bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Capacity and Consent to Treatment Recording, Park House Hospital
Authors: McKnight Rebecca , Fu Rachel 
Published: June 2022

AimsRe-audit for adherence of all inpatient wards at Park House Hospital to Trust Consent to Treatment policy. Improve hospital compliance to Trust Consent to Treatment policy. Reduce prescribing errors. Improve trainee confidence and knowledge of Consent to TreatmentMethods•Cross sectional audit.•Data collected between 8th and 12th November 2021•All wards in Park House Hospital•5 patient records and medication charts reviewed per ward.•Proforma used.•Data analysed using Excel.•Interactive teaching on Consent to Treatment delivered by Dr McKnight to Core Psychiatry Trainees on 3rd July 2020.•Dr McKnight presented the original audit data and consulted the Pharmacists and Consultants to assess and improve ward systems for recording Consent to Treatment. (26th May and 30th April 2021).•Dr McKnight presented to Greater Manchester Mental Health, Mental Health Act and Mental Capacity Act Quality Improvement Group (30th June 2020).Results•No wards had 100% capacity forms documented, kept in medication charts and uploaded to Paris.•7/9 wards had 100% compliance for completing T2/3/S62 forms.•6/9 wards had 100% compliance rate for retaining the T2/3/S62 forms in the medication charts.•78% T2/3/S62 forms were uploaded to PARIS.•80% medication charts matched T2/3 forms.When Dr McKnight asked trainees, “Do you feel confident with your knowledge of consent to treatment” only 24% answered yes, 35% answered no and 41% a little.When asked, “Do you check Consent to treatment forms before prescribing?” 32% answered yes, 24% no, 34% sometimes and 10% that they didn't know what they were.During the post-teaching quiz, trainees were asked, “Has this teaching session improved your knowledge and confidence regarding Consent to Treatment?” 91% answered yes, 0% answered no and 9% answered a little.Discussion with Consultants and Pharmacists concluded that it may be beneficial for wards to include Capacity to Consent and Consent to Treatment within ward round proformasConclusion•The two main concerns of the initial audit and re-audit, relate to Treatment Capacity and Consent forms compliance and prescribing.•New trainees rotate into the Trust every 6 months and levels of knowledge surrounding Consent to Treatment varies depending on trainee experience. Trainees require teaching on Consent to Treatment as part of their induction and teaching programme.•Based on the multidisciplinary nature of ensuring compliance to Consent to Treatment the authors propose monthly ward auditing of Consent to Treatment, which they believe will lead to better compliance rates across the hospital.
Patients With Psychotic Disorders Are More Likely to Refuse Vaccination: An Audit of Vaccine Acceptability on Acute Adult Psychiatric Wards
Authors: Miles-Marsh Rupert , Diamantis Elias , Duan George , Suarez Lori Edwards , Lankappa Sudheer 
Published: June 2022

AimsThis audit is looking at COVID-19 vaccine uptake in an acute adult psychiatric setting as part of the national drive to minimize COVID-19 infection. The aims of this audit are to identify: the number of patients that have been offered vaccination in a ward setting; the acceptability of the vaccination and the reasons for non-acceptance of vaccine.MethodsA total of 339 patients were admitted to acute adult psychiatric wards (Male, Female, PICU) at Highbury Hospital, Nottingham between February to August 2021. Data on the following parameters: demographics (age, sex, ethnicity), section status, HoNOS cluster, admission length and vaccine data (offered, accepted, received) using the RIO system and Health Informatics.ResultsOut of 339 patients, 31% (n = 105) had received or planned to receive the first dose of vaccine prior to admission. 43% (n = 100) of 234 patients who hadn't received vaccine were offered. Out of the patients who were offered vaccine, 59% (n = 59) accepted. 92% (n = 55) of patients who accepted vaccine, received vaccine. Those offered vaccination had an average length of stay of 117 days whilst those not offered had a shorter average length of stay of 81 days.For patients who were offered vaccine, those who were sectioned and in psychotic clusters refused vaccine compared to non-psychotic and informal patients. Deprivation, gender, age, admission length had no statistical significance in vaccine uptake for patients who were offered.Patients listed the following reasons for refusing the vaccine: media distrust; vaccine not effective; already had COVID-19; doesn't want it; believes vaccine made by consultant; doesn't want bad reaction; “Scientists and politicians are liars”; “I am fine and don't need it"; “Don't trust it and don't like needles”; “Don't want to be part of the game”; “Have had covid twice and, if I get it, I'd prefer my body to fight it”.ConclusionOur current vaccine acceptance rate of 59% is lower than those found nationally (80%) and in a medium secure psychiatric hospital (77%). The trust policy recommends all eligible patients should be offered the vaccine; our offer rate is lower than this standard. The low offer rate may be explained by vaccines being offered in rounds leading to patients possibly being missed. Our acceptance rate could be enhanced by improving our vaccination care plans for formally admitted psychotic patients.
Antipsychotic Prescribing Practice in Adults With a First Presentation of Psychosis Amongst Bolton's Early Intervention Team and Inpatient Mental Health Services: An Audit
Authors: Morrison Eve , Cappleman Hannah 
Published: June 2022

AimsIn Bolton Early Intervention Team (EIT) it was noticed that patients prescribed antipsychotics frequently required a change in medication due to side effects. Similar issues had been identified in Avon and Wiltshire NHS Foundation Trust where a prescribing guideline was developed which won the NICE Shared Learning Award in 2020. This recommends prescribing Aripiprazole first line and cautions using Olanzapine or typical antipsychotics first due to their side effects. The aim of this project was to identify which antipsychotic drugs are currently prescribed in first episode of psychosis (FEP) in Bolton EIT patients and to audit adherence to National Institute of Clinical Excellence antipsychotic prescribing guideline CG178.MethodsThe sample included all adults with FEP accepted by Bolton EIT across a four-month period from 01/12/20 until 31/03/21. Fifty-two people were identified.Measured standards were documentation of prescribing rationale, discussion regarding medication side effects and weekly weight monitoring for six weeks following initiation. Antipsychotic choice and need for a change within six months of initiation was recorded. Data were collected retrospectively from patients’ electronic records.ResultsThirty-eight patients had been prescribed an antipsychotic – fifteen as inpatients, seventeen by Bolton EIT and six by the Home Treatment Team.Of the fifteen inpatients Olanzapine (8) and Zuclopenthixol (3) were the most common choice. 5/15 had a documented rationale, and side effects were discussed with 3/15 patients. Weekly weight monitoring was performed in 7/15.Of the 17 people who started antipsychotic medication once under Bolton EIT Quetiapine (6), Olanzapine (6) and Aripiprazole (5) were the most common choices. 12/17 had a documented rationale and 13/17 were consulted regarding side effects. Weekly weight monitoring was not performed for any of these patients.Within six months, sixteen antipsychotic prescriptions (42%) were changed due to side effects (9), inefficacy (6) and non-compliance (1). The drugs changed were Olanzapine (6) Quetiapine (6) Zuclopenthixol (2) Aripiprazole (1) and Chlorpromazine (1).ConclusionThose initiated on antipsychotics as inpatients need better involvement in decision-making and consultation about side effects. A community initiative should be introduced to offer weekly weight monitoring. Further work is required to understand the rationale for frequently prescribing Olanzapine and Zuclopenthixol in inpatient services, and to consider why Aripiprazole is infrequently used first line.
Audit Against DVLA Guidance for New Psychiatric Patient Referrals at the Early Intervention for Psychosis Team (EIP)
Authors: Radhakrishnan Tharun Krishnan , Lathif Nismen 
Published: June 2022

AimsTo assess the compliance of the clinicians in EIP team with DVLA guidelines. Objectives: To assess if there was documented evidence of: 1)Patient's diagnosis, 2)Patients’ driving status, 3)Type of vehicle driven, 4)Informing the patient that their condition may affect their ability to drive, 5)Advice regarding driving restrictions where applicable, 6)Informing the patient that they have a legal duty to inform the DVLA about their conditionMethodsWe selected two-thirds of the patients(n = 40) enrolled in the EIP service in the last year by consecutive sampling. We collected the data retrospectively from the clinical documentation and analysed it using excel sheets.ResultsThe mean age of the study sample was 34 years. 95%(n = 38) had a documented diagnosis, 67.5%(n = 27) had a documented driving status. The documentation of driving status was completed by doctors in 52%(n = 14), nurses in 26%(n = 7) and by both in 22% (n = 6). The type of vehicle driven was documented for only 33%(5) of the drivers. Among the drivers identified 33%(n = 5) had been informed that their condition might affect their driving, 67%(n = 10) had received information on driving restrictions and 47%(n = 7) had received information that they have a legal duty to inform the DVLA.Discussion:One of the reasons for the low compliance may be because another team might have documented the information at the time of referral. It is possible that the professional involved did elicit the information but didn't document the same. Healthcare professionals(HCP) have to identify, discuss and document driving-related information as advised by the DVLA. In cases where the patients’ don't follow the advice, the HCP must notify the DVLA.ConclusionAssessment of driving history and the risks associated are critical. Awareness should be raised among the clinicians (through training and team meetings). This practice should be made an integral part of the structured initial assessments. Patients can be offered information leaflets. If successfully implemented, it will prevent unsafe driving and minimise the risk of harm for the patient and other road users.
Changes in Crisis Resolution Home Treatment Team Referral Numbers and Patient Caseload During COVID-19 Pandemic in First Lockdown
Authors: Raza Awon , Pillai Sujith 
Published: June 2022

AimsThe COVID-19 Pandemic has had an impact on most aspects of functioning on the world in general. We wanted to see what impact of COVID-19 Pandemic has had on a Crisis Resolution Home Treatment Team North Peterborough. The main objectives of this audit were to see changes in Crisis Resolution Home Treatment Team North number and source of referrals, average length of stay, total number of patients Home Treated during this period (Pre and during COVID-19 pandemic) and to also identify whether patients with a certain diagnosis deteriorated or presented more to services compared to others.MethodsWe retrospectively reviewed case-notes and data were collected from RiO Electronic Patient Records (EPR) covering all the factors we wanted to analyse. Data collection periods were pre-COVID-19 between 1st April 2019 and 30th September 2019 and COVID-19 pandemic (1st Lockdown) between 1st April 2020 and 30th September 2020. Total number of referrals received between April and September 2019 pre-pandemic were 844 and total number of referrals received during COVID-19 pandemic between April and September 2020 were 660. Data were exported from the electronic patient record into Microsoft Excel and quantitative analysis was performed using Microsoft Excel.ResultsThe results showed 21.8% drop in total number referrals from 844 to 660 and there were 20.89% (79) less patients Home Treated from April and September 2020 during first lockdown compared to the similar period in 2019. Significant increase observed in patients with bipolar affect illness by 32% (from 86 to 128 patients), acute stress reaction and adjustment disorder by 15% (from 68 to 80 patients) and psychotic disorder by 11.5% (from 245 to 277patients) in 1st lockdown period compared to 2019 similar period. Declining trend observed in intentional self-harm by various means by 20.75% and 4% drop in personality disorder patients. Anxiety and depression patients number remained same in both periods.ConclusionAlthough referral numbers dropped significantly and Crisis Resolution and Home Treatment Team caseload decreased during the COVID-19 pandemic first lockdown, the number of patients with serious mental illness presented to services increased remarkably (bipolar and psychotic illness). Overall, no major change in length of stay of patients with Crisis Team was observed when compared both periods and referral numbers remained low from all sources during COVID-19 pandemic.
Assessing the Impact of COVID-19 on Overdose Presentations Through the Emergency Department in a Large Tertiary Hospital
Authors: Saleh Raneem , Kutubi Abdubadie , Shobowale Zainab , Saleh Renad , Guerandel Allys , Moore Susan 
Published: June 2022

AimsThe outbreak of COVID-19, lockdown and self-isolation has created a lot of additional pressure on the society as a whole. We aim to audit the number of patients presenting to SVUH ED since March 27th 2020 (the date at which the government imposed a stay-at-home order) with an overdose.MethodsThe cohort of cases analysed was identified using ED MAXIMS under the subheading of ‘overdose and poisoning’ presentations. Data were collected using MAXIMS and clinical portal and stored on the SVUH system and analysed using Microsoft Excel and SPSS.ResultsThere were a total of 713 cases in both years (from 27th of March – 31st December), with 353 (49.5%) admitted in 2019 and 360 (50.5%) admitted in 2020. Out of those admitted, 423 patients were females (196 and 227 in 2019 and 2020 respectively). There was a significant increase in the number of female presentations in 2020, with a p value of 0.041.When stratifying patients based on age, the mean ages were 37.22 (SD 17.04) and 34.18 (SD17.32) in 2019 and 2020 respectively (p = 0.076). When dividing age groups in three categories (under 18, over 65 and 19–64), our data showed significant differences. There was a significant increase in numbers in the ≤18 yr and 19–64 age groups in 2020 compared with 2019. In the under 18 groups, there was an increase in numbers by 7.9% in 2020 (11.6% compared with 19.5%). When comparing numbers between Months per year, overall, there were no changes in presentations. Interestingly March 2020 had no presentations compared with March 2019, coinciding with the beginning of the pandemic in Ireland. May showed more than 50% decrease in presentations in 2020. Similar numbers were seen in the rest of the months of both years.ConclusionBetween 2019 and 2020, there was a 1.9% increase of ED presentations with overdoses, which did not show any significance in increase of numbers or in age demographics. There were three main findings from our analysis:
1. A significant difference between the two years in a rise in female patients admitted with overdose (p = 0.041)2. An increase in presentations in the age groups of under 18 and 19–64. This may allude to increase strain in the younger population with loss of jobs, financial burdens etc.3. There were no presentations in March 2020, coinciding with the beginning of the pandemic in Ireland.
An Audit to Assess the Quality of Ward Referrals Sent to City Hospital Liaison Psychiatry Team From Inpatients Wards D15, D17and D27, Between July 2021 to September 2021
Authors: Setlhare Kesegofetse , Woodman Hannah , Pahal Amandeep , Hickmott James 
Published: June 2022

AimsLiaison psychiatry provides psychiatric care to medical patients. Patients include those attending emergency departments, general hospital inpatients and outpatients. Liaison teams work hand in hand with several general hospital teams to offer advice, review and manage these patients. Over the last few months, the Liaison service in City Hospital have been receiving many inappropriate referrals. Inappropriate referrals are defined as patients who are referred to services, with one of the following reasons:
1.Insufficient presenting complaint2.No documented Past psychiatric history3.Insufficient Mental state Examination (MSE)4.No risk assessment5.No documented Drug/alcohol history6.Patients having not consented to referral.7.If one or more of the above criteria is not metOur aim was to evaluate the appropriateness of the referrals received from D15, D17, D27 inpatients wards in City Hospital over a 3-month period from July to September 2021. These wards were chosen as they commonly refer patients to liaison services.MethodsWe collated data retrospectively on the nature of all referrals from D15, D17 and D27 ward over a 3-month period. The patient referral portal was used, and referral content of each patient was analysed. An audit tool was devised to assess whether the referrals followed the liaison referral pathway and guidelines set by NHS England for referral structure to liaison services.Results18 patients were referred to the Liaison psychiatry from the three wards over the three-month period. We observed 77.8% (n = 14) of the referrals having insufficient information for the presenting complaints, whilst 22.2% (n = 4) of them did not state past psychiatric history. Approximately 94.4%(n = 17) did not state sufficient details of MSE. In 83.3% (n = 15) of referrals appropriate detailed risk assessment was not done, 27.8% (n = 5) of them did not have alcohol/ drug use stated and 22.2% (n = 4) of patients referred did not consent to the referral being made.ConclusionThe results demonstrated that ward referrals lack quality and contain inadequate information to allow for safe screening of patients and for the implementation of appropriate actions by the liaison team. A possible reason for inappropriate referrals may be due an existing knowledge gap and lack of confidence taking detailed psychiatric histories, assessing risk, and performing MSE in non-psychiatric trainees making referrals to liaison services.
Audit & Reaudit of Assessments Regarding Substance Misuse in Patients Referred to Liaison Psychiatry Service
Authors: Shittu Oriyomi , Mushtaq Samlan , Maria Dervis 
Published: June 2022

Aims1- What percentages of people presenting to general hospital that are referred to Liaison Psychiatry service have Substance misuse problems? 2- Are the assessments by Liaison Psychiatry services identifying substance misuse problems? 3- If substance misuse problem is identified then are we offering any advice/intervention/referralMethodsTo look at 100 consecutive assessments by using an audit proforma to capture information required to answer above questions.ResultsIn 78% of cases there was evidence documented that the patient was asked about alcohol use. In 22% - no evidence patient was asked about alcohol use.
–77% documentation about drug use. 23% no evidence documented that the patient was asked.–Of those asked about their alcohol use (n = 62), a misuse problem was identified by clinicians making the assessment in 6 cases (10% of those asked).–Of those asked about their drug use (n = 61), a misuse problem was identified by clinicians making the assessment in 8 of cases (13% of those asked).Of those with a substance misuse problem identified (n = 15), 20% identified misuse of both alcohol and drugs, 40% identified misuse of alcohol only, and 40% identified misuse of drugs only.
–Of those with a substance misuse problem identified (n = 15), 73% were offered advice or an intervention, and 27% had no intervention documented.ConclusionJust over a fifth of patients assessed were not asked about alcohol or drug use. This has improved since August 2020 when nearly half of the patients assessed were not asked about alcohol or drug use.
–Since audit in August 2020, there has been a 21% increase in documentation of advice or intervention being offered to patients identified to have a substance misuse problem.
Audit to Assess Melatonin Prescribing in Community CAMHS
Authors: Shroff Chirag 
Published: June 2022

AimsDisordered sleep is common, affecting 20–30%of children aged 1–5 years and often continues later into childhood. Neurodevelopmental disorders and psychiatric comorbidities pose a greater risk. The audit aimed to determine whether clinical prescribing practice of melatonin in Burlington House, Sefton CAMHS reflected current NICE recommendations. NICE suggest that first-line treatments for children with sleep problems include good sleep hygiene and behavioural therapy (including sleep diary).MethodsNice guideline CG170 provides guidance on Autism management. BNFC states that melatonin therapy should be reviewed every 6 months. Records of children currently prescribed modified release melatonin were checked to see if they met the inclusion criteria. Data were collected retrospectively from clinical case files and pharmacy records (December 2020- February 2021).ResultsThe results showed 18 young persons received melatonin for insomnia with ASD, 26 for insomnia without ASD, 3 for likely ASD and none for Smith Magenis syndrome. 36 received Specialist CAMHS review, 9 received Community Pediatrics review and 2 GP review. All patients received melatonin as per dose recommendations with 6 monthly reviews. Documentation on sleep hygiene was unclear.ConclusionWe concluded that Melatonin prescribing in community CAMHS tends to be high and discussion on sleep hygiene measures must be given importance.