached to the general hospital. This results in the view that physically unwell patients can be managed for longer before requiring transfer. Despite the proximity to the medical wards however, the unit is not equipped to manage physically deteriorating patients. This QI project aimed to improve communication between psychiatry and medical staff to improve patient safety.MethodsPatients transferred during their admission between the MHU and medical or surgical wards in May 2020, or in Oct-Dec 2021 were identified from 5 psychiatry wards. Electronic and paper notes were checked for a transfer form for each stage of transfer. Medications prior to transfer, on return and changes during admission were cross checked on Hepma, ECS and care partner as well as within documentation from medicine/surgery.ResultsIn May 2020, no patients admitted from medical wards had a transfer form completed, 62.5% transferred to medicine and 57.1% returned from medical wards had forms. 20% of transfers had medication errors Identified. After making the transfer form electronic and following hospital wide changes to the Trakcare and Hepma systems, 27.8% of patients admitted from medical wards had forms, 75.9% transferred to medicine and 72% of those returned from medicine had forms. There were no further medication errors identified. During the timeframes studied only 1 patient was transferred due to COVID-19 but 29 transfers were carried out for other acute physical issues.ConclusionChanging the documentation process to make it as easy as possible for psychiatry juniors to document treatment plans for transferred patients improved continuity of care and decreased medication errors. This also ensured that patients were medically fit to return to psychiatry wards. The range of physical comorbidities that psychiatry trainees were expected to manage extends beyond caring for patients who contract COVID -19.
Developing Inpatient Management Strategies for Behavioural and Psychological Symptoms of Dementia (DIMS-BPSD)
Authors: Parker Jennifer , Beazley Ryan , De Souza Stephen 
Published: June 2022

AimsThis project details the development of a Quality Improvement Project aiming to review and improve the management of behavioural and psychological symptoms of dementia (BPSD) on an old age psychiatry ward. BPSD refers to a constellation of non-cognitive symptoms and signs which arise in people with dementia, including disturbed perception, thought content, mood or behaviour. Examples include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, and socially inappropriate behaviours. BPSD arise in 5/6 of people with dementia over the course of their illness and are associated with a deterioration in cognition and progression in dementia plus secondary harms such as falls and hospitalisation. Pyrland Two ward is a mixed gender specialised organic old age psychiatry inpatient unit serving the county of Somerset. Most patients have a diagnosis of dementia, are being cared for using either MHA or MCA legislation and exhibit one or more BPSD. There was no structured or formalised approach to the management of BPSD at inception.Methods1.A point-in-time audit was conducted to produce baseline measurements of BPSD management on the ward, measured against NICE criteria.2.Plan-Do-Study-Act (PDSA) methodology was employed to incorporate incremental quality improvement interventions such as a ward-round checklist and staff education.Results•Baseline: (n = 14) 4/14 formally diagnosed with BPSD. 6/14 were prescribed antipsychotic medications, of which 1/6 fully met NICE standards. 2/14 had structured assessment tools used.•Results following introduction of improvement methods: (n = 8) 8/8 formally diagnosed with BPSD. 7/8 were prescribed antipsychotic medications, of which 4/7 fully met NICE standards. 7/8 had structured assessment tools used.ConclusionIt was possible to see modest improvements in the ward-based management of BPSD using quality improvement methodology, including more favourable psychotropic prescribing. However, total patient numbers are small and further interventions, such as more PDSA cycles, may add value and encourage sustainability.
Timeliness and Quality of Response to Referrals Received by a Psychiatry Liaison Service for Older Adults During a Pandemic
Authors: Beehuspoteea Nirja , Wilcha Robyn-Jenia , Edwards Amelia , Mbazira Agnes 
Published: June 2022

AimsTo improve timeliness of response and provide a committed plan to referrals received by the liaison service for older adults in Croydon University Hospital. Background: A quality improvement project in 2019 aimed to evaluate effectiveness of the liaison referral pathway. A questionnaire distributed to ward staff revealed some comments regarding ‘non-committal advice’ given by the liaison team.MethodsData were collected from 44 referrals received by the liaison team in June 2021. Variables included referral date, reason for referral, date of first assessment, plan documented in the notes, date and details of committed plan of action.Multi-disciplinary team (MDT) discussion identified that more committed advice could be provided by the following, which were implemented at the start of September 2021.
1.Huddle at the start of each day to triage and allocate referrals to appropriate members of MDT.
a.Prompt discussions with senior members of the team following assessment to discuss diagnosis and management.b.Team teaching sessions were organised once a week, in the form of case-based discussions and role play, to improve communication skills, confidence and history-taking.Data were then collected from 48 referrals received in September and October 2021.ResultsOf the 44 patients in June, average time taken from point of referral to assessment was 1.27 days and to providing a concrete plan 1.80 days.Of the 48 patients between end of September and October, average time to assessment was 1.31 days and to providing a concrete plan 1.88 days.In June, 75% of patients were seen on same day or within one day and 50% had a concrete plan within one day.In September/October, 65% of patients were seen on same day or within one day and 52% had a concrete plan within one day.ConclusionThese results highlight that assessments by older adult liaison service require detailed collateral history, investigations and MDT discussions.While ‘obtain collateral history’ may not seem as committed a plan as prescribing medication, it remains an important part of old age psychiatry.Given the rapid turnover of patients and increased pressures during the pandemic, it is the responsibility of the liaison team to communicate effectively with the wards and offer a timeline for completion of plan.Following above changes, another questionnaire has been sent to request feedback on effectiveness of the liaison team.
Evaluating the Dissemination of Mental Health Resources and Service Information in Primary Care: A Quality Improvement Project
Authors: Challen Chloe 
Published: June 2022

AimsBackground: Demand for mental health support in primary care has increased during the COVID-19 pandemic. Furthermore, in an era of social distancing, the use of digital technology for communication has never been more important. It is therefore vital for mental health services to be easily accessible online, especially because 90% of people with mental health problems are cared for entirely within primary care, despite using <10% of mental health expenditure. Aims: 1. To evaluate the dissemination of resources and services to patients during initial mental health consultations. 2. To develop an easy to access and cost-effective resource containing details of both adult and child mental health services.MethodsAn anonymised survey was used to explore the dissemination of mental health resources at the Cotswold Medical Practice. The baseline data collection revealed a lack of easily accessible and shareable information, furthermore, a review of existing literature found that no resource existed containing details of both local and national services. Consequently, two virtual documents were created for adult and child mental health resources. These were added to an accuRx template to allow clinicians to easily send the resources to patients via text message. The resources were then re-evaluated 1–week and 5–weeks post–intervention.ResultsPre–intervention the average GP provided patients with 2.4 mental health resources and there was no standardisation of the information given. Post-intervention, over 25 resources were provided as both 6–page virtual documents contain a range of resources including: NHS services, local and national charity services, private services, self-help books and mobile apps.ConclusionThe novel virtual resource produced is a cost-effective resource that helps improve the quality and quantity of information provided to patients about mental health services. The resource produced is compatible with virtual consultations and is sustainable for long term use.
An Evaluation of Higher Trainee Views on Clinical Posts in West, North and East Yorkshire Psychiatry Trainee Scheme
Authors: Elisha-Aboh Christiana , Shaw Laura , Mozdiak Rose , Davies Sara , Pillai Anilkumar 
Published: June 2022

AimsGathering honest feedback is challenging as trainees are often reluctant to do so due to the perceived impact on their reputation, future careers, and professional relationships. A lack of constructive feedback severely impacts future trainees and can prevent necessary improvements. There is considerable variation over collection of feedback. The aim of the project was to allow higher trainees and newly appointed consultants within two years of completing training, provide feedback on previous training posts in a confidential manner. The information obtained would be used to improve trainee experience, support a change in culture around feedback and highlight posts in need of input from Training Programme. Directors (TPDs).MethodsAnonymised questionnaires were sent to higher trainees and newly appointed consultants using a survey monkey link left open for a month. Reminders were sent via Medical Education, text messages, chats, and informal conversations. There were three basic open questions asked with free-text boxes. The questions were: What things were good about this post? What things could be improved? Would you recommend this post to a colleague? The data collected were in quantitative and qualitative formats.ResultsWe received 22 responses of 46 higher trainee posts within the scheme. The general themes from the project were that trainees wanted more focus on training rather than service provision, more independent working while still having good clinical support/supervision; based on their level of experience, better support to meet non-clinical Intended Learning Outcomes (ILOs) and ensuring a good balance of being busy while not finding it overwhelming. Trainees in community settings suggested allocation of selected cases focused on training experience, the opportunity to manage complex situations with supervision, being able to shadow and have joint reviews with consultants. The themes highlighted in the inpatient settings included having protected time to develop non-clinical ILOs, assuming greater leadership of clinical meetings, and having the opportunity to manage a patient from admission to discharge. A total of 4 posts were not recommended for reasons outlined above.ConclusionClearly there is a balance to be made between appropriate levels of independence and supervision. The vast majority of training posts reviewed have got the balance about right, however there are still some posts that require improvements. Careful consideration by both trainers and trainees needs to be given to various aspects of training, to achieve required ILOs, as not everyone fits the mould. This highlights the importance of creating individualised frameworks for trainee support and supervision.
A Quality Improvement Project (QIP) Within the Bolton Learning Disability (LD) Team (Greater Manchester Mental Health Trust) Aiming to Enhance Communication Among Multi-Disciplinary Team (MDT) Professionals and Wider Stakeholders, for the Purposes of Enhanced Care Delivery and Improved Patient Outcomes During COVID-19 pandemic. Project Lead: Dr Syeda Hasan
Authors: Hasan Syeda , Moir Rachel , Neary Jessica , Gupta Rupa 
Published: June 2022

AimsThis QIP aims to improve communication and information sharing between the community LD team, administration team, service providers and wider stakeholders, to ensure patient safety. The primary objective is to evaluate local initiatives to improve communication between MDT professionals and wider stakeholders. The secondary objective is to improve patient safety and staff satisfaction.MethodsThe COVID-19 pandemic created unprecedented communication challenges within the workforce and highlighted areas requiring review; this included information sharing among internal and external teams, collaborative teamworking, support in absence of senior clinical leadership and transition pathways from Child and Adolescent Mental Health Services to adult LD services. The QIP was initiated in March 2021.The discovery process included an initial consultation exploring practitioners’ experiences, areas for development and to share ideas for good practice.We used QI methodology, following ‘plan-do-study-action’ cycles, to analyse change. Change ideas included a single point of contact for internal and external queries, regular complex case management meetings, development of a referral process and clinical review for complex cases along with teaching sessions.Qualitative feedback from the team pre- and post-intervention, at baseline and regular follow-up intervals, in the form of monthly team meetings, emails, focus-groups and semi-structured interviews.ResultsA full thematic map was created after initial consultation; themes included communication improvement between teams and external agencies, timely support for complex case management, improving transition processes and development of robust clinical review processes.Qualitative feedback has been collated, analysed and final recommendations to be shared with the MDT professionalsConclusionPreliminary results have shown improvements in communication among the MDT, stakeholders, and external agencies.The consultation process highlighted that there is a substantial need for standardisation and consistency within communicative practices to promote enhanced care delivery and improved patient outcomes.