scholarly journals Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S176-S177
Author(s):  
Sarah Brennan ◽  
Rajdeep Routh
Keyword(s):  
Old Age ◽  
Good Practice ◽  
Health Board ◽  
List Type ◽  
Care Planning ◽  
Care Plans ◽  
Information Leaflets ◽  
Medical Emergencies ◽  
Old Age Psychiatry ◽  
Treatment Escalation

AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.

scholarly journals Implementation of treatment escalation plans in an old age psychiatry inpatient hospital

2021 ◽  
Vol 10 (4) ◽  
pp. e001640
Author(s):  
Anne Y T Chua ◽  
Adnaan Ghanchi ◽  
Sangeeta K Makh ◽  
Jessica Grayston ◽  
Stephen J Woolford ◽  
...  
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Tertiary Hospital ◽  
Improvement Project ◽  
Inpatient Hospital ◽  
Psychiatric Setting ◽  
Uptake Length ◽  
Old Age Psychiatry ◽  
Effective Decision Making ◽  
Treatment Escalation

A treatment escalation plan (TEP) enables timely and appropriate decision making in the management of deteriorating patients. The COVID-19 pandemic precipitated the widespread use of TEPs in acute care settings throughout the National Health Service (NHS) to facilitate safe and effective decision making. TEP proformas have not been developed for the inpatient psychiatric setting. This is particularly concerning in old age psychiatry inpatient wards where patients often have multiple compounding comorbidities and complex decisions regarding capacity are often made. Our aim for this quality improvement project was to pilot a novel TEP proforma within a UK old age psychiatry inpatient hospital. We first adapted a TEP proforma used in our partner acute tertiary hospital and implemented it on our old age psychiatry wards. We then further refined the form and gathered data about uptake, length of time to complete a TEP and the ceiling of care documented in the TEP. We also explored staff, patient and family views on the usefulness of TEP proformas using questionaries. TEP decisions were documented in 54% of patient records at baseline. Following revision and implementation of a TEP proforma this increased to 100% on our two wards. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. Feedback from staff showed improvements in understanding about TEP and improved knowledge of where these decisions were documented. We advocate the use of TEP proformas on all old age psychiatry inpatient wards to offer clear guidance to relatives and treating clinicians about the ceilings of care for patients. There are potentially wider benefits to healthcare systems by reducing inappropriate transfers between psychiatry and acute NHS hospitals.

scholarly journals Conversations that count: Advance Care Planning as preventative medicine

2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Kate Grundy ◽  
Jane Goodwin ◽  
Elaine McLardy
Keyword(s):  
Health Care ◽  
Advance Care Planning ◽  
Health Care Professionals ◽  
Consumer Information ◽  
Health Board ◽  
Care Planning ◽  
District Health ◽  
Awareness Campaign ◽  
Care Plans ◽  
Advance Care

Background: Fundamental to the concept of Advance Care Planning (ACP) is empowering individuals and communities to recognise death as an inevitable part of life.Methods: ACP facilitators and clinical champions in the Canterbury region of New Zealand have been very active in engaging the community. This has occurred through consumer presentations, the creation of specific pages on the Canterbury District Health Board (CDHB) consumer information website (HealthInfo) and support of the National ACP awareness campaign ‘Conversations that Count’.Results: ‘Consumer power’ has been invaluable in driving the uptake of ACP in the CDHB. A survey of 49 GPs in 2015 found many were reluctant to start ACP conversations or felt they ‘did not have time’. The turning point was the realisation that patients are not only wanting but are actively asking to have these important conversations and to create Advance Care Plans (ACPlans). 1200 electronic ACPlans have now now been created in Canterbury, with 80% generated in primary care.The ACP pages on HealthInfo are consistently in the top 20 pages viewed each month which indicates that the community is seeking information and wanting to take control. Uptake and demand for consumer presentations and ‘Conversations that Count’ resources also continues to grow year on year.Discussion: Increased awareness and understanding of ACP gives people the opportunity to think and frame their reasoning, so they are better prepared to have well informed discussions with health care professionals. It helps them be clearer in their mind about their own limits and concerns. It is important for people to consider the question - “what is O.K for me and what isn’t?”. In this context, ACP conversations can be seen as preventative medicine.Patients need to be as well equipped as possible to be active participants in healthcare decisions, especially regarding end of life. Through the ACP process, unnecessary suffering, confusion and conflict can be reduced or prevented and unwanted or  burdensome treatment that is not in line with their goals and priorities can be averted.Conclusion: Valuing and honouring a person’s participation in their health care decision-making is important for all healthcare organisations. Prioritising ACP is an effective way of making this happen. 

scholarly journals Clozapine use in old age psychiatry

2018 ◽  
Vol 24 (3) ◽  
pp. 204-211
Author(s):  
Amey Kirrane ◽  
Biswadeep Majumdar ◽  
Anna Richman
Keyword(s):  
Older Adults ◽  
Old Age ◽  
Older Patients ◽  
Learning Objectives ◽  
Ageing Population ◽  
List Type ◽  
Treatment Resistant ◽  
Working Age ◽  
Old Age Psychiatry ◽  
Effective Drugs

SUMMARYClozapine is one of the most effective drugs available to psychiatrists for treating psychosis. It is currently licensed for use in treatment-resistant schizophrenia and psychosis in Parkinson's disease, but its use in old age psychiatry is very uncommon. With the ageing population, and the increased incidence of psychosis in older patients, it is important to consider whether this is a drug that is not being used to its full advantage.LEARNING OBJECTIVES•Appreciate the differences in titration and monitoring of clozapine in older adults, compared with working-age adults•Consider the efficacy of clozapine in older people and its impact on mortality•Understand the side-effect profile of clozapine in older adultsDECLARATION OF INTERESTNone.

scholarly journals Interface between general adult and old age psychiatry

2018 ◽  
Vol 24 (3) ◽  
pp. 188-194 ◽  
Author(s):  
Oleksandr Khrypunov ◽  
Raheel Aziz ◽  
Ban Al-Kaissy ◽  
Ketan Jethwa ◽  
Verghese Joseph
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Old Age ◽  
Mental Health Problems ◽  
Psychiatric Services ◽  
List Type ◽  
Late Life Depression ◽  
Early Onset Dementia ◽  
Old Age Psychiatry ◽  
The Uk

SUMMARYOlder people with mental health problems are entitled to the same level and quality of care as younger people. Several factors continue to influence policy and delivery of older adults' mental health services in the UK. Following the introduction of the Equality Act 2010, there has been a drive to create an ‘ageless’ National Health Service. This has opened up the debate about whether such a service is best equipped to meet the specific needs of older adults. In this contribution we consider the concepts of ‘old age’ and ‘frailty’ and their clinical and service provision implications in psychiatry. The management of late-life depression and early-onset dementia, advance care planning and palliation in dementia are also considered.LEARNING OBJECTIVES•Appreciate how old age psychiatric services and the concept of ‘old age’ have evolved over time•Gain an understanding of issues at the interface between old age and general adult psychiatry and those specific to old age psychiatry•Gain an overview of procedures involved in transferring care between general adult and old age psychiatric services and the need for a separate old age psychiatry subspecialtyDECLARATION OF INTERESTNone.

OAP Actual Problems in European Countries

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
H. Firmino ◽  
N. Tataru
Keyword(s):  
Mental Health ◽  
Old Age ◽  
Health Problems ◽  
Dementia Care ◽  
World Population ◽  
List Type ◽  
Ethical Aspect ◽  
The World ◽  
Old Age Psychiatry ◽  
And Training

Aging of the world population risks to be accompanied by an increase of chronic health problems, and most particularly of mental health problems. To face to these problems the organization of care and education in old age psychiatry is still quite insufficient worldwide. Like in all countries in this part of the world, the geriatric psychiatry is still not enough represented. Only in some countries in Europe old age psychiatry is a recognized specialty (18% of European region countries responded at a WPA survey of teaching and training in OAP). The number of professionals working in the field is still very low to satisfy the needs of care of elderly with mental disorders. There is inadequate training for formal caregivers and lack of support for informal ones. This is the reason to support the development of postgraduate education on old age psychiatry as a priority in Europe. We discuss about teaching and training in old age psychiatry, psychiatric and psychological expertise exams and the assessment of competence in dementia and ethical aspect of care and research in elderly demented people.We also present some aspects of elderly sexuality and abuse and about mental health from strategy to reality and dementia care in different Europe countries.Chairs: Horacio Firmino-Portugal, Nicoleta Tataru-Romania.Speakers:1.Alexandra Milicevic-Kalasic, Serbia: ‘Mental Health in Serbia-from Strategy to Reality’.2.Horacio Firmino, Portugal: ‘Education on Old Age Psychiatry at Europe: facts and proposals’.3.Ilkin Icelly, Turkey: ‘Elderly abuse in Turkey’.4.Jerzy Leszek, Poland: ‘Dementia care in Poland’.

scholarly journals Lithium monitoring in patients over 65 in NHS Greater Glasgow and Clyde

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S32-S32
Author(s):  
Catriona Ingram ◽  
Karli Dempsey ◽  
Gillian Scott ◽  
Joe Sharkey
Keyword(s):  
Old Age ◽  
Catchment Area ◽  
Current Practice ◽  
High Variability ◽  
Health Board ◽  
Data Set ◽  
Number Of Patients ◽  
Adult Psychiatry ◽  
Old Age Psychiatry ◽  
Plasma Monitoring

AimsOur aim was to identify current practice for Lithium monitoring for >65s in NHS GGC and assess compliance to local Lithium monitoring guidelines.MethodA retrospective analysis was undertaken of patient data (demographics, diagnosis, biochemistry results) with Caldicott approval at two points over the course of 2018/19. For the first analysis, old age Community Mental Health Teams (CMHTs) were approached and asked to provide a list of their patients on Lithium. This was then assessed for compliance to Lithium monitoring guidelines.For the second analysis, pharmacy provided data for every patient in the health board dispensed lithium, regardless of whether they were open to a CMHT or not. We were then able to identify patients who we had not picked up on our initial analysis, and re-assess the entire data set for compliance to Lithium monitoring guidelines.ResultFrom our first analysis, 13 CMHTs identified 155 patients on Lithium. There was a high variability in how these patients were identified. 44% of patients were monitored by CMHTs who took bloods and chased them, 38% were monitored by GPs who were prompted by CMHTs in routine clinic letters, and 14% were monitored by GPs who were prompted by CMHTs more assertively using a lithium register. Overall, Lithium plasma monitoring was done well irrespective of method (91%), however compliance to the local standards was poor (58%) with proactive CMHT prompting GPs appearing to be the most effective method (71%).In our second analysis, we identified 508 patients >65 in NHS GGC prescribed Lithium. Of those, 44% were open to old age psychiatry, 25% general adult psychiatry and 19% were not open to anyone. Of those open to old age services, only 58% had been identified in the previous audit. Lithium monitoring compliance was better in those open to a CMHT versus those not (61% to 23%), and better in CMHTs where monitoring was done by CMHTs rather than GPs. For each CMHT, there were roughly 7 patients per catchment area on Lithium not open to psychiatry.ConclusionLithium monitoring does appear to be highly variable and not particularly compliant with local standards. CMHTs have inconsistent methods of identifying patients prescribed Lithium. There are a significant number of patients not open to old age CMHTs prescribed Lithium, and these patients have poorer compliance to Lithium monitoring. Of patients open to CMHTs, CMHT-led monitoring appears superior to other forms.

scholarly journals Home assessments in old age psychiatry

2002 ◽  
Vol 8 (1) ◽  
pp. 59-65 ◽  
Author(s):  
Barbora Richardson ◽  
Martin Orrell
Keyword(s):  
Mental Health ◽  
Older People ◽  
Old Age ◽  
Good Practice ◽  
Fire Hazards ◽  
Adequate Food ◽  
Audit Commission ◽  
Accurate Picture ◽  
Old Age Psychiatry ◽  
At Home

“For people to be successfully supported at home, a comprehensive assessment is an essential first step.” (Audit Commission, 2000: p. 43.)Home visits by old age psychiatrists remain popular with elderly patients, their carers and general practitioners (GPs). Home assessments by various disciplines working with older people have been endorsed as a sign of good practice by the Audit Commission (2000) in their recent national report on mental health services for older people: “Assessment at home is often better as people are most likely to behave and communicate in their normal way in familiar surroundings. Staff can also build a more accurate picture of people's needs and learn the views of their carers. Professionals can observe whether there is adequate food in the house, whether people can make themselves a hot drink, and whether there are any likely risks from poor hygiene or fire hazards.” (Audit Commission, 2000: p. 43.)

Old age psychiatry in Ireland: The way forward

1996 ◽  
Author(s):  
Colm Cooney ◽  
Margaret Kelleher
Keyword(s):  
Old Age ◽  
Old Age Psychiatry ◽  
The Way
Sign in / Sign up

Export Citation Format

Share Document