bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Audit on the Adherence to Antipsychotic Prescription Policy for the Management of Delirium in the Medical Wards
Authors: Simiyon Manjula , Loo Jiann , Baker Catherine , Lepping Peter , Jones Steven 
Published: June 2022

AimsThis audit aimed to assess the adherence to the anti-psychotic policy for delirium in the medical wards. It aimed to assess compliance with each of the guidelines mentioned in the health board's policy which is based on the National Institute for Health and Cares Excellence (NICE) guidelines.MethodsAfter registering the audit, the Acute medical ward was approached for the hospital numbers of all the patients admitted in the months between January and March 2021, and 70 case records were screened. Case notes of patients above 18 years who were diagnosed with delirium including those after managing alcohol withdrawal were included. Those who were admitted only with alcohol withdrawal delirium were excluded. 47 case records were selected for data collection. A proforma was prepared based on the policy available in the intranet and data were entered.ResultsRetrospective data of 47 patients who had delirium were analysed which included 18 males and 29 females. The mean age of the participants was 80.7 years (range 40–101; SD + 30). The mean days of referral after admission were 28(+7.07). 34%were diagnosed to have delirium by the treating team,8.5% were diagnosed by the Emergency Department (ED) team and 57.4% were diagnosed by the liaison psychiatric team. 57% had another psychiatric diagnosis. The cause for delirium was mentioned in 55% of the records and the most common cause was urinary tract infection (31%) followed by multifactorial delirium (27%). Antipsychotics were prescribed for 57% and among those who received 74% received risperidone, 15% received olanzapine, and 11% haloperidol. Compliance was 100% in prescribing appropriate antipsychotics, maximum dose, investigations (expect x-ray chest and CT scan), only 54% compliance was observed with regards to stopping the antipsychotic before discharge and in 23% it was mentioned to be monitored by the GP and another 23% by the treating team.ConclusionThis audit has displayed the lacuna in the prescription of antipsychotics for patients diagnosed with delirium. Periodic programs will be planned and executed for training the liaison practitioners and the staff in the medical wards regarding the diagnosis and management of delirium especially the prescription of antipsychotics. A re-audit will be conducted after 6 months.
An Audit of Compliance With NICE Guideline: Obesity: Identification, Assessment and Intervention by the Forensic Community Mental Health Team Based at a Supported Accommodation
Authors: Lin Chung Mun Alice , Sud Neeti 
Published: June 2022

AimsIn England, 64.8% of adults are currently classified as overweight or obese, with rates even higher in the North East at 68.6%, especially in adults with severe mental health illnesses. This additional body weight has the potential to increase the risk of developing a number of serious health conditions including diabetes, heart disease and even cancer. Studies have shown that patients with schizophrenia have a 2.8–3.5 increased likelihood of significant weight gain and reduction in life expectancy of 15–20 years, mainly due to preventable physical illness. Monitoring of risk factors for this, particularly weight gain, is therefore crucial. The NICE Guideline (2014) recommends that patients are routinely categorised into BMI categories to assist with obesity identification, management, and monitoring. A waist measurement is also advised to help with risk stratification. Patients with psychosis or schizophrenia, especially those taking anti-psychotics are also recommended to be offered a combined healthy eating and physical activity programme by their mental healthcare provider. Finally, patients with rapid or excessive weight gain, abnormal lipid levels or problems with blood glucose management should be offered appropriate interventions. Our main objective was to identify whether the obesity assessment, monitoring and intervention care delivered by our community team is in line with current guidance.MethodsA total of 12 residents living in community forensic supported accommodation and currently taking antipsychotic medications were included. Data reviewed were from September 2020 to September 2021. Data audited were from electronic medical records.ResultsThis audit found that 10 out of 12 patients (83%) fell into either the overweight or obese BMI categories (seven obese and three overweight). Only four patients had agreed to have their waist circumference measured, which meant only four patients were able to be appropriately risk stratified. One patient was identified as pre-diabetic and another diabetic. All patients identified to be overweight or obese received appropriate lifestyle advice. Qrisk scores, to assess cardiovascular risk, were calculated for the majority of eligible patients, except for two.ConclusionThis audit highlights that patients who are on regular antipsychotic treatment and living in the community are at high risk of obesity and its associated complications. It is important to perform regular health checks in this cohort due to this risk, both to improve their quality of life and prevent significant morbidity and mortality. Waist circumference measurements should be encouraged to enable risk stratification and accurate documentation will enable timely treatment intensification.
A DVLA Notification Audit in Forensic Supported Accommodation
Authors: Lin Chung Mun Alice , Lim Nicole , Sud Neeti 
Published: June 2022

AimsThe Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver. The driver is legally responsible for telling the DVLA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Patients with acute schizophrenia or an acute psychotic disorder must not drive and must notify the DVLA. In alliance with the above, the GMC advises that clinicians have a responsibility to explain the above information to the patient and inform them that they have a legal duty to inform the DVLA. Doctors should also inform patients that relevant medical information may need disclosing about them to the DVLA if they continue to drive against advice, and any advice given should be documented. The main objective of this audit is to identify if notification of DVLA for forensic patients living in supported accommodation, is in accordance with the DVLA guidelines.MethodsA total of 12 residents living in community forensic supported accommodation who have a notifiable diagnosis were included. Data collection took place in September 2021, looking through all previous records relating to the search words “DVLA”, “drive”, “driving” and “license”. Data audited were from the trust's electronic patient records.ResultsDiagnoses included paranoid schizophrenia, delusional disorder and personality disorder. Antipsychotic medications included Olanzapine (oral and IM), Clozapine and Zuclopenthixol +/- antidepressants. Legal status included community treatment orders (civil section), voluntary community patients and those on a conditionally discharged restriction under secretary of State supervision. Two patients held full driving licences and a further two held provisional licences, with DVLA documented discussions and notification compliance at 100%. The remaining eight patients had no documentation regarding driving nor DVLA discussions or notification.ConclusionThis audit found that DVLA discussions are not currently well documented, with only four patient records that have this recorded. Although it is the clinical team's responsibility to advise the patient to notify the DVLA, it is ultimately the patient's responsibility to notify the DVLA themselves. DVLA discussions need to be had regardless of driving status and documentation should reflect this.
Audit: Do Electronic Mental Health Records Match General Practice Shared Records of Medications and Allergies for Patients Residing at a Community Forensic Supported Accommodation?
Authors: Bernard Kate , Sud Neeti 
Published: June 2022

AimsMedicine reconciliation in community teams is guided by trust guidance, which emphasises that for all new patients accepted into a community team, staff should be aware of all current medication (both psychotropic medication and those prescribed for physical health needs). This information needs to be considered at each review to inform safe prescribing. Upon this background, concordance between electronic mental health records and general practice shared records of medications and allergy status for patients residing at a community forensic supported accommodation was audited in order to identify areas for improvement in practice.MethodsData were collected from mental health electronic records (Rio) and general practice records (Health Information Exchange). All patients residing full-time at a community forensic supported accommodation in Cumbria Northumberland Tyne and Wear NHS Foundation Trust during January 2022 were included. Concordance between the records in medication and allergy status was assessed. Initial assessment was performed by one reviewer and 100% of included records were then cross checked by a second reviewer. Data collection was intended to pick up any mismatch in the records. Standards were set at 100% concordance.ResultsEight patients were included. For allergy status, in two patients’ (25%) records showed allergies which were present in electronic mental health records were not present in general practice records. The reasons as to lack of documentation of allergy status in general practice records were unclear. Cross check of the discharge summaries to primary care from the wards where allergies were originally identified indicates that allergies were clearly documented.For medication, discrepancies between records were found in two patients (25%). In these patients, medications present on general practice records were not present on mental health records. These were both physical health medications (vitamin D supplements) which were being prescribed regularly by primary care and had been omitted during transcription onto electronic mental health records.Conclusion1) Currently, standard practice is for updates of medication on mental health records to take place every four months as part of quarterly care coordination reviews. Electronic mental health records should not be relied upon solely to check patients’ medication: while they provide a snapshot, cross checking with primary care records and pharmacy remains a must. This is current practice and ensures patient safety.2) Primary care to be made aware of the omissions and requested to update their records as per the discharge summaries.3) Continue regular re-audits every four months
Buckinghamshire Early Intervention Service’ (BEIS) Compliance With the National Institute for Health and Care Excellence (NICE) Antipsychotic Monitoring Guidelines: Practical Challenges, Including Those Posed by the Pandemic, in an Outpatient Setting
Authors: Tan Shinn , Butt Harun , Pike Grace , Williams Busayo , Breton Alexandre , Reid Alaistair 
Published: June 2022

AimsAntipsychotic use is associated with cardiovascular and metabolic side-effects, which may contribute to increase mortality and morbidity in this patient group. This highlights the importance of physical health monitoring. We aimed to assess our compliance with the more stringent NICE guidelines, updated in September 2021.MethodsHalf of BEIS team's caseload was audited (n = 67) during October 2021 for compliance with NICE's monitoring guidelines for patients initiated on antipsychotic medication. These included initial and, if indicated, repeat monitoring of body mass index (BMI), pulse, blood pressure (BP), blood results, electrocardiogram, and adverse effects. Patients who were not on antipsychotics were excluded. 61% of patients were initiated on antipsychotics as inpatients, and 39% were outpatients. These patients have been started on antipsychotics within the last three years. Data were collected via electronic record systems. 80% compliance was set as the standard, in line with National Clinical Audit of Psychosis standards.ResultsIn the first three months of antipsychotic initiation (61% as inpatients, 39% in the community) six out of nine parameters met standards (ranging from 2% to 100%), with BMI measurement (weekly), pulse and BP measurements and one month repeat haemoglobin A1C (HbA1c) failing. When only accounting for patients who were started on antipsychotics in outpatient settings (BEIS or crisis team), compliance was only met on two parameters.Three months post initiation, when patients were mainly monitored in the community, only three of the nine parameters met compliance (lipids, HBA1c, and side-effects).ConclusionAdherence to the NICE standards for physical health monitoring in the community poses significant challenges. Possible barriers include reduced patient contact during the pandemic, lack of awareness of monitoring requirements, poor documentation (particularly of declined screening) and a lack of time and resources. There is also a possibility of unnecessarily stringent and impractical guidelines which are difficult to achieve in outpatient settings – such as weekly BMI. We plan to implement interventions including providing a checklist for medical and nursing staff and encouraging patients to monitor their own blood pressure and weight at home. We will reaudit the same parameters in 6 months’ time.
Availability and Functionality of Physical Health and Resuscitation Equipment in an Inpatient Setting: A Closed Loop Audit Cycle
Authors: Tang Song Ling , Fadlalla Ikhlas 
Published: June 2022

AimsTo ensure physical health and resuscitation equipment on all wards in a mental health hospital fulfil relevant standards. A closed-loop audit of this was performed on four acute adult inpatient wards after implementing interventions.MethodsData were collected from treatment rooms on each ward, with standards based on Physical Health in Mental Health; Final Report of a Scoping Group (Royal College of Psychiatrists) and Mental Health Inpatient Care Equipment and Drug Lists (Resuscitation Council UK) – parallel to the trust approved standards.Percentage of availability and functionality against audit standards were tabulated and interventions were carried out, including:
1.Awareness presentations at trust clinical governance meetings.2.Each ward to have own complete sets of physical health and resuscitation equipment.3.Policy for wards to register their physical health equipment and service details on the trust maintenance services database. The medical device engineering team to complete maintenance and repair as needed.4.Resuscitation equipment on each ward being checked weekly and replaced as needed (monthly before).A re-audit was performed one year post intervention on four acute adult inpatient wards in the mental health hospital using similar parameters.Results1.In general, 90.0% of the standards are met (out of 160 pieces of equipment, 144 are in stock and functional), similar to that of previous year (90.0%).2.Decrease in overall available and functional physical health equipment: 76.6% (49/64) compared to 83.8% last year.3.Increase in overall in overall available and functional resuscitation equipment: 99.2% (95/96) compared to 94.2% last year.ConclusionThere is a significant decrease in percentage of overall available and functional physical health equipment; while that of resuscitation equipment has significantly improved when checked and corrected weekly using the trust Resuscitation Check Form.Action plan:
1.All unavailable/ inadequate equipment to be reordered or sent for maintenance immediately.2.Discussion in the upcoming trust Physical Health Nurses Forum and Medical Devices Standards Group on audit recommendations below:
. Allocation of named permanent staff member to check presence and functionality of medical equipment regularly.a. Creating a checklist similar to the Resuscitation Check Form for physical health equipment.3.Discussion in the trust Resus Standards Group on ‘My Kit Check’ (MKC), a centrally monitored electronic checking platform with alerts automatically sent for incomplete checks or expired resuscitation items (e.g., AED batteries, anaphylaxis kit) that are not replaced. A funding request has been submitted for this.
Audit on Smoking Cessation in a Community Secondary Mental Health Service
Authors: Tu Hanna , Campion Jonathan 
Published: June 2022

AimsSmoking is the single largest cause of preventable death. Smoking prevalence is higher in people with mental disorders and impacts on physical health, mental health and bioavailability of psychotropic medications. Evidence-based interventions exist to support smoking cessation (SC)/reduction in people with mental disorders, although evidence suggests less provision compared to the general population. We aim to determine the unmet SC needs and associated causes in a community secondary mental health service, in order to advise appropriate service response. This audit will inform relevant work of the RCPsych Public Mental Health Implementation Centre as a case example.MethodsFrom the caseload of 364 patients, a sample of 91 case records was randomly selected for recording of smoking and provision of treatment. A survey of 31 smokers and 12 ex-smokers identified patient attitude and barriers in SC. Information on availability and nature of other SC provision in the community was gathered from staff and relevant services.ResultsA sample of case records found 44% (n = 40) of patients were smokers compared to 13,5% in the general UK population. 31 patients were offered SC advice of whom 2 were recorded as wanting to quit. Nicotine Replacement Therapy (NRT) was offered to 13 patients and 5 were referred to SC services (SCS). Aside from smoking status, limited information on smoking was recorded.The survey revealed that 20/31 smokers wanted to reduce or quit smoking, of whom 10 used NRT. Six were referred to SCS which helped 3 reduce. Four ex-smokers used SCS, which helped 3 to quit. Most frequently reported barriers in SC were habit, social isolation, availability of tobacco, and stress. Frequently reported enhancers in SC were NRT, allocated support with follow-up, social interventions and family support.Regarding current service provision, we identified that local GP's did not prescribe NRT. Targeted SCS exist exclusively for inpatients and the only community SCS available offered 12 SC sessions without targeting needs of people with mental disorder.ConclusionDespite high smoking prevalence in our caseload, there is an implementation gap in providing and recording SC advice and treatment, both in our service as in local primary care and community services. Provision of evidence-based interventions and coordination with GP's and SCS could prove useful in narrowing this gap. Results from this local project could be explored on a larger scale to address the implementation gap in SC in this population at high risk of smoking associated harm.
An Audit of the DNACPR Policy at Malta's Mount Carmel Hospital
Authors: Warwicker Sean , Bellizzi Annalise 
Published: June 2022

AimsA consideration for patient dignity in end-of-life care dictates that good clinical judgment should be exercised in advance resuscitation decisions. The COVID-19 pandemic, and its inherent risks to caregivers, only adds to this importance. Our aim was to audit the standards for the DNACPR policy at Mount Carmel Hospital (MCH), which is Malta's major inpatient psychiatric hospital, against those at Saint Vincent De Paule Residence (SVPR), which is a long-term care facility where DNACPR decisions are taken by geriatricians as opposed to psychiatrists.MethodsResuscitation status designation and rates of form completion were measured in the five chronic psychiatric inpatient wards at MCH. This 98-patient population was compared against an age-matched cohort from SVPR to evaluate differences in decision-making.Medical comorbidities and frailty scores (measured using the Clinical Frailty Scale) were compared between the two groups. As far as age-groups would allow, as many patients with a psychiatric comorbidity as possible were included from SVPR (36).Z-score testing for two population proportions was used to evaluate the differences in resuscitation status designation. The Independent Sample T-Test was used to compare means in medical comorbidity and frailty. A p-value of <0.05 was used to assume statistical significance.ResultsRates of resuscitation form completion were 73.47% and 94.90% in MCH and SVPR, respectively. In those patients with completed documentation, 9.72% of patients were designated as “Not for CPR” in MCH, compared to 61.29% in SVPR.Between these two age-matched cohorts, the mean frailty score was slightly greater in SVPR, which was not statistically significant (5.83 vs 5.48, p = 0.1456). The mean number of medical comorbidities was significantly greater in the SVPR cohort (3.50 vs 2.47, p = 0.0002).ConclusionThis striking difference in DNACPR designation suggests that geriatricians have a higher threshold for determining whether a patient would benefit from CPR compared to psychiatrists. Furthermore, rates of resuscitation form completion at MCH were disappointing. The greater likelihood for chronic psychiatric inpatients to be designated “For CPR” may be due to the perception that this entails a higher level care. In reality, in older, frailer patients, CPR may only prolong suffering, while a “Not for CPR” decision does not necessarily imply an omission of care.In Malta, we've tailored resuscitation training to the inpatient psychiatry setting, which includes stations on decision-making and COVID-19.