bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quantitatively Evaluating the Impact of Eliminating Risk Assessment Checklists for Granting Leave in a Specialist Personality Disorder Ward
Authors: Philbey Alasdair 
Published: June 2022

AimsSpringbank Ward, in the CPFT NHS trust, is a specialist unit for patients with a diagnosis of emotionally unstable personality disorder (EUPD). Psychiatric wards often use restrictive practices to try and minimise suicide risk. Using risk assessment checklists to decide whether to grant leave is one example. Research shows that it is not possible to predict suicide or self-harm risk at an individual level, regardless of the assessment method used, so we questioned the utility of such an approach. A previous evaluation of our leave protocol showed that patients and staff would favour a less restrictive and more personalised approach. We introduced a new protocol that eliminated use of checklists, replacing them with an optional 1:1 conversation with staff before leaving the ward. Our aim in this service evaluation was to determine whether there was any significant change in rates of incidents on the ward and during leave as a result of this new, less restrictive leave protocol.MethodsData were obtained from the records of incidents on Springbank ward from March 2019 to March 2021. These incidents were recorded by members of staff on the ward, and ranked according to the severity of harm that resulted from these incidents. The rankings from least severe to most severe recorded during the study were ‘No harm’, ‘Low (Minimal Harm)’, and ‘Moderate (Short term harm)’. The number of incidents which occurred for the year before and the year after the policy change were compared. The comparison compared both the total amount of incidents and the sub-types of incidents.ResultsIn the 365 days following the change in protocol, there was a 15.5% decrease in total incidents and a 51.0% decrease in incidents occurring off the ward compared to the 365 days before the change in protocol. Notably there was a 61% decrease in total (both on and off the ward) Moderate (Short term harm) incidents, the most harmful type of incident recorded, following the change in protocol.ConclusionThe decrease in incidents following the change in protocol suggests that replacing the use of a formal risk assessment checklist with a holistic alternative improves patient safety.
Improving Patient Engagement in Psychological Interventions
Authors: Sivaji Rajeswari , Belgamwar RavindraB 
Published: June 2022

AimsThe aim of this service evaluation project is to gain understanding about the reasons for service user's disengagement in psychological interventions. We felt that the findings of this project will enable services to better understand the experience of service users and help recognise why someone requesting services does not follow through. Around 68% of patients who were referred to psychological therapy did not complete therapy in our community mental health team highlighting a need to improve patient engagement in psychological interventions. Patients under secondary mental health services have complex needs and any referral decision to the most appropriate psychological intervention will need to be carefully considered as a part of their treatment plan. Premature termination from psychological interventions can lead to poor treatment outcome, waste staff time and contribute to unnecessary long waiting lists.MethodsRandom sample of 20 service users who disengaged from psychological therapy were chosen and telephone interviews were conducted to determine their perspectives on reasons for their termination. Introductory letter informing about this project was posted to the service users and they were contacted after a week to gather information. The following themes were included in the interview questionnaire like demographic characteristics, psychopathological difficulties, problems related to therapy or therapist, external circumstantial problems, internal factors and service user views on satisfaction/achievement of therapy goals.ResultsThe results showed:
1.The most frequent reported reason for disengagement from psychological intervention was COVID-19 and internal factors (thinking that therapy would not help, low mood/too anxious, previous bad experience with therapy and feeling unwilling to open).2.Number of session's service users attended ranged from 0 to 6 and no one completed the therapy.3.Waiting time (from referral to start of therapy) ranged from 2 to 6 months.4.37.5% of service users were not aware about therapy details.ConclusionThe results were shared with staff via local meetings Recommendations were drawn to improve patient engagement and retention in therapy.
1.Outpatient pack resources developed to offer service users at appointments which has written information sheets about presenting problems, overview of psychological interventions/assessment and diaries for service users.2.New template was drafted to improve the referral process to psychology by referrers having access to guides on how to assess a person's psychological needs, readiness for therapy and the provision of consultation slots with psychologists.
Service Evaluation of COVID and Non-COVID Admission Trends to an East Midlands General Adolescent Psychiatric Inpatient Unit
Authors: Tan Sue Fen , Chand Parveen 
Published: June 2022

AimsTo explore the differences in admissions between the first COVID-19 lockdown cohort and a pre-COVID-19 cohort.Methods23 young people who were admitted to an East Midlands General Adolescent Inpatient Unit during the first COVID-19 lockdown from March 2020 to September 2020 were compared with the 48 young people who were admitted in the same period in 2019. Demographic details, admission duration and reasons, mental health act (MHA) status, diagnoses, functional status, and incidents were obtained retrospectively from the trust's online records.ResultsThe unit received more female admissions prior to lockdown (60.4% Vs 47.8%). Approximately 30% of adolescents in the pre-COVID-19 group were not in education whereas those admitted during COVID-19 were all receiving education. More of the pre-COVID-19 group attended school than college and more of the COVID-19 group were employed, consistent with a lower mean age of admission in the former group. Most of the COVID-19 admissions were local and none were out of area. Young people were also more likely to be looked after by their parents during COVID-19 (82.6%) and none were taken care of by their relatives.Pre-COVID019 admissions were discharged sooner than their counterparts, which had 13% of admissions between 6–9 months. Both cohorts had mainly informal admissions due to risk to self. Most of the COVID-19 admissions were due to anxiety, followed by self-harm while the majority of pre-COVID-19 admissions were due to depression and PTSD. 43% of the COVID-19 admissions had at least one comorbid diagnosis, notably depression. More adolescents in the COVID-19 cohort were not started on any psychiatric medication during and after admission.The mean number of incidents were two times higher in the COVID-19 group; self-harm was the most common reason. There was more violence towards staff during lockdown. However, absconsion, possession of contraband items, and staff error were higher in the pre-COVID-19 group.ConclusionThe introduction of COVID-19 restrictions was associated with a change in both the frequency and nature of inpatient admissions to this ward. Less young people were admitted during COVID-19, more frequently with anxiety as the primary reason and stayed for longer. Although the pre-COVID-19 group received more psychiatric medication, it is unclear if this contributed to a better functional status overall. This service evaluation also demonstrated the impact of COVID-19 on young people's mental health and life circumstances. An exploration of these trends in other units across the country would increase the generalisability of results.
Physical Health and Mental Health Comorbidities of People With Functional Neurological Disorders Referred to a Community Neuropsychiatry Service Pre-& Post March 2020 Lockdown Due to COVID-19
Authors: Williams Verity , Olaluwoye Oluwaseun , Dunlop Alan , Faruqui Rafey 
Published: June 2022

AimsHealth comorbidities contribute significantly to the development and maintenance of illness in patients with Functional Neurological Disorder (FND). As part of a service evaluation project, we investigated the physical and mental health comorbidities of people referred to a community neuropsychiatry service in East Kent, in one-year periods preceding and following the March 2020 lockdown due to COVID-19.MethodsWe included all people accepted to the service between 23rd March 2019 and 23rd March 2021, where the reason for referral was Functional Neurological Disorder (FND) or Non-Epileptic Attack Disorder (NEAD). Referrals to the service for other reasons were excluded, as were declined referrals. Routinely collected data sources were reviewed and data stored in anonymized fashion. Data were analysed using Statistical Package for Social Sciences (SPSS).ResultsTotal number of referrals for FND in the 2-year period was 260, with 161 referrals for NEAD and 99 for other FND.In the pre-lockdown period, 163 patients were referred due to FND (101 with NEAD, 62 for other FND). There were fewer FND referrals in the post-lockdown period: 60 referrals for NEAD and 37 for other FND. The majority were female (74% pre-lockdown, 81% post-lockdown). Where ethnicity was recorded, White British was the most common (94% pre-lockdown, 90% post-lockdown), with a small number of people from other ethnic groups (3.5% White Other, 1.4% BAME, 1.4% Mixed pre-lockdown; 5.4% White Other, 3.2% BAME and 1.1% Mixed post-lockdown). Ethnicity was not specified in 21 cases (13%).Of the pre-lockdown group, 15 patients had prior contact with Child and Adolescent Mental Health Services (9%), with 7 patients (7%) in the post-lockdown group. Many patients had previous contact with mental health services (47% pre-lockdown, 53% post-lockdown). The majority of patients had at least one physical illness (69% pre-lockdown, 73% post-lockdown). Most had 1–3 physical comorbidities but 9% (pre-lockdown, 7% post-lockdown) had more than 4. Fibromyalgia (14% pre-lockdown, 12% post-lockdown), chronic pain (23% pre-lockdown, 21% post-lockdown), and epilepsy (11%, 9%) were common. Over 90% had psychiatric illness in both periods. Most patients had 1–3 psychiatric illnesses; a few had more than 4 (6.1% pre-lockdown, 1.4% post-lockdown). Depressive disorder was the most common comorbidity in both groups (41% pre-lockdown, 44% post-lockdown), followed by anxiety (35% pre-lockdown, 36% post-lockdown). PTSD was present in 8% pre-lockdown and 8.2% post-lockdown.ConclusionPhysical and psychiatric comorbidities are common in people with FND; multidisciplinary working and liaison between services is crucial for care of these patients.
Improving Clinical Care in Tobacco and Smoking-Related Problems: A Report of Clinical Audit and Quality Improvement Project
Authors: Loo Jiann Lin , Raja Jawad , Anyanwu Ugochukwu , Shankar Nikhil Gauri , Elsayed Asmaa , Azahr Zeenish , Clifford John , Graver Faye 
Published: June 2022

AimsAround 40% of people with serious mental health problems smoke, which is significantly higher compared to the general population of the United Kingdom. The Welsh Government has set the target to reduce the overall prevalence of smoking in Wales to 16% from 19. In order to reduce the impact of smoking on the population, the first step is to identify the problem. Hence, a comprehensive history of smoking will help to identify the addiction-related problems. Hence, this combined clinical audit and quality improvement project (QIP) is aimed at the evaluation of the admission clerking around the assessment and management of smoking-related problems in an inpatient mental health unit.MethodsThis clinical audit was carried out at the local inpatient general adult mental health units in Wrexham. It was based on NICE smoking guidelines “Smoking: acute, maternity and mental health services”. Clinically relevant information without personal identification information was collected based on a proforma. The first re-audit was repeated without a specific intervention to see any change in pattern and the need for intervention. This was followed by the first intervention, i.e., the sharing of a PowerPointTM presentation discussing commonly utilised measurement tools in the assessment of smoking-related behaviours and the second re-audit.ResultsThe first round of clinical audit involves 32 admissions, the first re-audit was 19 admissions, and the second re-audit was 37 admissions. The baseline showed 71.88% of inpatient admissions were asked about their smoking history, but only less than 10% of them were assessed in detail around the types and quantity of tobacco products, features of dependence and withdrawal, the motivation of the clients to quit smoking, and any help offered to the patients. The number of inpatient admissions which was assessed for their smoking-related behaviour dropped to 36.84% during the first re-audit, and less than 16% of them were assessed in detail. The number improved slightly to 57.14% after the first intervention, although less than 40% of the inpatient admissions were assessed in detail.ConclusionThere is an inconsistent pattern of change in the percentage, and it seems that the intervention leads to minimal improvement of the assessment of smoking-related problems during admission clerking. The minimal change may be attributable to the change in posting around the intervention period. The future plan includes a more regular intervention arranged around the beginning of new postings for doctors to ensure they have adequate exposure to the assessment of smoking-related addiction problems.
Physical Health Monitoring of Patients Prescribed Depot Antipsychotic Medication in North West Edinburgh Community Mental Health Team (CMHT)
Authors: Klejnotowska Adrianna , Bailey Robyn , Thompson Alexandra , Wojtowicz Jakub , Haggart Josh , Evans Hamsi , Choi Hae-young , Mallis Adam , MacLeod Anna , Murdie Douglas , Argent Vikki 
Published: June 2022

AimsTo assess the effect of interventions in the physical health monitoring of patients prescribed depot antipsychotic medications. We hypothesised that compliance with monitoring would improve post-intervention. It is well recognised that patients with severe mental illness have a significantly reduced life expectancy. Depot antipsychotic medication increases the risk of cardiovascular disease, metabolic syndrome, stroke and type 2 diabetes. The SIGN guidelines recommend that all patients on antipsychotic medications should have annual physical health monitoring. Baseline data of patients on depot antipsychotic medication in North West (NW) Edinburgh CMHT in 2019 demonstrated that this was not being achieved. We sought to create interventions to improve compliance with physical health monitoring for patients on depot antipsychotic medication.MethodsBaseline data were collected in 2019 for all patients under NW Edinburgh CMHT receiving depot antipsychotic medication (60 patients). The data addressed 9 domains including smoking status, blood monitoring, BMI and physical monitoring.Following the baseline data collection interventions were put in place to increase compliance with monitoring. These interventions included a physical health questionnaire and training of staff in the CMHT to perform phlebotomy and ECGs.Following these interventions the data (74 patients) were re-audited in 2020 following the same domains.After this initial re-audit a physical health monitoring clinic was implemented in order to specifically target this patient population. The data (66 patients) were then re-audited in 2021.ResultsBaseline data identified that domains were reached between 8% (Lipid monitoring) and 51% (glucose monitoring). Following the initial interventions 77% of domains improved in compliance. Between the two periods, notable improvements were observed in the monitoring of Blood Pressure (9% to 37%), ECG (20% to 43%) and lipids (29% to 46%). There was however a decline in all domains between the 2020 and 2021 data, with 66% of domains still having improved compared to 2019 data.ConclusionOverall, interventions have improved compliance with monitoring of physical health for patients on depot antipsychotic medications. It is likely that continuing effects of the COVID-19 pandemic contributed to the decline between the 2020 and 2021 data. As a result of this audit a weekly physical health monitoring clinic has been set up and once formally established it is hoped that compliance with physical health monitoring will continue to improve. Limitations include effects of COVID-19 pandemic, inconsistency in documentation and patient non-attendance to the monitoring clinic. We recommend further audit cycles, with additional interventions being implemented as identified.
Use of Formulation Information Risk Management in Low Secure Services: An Audit Project
Authors: Burns Alex 
Published: June 2022

AimsRisk assessment is a key component of patient care in forensic psychiatry. This audit aimed to measure the completion of different aspects of the Formulation Information Risk Management (FIRM) risk assessment for patients in the care of Low Secure Services. The FIRM incorporates formulation and a care plan into the risk assessment and should be completed for all inpatients in the trust. It was hoped that this audit would help identify any areas of improvement required in the completion of this risk assessment, and provide recommendations that would contribute to improving standards where required.MethodsData were collected on 23rd December 2021 from the electronic patient records of 37 inpatients at a Low Secure Services Unit in Northern England. 5 audit criteria were devised following review of the trust standards regarding the completion of the FIRM assessment. These criteria included the completion of the Current / Historical Risks section, Formulation and Staying Safe / Staying Well Care Plan aspects of the assessment. It also assessed patient involvement in completion of the assessment and whether the assessment had been updated in the last Care Programme Approach (CPA) period. The findings of the audit were presented at a local academic meeting and were distributed to the relevant staff.Results100% of patients had the Current / Historical Risks section completed89% of the patients had the Formulation completed73% of patients had the Staying Safe / Staying Well Care Plan completedIn 16% the service user had been involved in the risk assessment completionIn 70% of cases the FIRM had been updated since the last CPA (or in the last year if not applicable)ConclusionCurrent / Historical Risks section completion rates matched expected trust standards. Significant improvement was seen in completion of the Formulation and Care Plan compared to auditing done in October 2021. There was room for improvement regarding increasing patient involvement in the completion of the risk assessment, often due to it being completed at night leading to the patient being unavailable. It was recommended that the FIRM should be more consistently reviewed and updated as part of each patient's 6 monthly CPA review. A re-audit would prove useful to monitor the progress of these measures, and the scope of a future audit could also be widened to include the timeliness in which the FIRM is completed for new patients.
A Gap in Psychiatry On-Call Training: Post-Ligature Assessment
Authors: Donaldson Maja , Nizam Ain 
Published: June 2022

Aims1. To assess documented practice on post-ligature assessment following a teaching session and simulated induction session introducing a post-ligature assessment tool. 2. To implement the post-ligature assessment tool, for assessing patients who have tied a ligature, into trust guidance. 3. To support the incorporation of simulated induction teaching on post-ligature assessment into the standard induction timetable delivered to all new trainees in the trust, in order to complete the audit cycle.MethodsAudit Cycle 1 - Patient data collection November 2020 - January 2021Action - Locality teaching presenting findings of audit and post-ligature assessment tool developed as part of audit. Concurrent trial of incorporation of post-ligature assessment tool into trust-wide simulation teaching for new trainees.Audit Cycle 2 - Patient data collection August - October 2021ResultsAudit Cycle 1:15 incidents2 involving anchor point/dropMedic informed in 4 incidents0 documented in ABCDE format0 NEWS monitoring3 follow-up plans documented3 complications reportedAudit Cycle 2:10 incidents0 involving anchor point/dropMedic informed in 4 incidents0 documented in ABCDE formatNEWS monitored in 6 incidents4 follow-up plans documented3 complications reportedOverall, slight improvement in documentation of NEWS monitoring and follow-up.ConclusionDocumentation continues to be highly variable. This may be because the teaching done was not trust-wide, simulation session involved only on new doctors in August, some incidents involved locum doctors, and small reach of assessment tool.We aim to introduce the post-ligature assessment tool as part of trust practice through liaison with the resus teaching team, as well as incorporating it permanently into trust-wide simulation induction teaching.
An Audit on Driving Advice After Hospitalization in a Mental Health Unit
Authors: Elsankary Mohammed , Fawaz Israa , Shazad Farhan , Elashmawy Maged 
Published: June 2022

AimsTo ensure driving status is confirmed on admission (Target 100%) and to confirm driving advice is given to all patients deemed unfit to drive (Target 100%) and to ensure adequate documentation is made in online clinical notes with regards to discussions about drivingMethodsThe first cycle of data involved collecting retrospective data from two acute adult psychiatric units and one old age mental health ward. The first cycle of data consisted of inpatients admitted over a two month period in 2020 (36). Data were collected from OpenRio progress notes, OpenRio ward round notes and patient discharge summaries. Following the implementation of interventions the second cycle of data were collected over a 2 month period in 2021. 51 patients met the inclusion criteria for this.ResultsFollowing our interventions, 47% (24) of patients had their driving status confirmed on/during admission compared to 42% (15) in the first cycle. 15 current drivers were identified in the second cycle.Of the confirmed drivers, there was a 6% improvement of patients informed they were unfit to drive. A 22% increase in patients given DVLA driving advice was also noted. DVLA notifications increased by 18% following the interventions.ConclusionThis quality improvement project has shown that educational awareness through teaching sessions and written guidance can improve adherence to national legal guidance. However, further work is required to ensure all psychiatric patients receive adequate information regarding their fitness to drive.