scholarly journals Audit on monitoring physical health of patients on mood stabilisers following NICE guidelines

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S104-S105
Author(s):  
Sathyan Soundararajan ◽  
Asha Dhandapani ◽  
Claire Jones
Keyword(s):  
Physical Health ◽  
Practice Guidelines ◽  
Health Monitoring ◽  
Good Practice ◽  
Patient Case ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Retrospective Audit ◽  
Clinical Records

AimsThe aim is to find out if the physical health monitoring is adhered to in accordance with NICE guidelines in individuals with Intellectual disability who are on mood stabilisers and known to LD services.MethodWe sought to explore if the physical health monitoring for prescribing mood stabilisers in a sample of people with ID was consistent with good practice guidelines.We collected the data by reviewing the clinical records of individuals with LD who were under the care of mental health services in the CLDT- Wrexham and prescribed a mood stabiliser drug. We also contacted the patient's carers who came to outpatients and by calling the GP surgery and enquiring about the details. We also assessed the Welsh clinical portal in order to assess the blood tests.Data were collected by trainee doctors in Psychiatry. This was a retrospective audit, looking at data from Learning Disability psychiatry caseload. We identified about 16 patients on mood stabilisers.ResultPhysical health monitoring for prescribing mood stabilisers was almost consistent with good practice guidelines. This has shown that the majority of the monitoring has complied. There are few lacunae, such as Thyroid function not being monitored every 6 months for patients on Lithium, Serum Carbamazepine levels not being monitored as per guidelines with 1 patient not having blood done at all whilst on Carbamazepine. Moreover, the details are not readily available for the Consultant/ team when needed, thus making it very tedious for them to search/ contact the GP, etc.ConclusionMedications such as mood stabilisers can increase the risk further if the patient's physical health is not monitored regularly. This can lead to compromised quality of life for the patient and in some cases increased morbidity. Hence we have come up with a proforma that can be attached to patient case notes. This will serve as a record for us and prompt for physical monitoring. We will keep a database online with reminders set. This is to ensure a continuity of care for the patients.

scholarly journals Are we meeting local and national guidelines for physical health assessment following admission to the meadows?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S304-S305
Author(s):  
Yasmin Abbasi ◽  
Ruairidh Morgan ◽  
Alice O'Docherty
Keyword(s):  
Physical Examination ◽  
Physical Health ◽  
Psychotropic Medication ◽  
Health Assessment ◽  
Health Examination ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Healthcare Needs ◽  
Common Diagnosis ◽  
Level Of Consciousness

AimsWe audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.BackgroundSABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.MethodAll admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.The sample included 35 patients.Result55% of patients had a diagnosis of dementia.63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.ConclusionWe found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.

scholarly journals Antipsychotic monitoring in dementia: quality of completion of antipsychotic monitoring forms in an older adult mental health service

2021 ◽  
pp. 1-7
Author(s):  
Helen Anderson ◽  
Anna Kolliakou ◽  
Daniel Harwood ◽  
Nicola Funnell ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Pharmacological Interventions ◽  
Health Records ◽  
People With Dementia ◽  
Adult Mental Health Service

Aims and method To support safe prescribing of antipsychotics in dementia, antipsychotic monitoring forms were embedded into our electronic health records. We present a review of the data collected on these forms to assess prescribing and identify areas for improvement in our practice and processes. Data were extracted from the structured fields of antipsychotic initiation and review forms completed between 1 January 2018 and 31 January 2020. Results We identified gaps in practice where improvements could be made, mainly with regard to physical health monitoring (and particularly electrocardiograms, performed in only 50% of patients) and the low (less than 50%) recorded use of non-pharmacological interventions for behavioural and psychological symptoms of dementia. In addition, antipsychotic treatment was continued despite lack of benefit in almost 10% of reviews. Clinical implications We advocate for recommendations on physical health monitoring of people with dementia taking antipsychotics to be added to the National Institute for Health and Care Excellence guidance on dementia and the Prescribing Observatory for Mental Health (POMH-UK) national audit.

Do clinicians assess patients’ religiousness? An audit of an aged psychiatry community team

2018 ◽  
Vol 26 (4) ◽  
pp. 401-404
Author(s):  
Vahid Payman ◽  
Zheng Jie Lim
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Assessment Tool ◽  
Religious History ◽  
History Taking ◽  
Retrospective Audit ◽  
Old Age Psychiatry ◽  
Clinical Records ◽  
Community Team

Objectives: To determine the frequency and quality of religious history taking of patients by clinicians working in an old age psychiatry service. Methods: A retrospective audit of 80 randomised patient files from the Koropiko Mental Health Services for Older People (MHSOP) in Middlemore Hospital, Auckland, New Zealand. Results: A total of 66 clinical records were available for analysis. A religious history was taken in 33/66 (50%) patients. However, when such histories were evaluated using the FICA assessment tool, only 10/33 (30.3%) histories contained detailed information regarding the patient’s religiousness. Conclusions: The infrequency and low quality of religious histories discovered in this audit suggest that clinicians need more training in taking a religious history from patients.

Meeting standards set for non self-harm presentations to emergency departments

2011 ◽  
Vol 28 (4) ◽  
pp. 185-190
Author(s):  
Diane Mullins ◽  
Siobhan MacHale ◽  
David Cotter
Keyword(s):  
Practice Guidelines ◽  
Emergency Departments ◽  
Good Practice ◽  
Beaumont Hospital ◽  
Psychosocial Assessment ◽  
Standards Of Care ◽  
Nice Guidelines ◽  
Deliberate Self Harm ◽  
Self Harm ◽  
Recorded Data

AbstractObjectives: The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.Method: From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.Results: Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.Conclusions: The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.

scholarly journals Testing a computerised tool to improve physical health monitoring in a medium secure forensic setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S222-S223
Author(s):  
Mike Smith ◽  
Mustafa Abbas
Keyword(s):  
Physical Examination ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Relevant Information ◽  
Substantial Improvement ◽  
Due Date ◽  
Blood Tests ◽  
The Past ◽  
Health Checks

AimsThis project aimed to improve adherence to regular monitoring of the physical health of inpatients within a medium secure forensic psychiatric unit. A computerised tool to remind doctors to do checks was created, which was proposed would improve adherence.BackgroundThe physical health of people with mental health problems is of some concern, with higher rates of physical comorbidity and mortality compared to the general population.The forensic inpatient population has a high burden of both severe mental illness and physical ill health, and a high medication burden with potential adverse effects on physical health.To support the health of patients in our medium secure unit, each should routinely have three physical health checks done at least every six months. These are 1) an electrocardiogram (ECG), 2) a set of blood tests and 3) a full physical examination.MethodPatient records for 26 patients across two medium secure psychiatric wards were checked for 1) an ECG, 2) a full set of blood tests and 3) a full general physical examination within the past 6 months.A tool was created that automatically calculated the next due date for each check and colour coded which were overdue (red) or within 30 days of the due date (yellow). This tool was given to the core trainees working on these wards to help them keep track of which checks needed to be done.The records for patients on the same two wards were rechecked four months later and the adherence rates compared.ResultOn both wards, for each of the three physical health checks, a substantial improvement was seen in the proportion completed within the past 6 months.ConclusionThe tool created was a useful means of presenting, in one place, relevant information needed by doctors working in medium secure forensic wards regarding physical health checks, and drawing their attention to tasks that needed to be done. This led to an improvement in the adherence to physical health monitoring in these wards. An area for future improvement was identified regarding the unit's capacity to perform ECGs in a timely manner.

scholarly journals Improving standards in clinical record-keeping

2006 ◽  
Vol 12 (4) ◽  
pp. 280-286 ◽  
Author(s):  
Ian Pullen ◽  
John Loudon
Keyword(s):  
Clinical Care ◽  
Good Practice ◽  
General Medical Council ◽  
Medical Council ◽  
Record Keeping ◽  
Fit For Purpose ◽  
Clinical Tools ◽  
Reasons For Decisions ◽  
Clinical Records

Clinical records are the most basic of clinical tools. Aggregated, they form a permanent account of individual considerations and the reasons for decisions. Essential for effective communication and good clinical care, they are often accorded low priority, are poorly maintained and not readily available. Independent inquiries, health ombudsmen's reports and the courts have repeatedly criticised the quality of records and the resulting failings of care. Most advice from professional bodies, indemnity organisations and the General Medical Council is extremely brief and confined to individual entries in the record. Patient safety and the demands of clinical governance make change essential. This article draws together standards and concludes with some good practice points for a fit-for-purpose, structured, multidisciplinary record to support good care and protect the interests of patients and clinicians. These principles should be equally applicable to electronic records.

scholarly journals Improving physical health monitoring for out-patients on antipsychotic medication

2010 ◽  
Vol 34 (3) ◽  
pp. 91-94 ◽  
Author(s):  
Carlos Gonzalez ◽  
Niyaz Ahammed ◽  
Robert Fisher
Keyword(s):  
Mental Illness ◽  
Inner City ◽  
Physical Health ◽  
Health Monitoring ◽  
Health Assessment ◽  
Clinical Implications ◽  
Blood Testing ◽  
Routine Blood ◽  
Physical Morbidity

Aims and methodMental illness is associated with increased physical morbidity. We aimed to assess and improve the routine blood testing of prescribed antipsychotics in out-patients from a busy London inner city area. Audit findings were presented locally to prescribers, together with educational suggestions to improve physical health assessment.ResultsInitially, the numbers monitored were low in the overall number of 126 patients included in the first audit. Following the intervention, this improved significantly in the second audit (of 106 patients).Clinical implicationsA simple one-page monitoring prompt and an educational intervention could significantly increase the adherence to routine blood-testing guidelines. Better physical screening may help reduce physical morbidity and mortality, and improve the quality of life of individuals with mental illness.

scholarly journals Are blood tests being performed for new inpatient admissions to a psychiatric hospital as recommended by RCPsych guidelines?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S98-S98
Author(s):  
Isabella Piper
Keyword(s):  
Physical Health ◽  
Blood Test ◽  
Health Conditions ◽  
Full Blood Count ◽  
Thyroid Function Tests ◽  
Electronic Reminder ◽  
Blood Tests ◽  
Standard Set ◽  
Clinical Records ◽  
Health And Mortality

AimsSevere mental illness (SMI) has a significant impact on a person's physical health and mortality. There is a 10–25-year life expectancy reduction in patients with SMI. The majority of deaths are due to physical health conditions. The Royal College of Psychiatry (RCPsych) sets out a standard that new inpatient admissions to Mental Health Services should have routine blood tests performed within 24 hours of admission, unless they have had a recent blood test. The aim of this audit was to review whether blood tests were performed either in the 48 hours preceding admission or the 48 hours after admission to Leverndale Hospital.MethodClinical records were reviewed for new inpatient admissions to two general adult wards over a four-month period.Result79 patients were admitted (M = 39, F = 40, Age: 18–62 years old). 70/79 (89%) had blood tests performed within the 48-hour timeframe. 5/79 (6%) had a blood test performed after 48 hours of their admission. 4/79 (5%) did not have a blood test. The blood tests performed varied. 51/75 (68%) patients had at least one abnormal blood test. The yield of abnormal blood results ranged from 2% for thyroid function tests to 35% for a full blood count.ConclusionThis audit has established that the majority of patients had blood tests performed within the 48-hour timeframe. This could be improved by setting up an electronic reminder to prompt the clinician to perform a blood test at 24 hours as per RCPsych guidance if one had not yet been done. The blood tests performed varied. RCPsych guidance does not specify which blood tests should be done. A further scope for this audit could be to review the clinical significance of abnormal blood results to develop a standard set of blood tests for admission.

scholarly journals Physical health monitoring of patients prescribed depot antipsychotic medication in north west Edinburgh community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S336-S337
Author(s):  
Douglas Murdie ◽  
Jakub Wojtowicz ◽  
Alexandra Thompson ◽  
Anne MacLeod ◽  
Adam Mallis ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
North West ◽  
Depot Antipsychotic ◽  
Major Mental Disorder

AimsTo monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.BackgroundAntipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.MethodThe records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.ResultWe identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.ConclusionThere is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.

scholarly journals Are the rapid tranquilisation nice guidelines adhered to, in patients with agitated/aggressive behavior? a QIP

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S184-S185
Author(s):  
Asha Dhandapani ◽  
Sathyan Soundararajan ◽  
Rajvinder Sambhi
Keyword(s):  
Intensive Care Unit ◽  
Physical Health ◽  
Health Monitoring ◽  
Positive Reinforcement ◽  
Nice Guidelines ◽  
North Wales ◽  
Rapid Tranquilisation ◽  
The Difference ◽  
The Uk ◽  
Open Wards

AimsTo explore whether the NICE guidelines for rapid tranquilisation are adhered to in the Psychiatric intensive care unit (PICU/ Tryweryn).MethodData were collected by core trainees. Standards were taken from NICE guidelines NG10. All patients who had received rapid tranquilisation, that were in PICU from August 2019 to February 2020 were considered in this a.ResultDuring the first PDSA, we discussed with the staff in the ward regarding the protocol. Prior to actually starting the second audit, the adherence was noted to be low. However following persistence and having created a protocol jointly with the ward manager, we could see the difference. The staff were appreciated for their efforts in maintaining 100% adherence. The same was intended to be continued with some positive reinforcement from the auditing team. Over the first 2 months, 12 patients received Rapid Tranquilisation. Out of these 12, we randomly selected 4 patients to find the adherence of the NICE guidelines to be 100 per cent. The predictions regarding the adherence to protocol showed that the PDSA was successful.During the second PDSA, the adherence was 100% again. The adherence to the protocol has been followed for not just the sample that was selected, but for the entire set of patients who received the Rapid Tranquilisation. Following this QIP, we formatted the proforma which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and response to medication.ConclusionThe utilisation of de-escalation techniques and behavioural support plans that was person-centred in turn brought down the rate of Rapid Tranquilisation successfully. Thus placing our PICU as having the least restraints in the UK in 2019 (Second least 3/ month). Our PICU was awarded the prestigious Nursing Times Team of the Year Award for their pioneering work.Following this QIP, we then formatted the proforma for Rapid Tranquilisation which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and patients response to medication. The PICU will continue to maintain this 100% standard and we would then consider extending the Audit to both Open wards and PICU in entire North Wales.

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