scholarly journals Improving cardiometabolic screening on an inpatient psychiatric ward: a quality improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S194-S194
Author(s):  
Harrison Howarth ◽  
Jonathan Pass ◽  
Fahel Ahmed ◽  
Sarah Wiethoff
Keyword(s):  
Mental Illness ◽  
Quality Improvement ◽  
General Population ◽  
Serious Mental Illness ◽  
Quality Improvement Project ◽  
Cardiometabolic Health ◽  
Improvement Project ◽  
Information Leaflets ◽  
Increased Risk ◽  
Cardiometabolic Screening

AimsPrimary aim: To increase the proportion of patients receiving a full cardiometabolic screen whilst on the ward to 75%.Secondary aims: To improve communication with GPs regarding cardiometabolic health, to improve the rates of intervention when abnormalities are found to 75%.BackgroundPeople with serious mental illness are known to have significantly increased risk of cardiometabolic syndrome than the general population. Estimates suggest there would be up to 12,000 fewer deaths from cardiovascular disease if people with serious mental illness had the same outcomes as the general population. People with serious mental illness die on average 20 years earlier than the general population due to preventable physical health problems.Whilst on the ward, we have an excellent opportunity to screen and treat patients with cardiometabolic risk factors, yet screens are often incomplete, not acted upon, or simply not carried out.MethodUsing the Plan-Do-Study-Act (PDSA) methodology, we trialed interventions to improve the cardiometabolic screening process on out 16 bed inpatient ward. Across 8 cycles, we set up a protocol to ensure all new patients received a full cardiometabolic screen during their admission reviews, engaged nursing staff with the process and managed inconsistencies with blood transportation and delivery. We also started using British Heart Foundation information leaflets, and treating patients in accordance with the Lester Tool: Positive Cardiometabolic Health Resource. We made design changes to the discharge summary template allowing for clear communication with GPs on discharge.ResultAt the end of 8 cycles, we had achieved 100% compliance with the full cardiometabolic screen (as defined by the Lester Tool) from a baseline of just 25%. We also improved intervention with identified abnormalities from a baseline of 0% to 100%.ConclusionImprovements in cardiometabolic screening and treatment were possible using the PDSA methodology. Given the success of this quality improvement project, we plan to introduce our methodology onto other wards in the trust.

Bringing Personalized Medicine to a PACT Program: A Quality Improvement Project

2019 ◽  
Vol 26 (1) ◽  
pp. 77-85
Author(s):  
Virginia M. Conley ◽  
Sandra Daack-Hirsch ◽  
Katie Halbmaier ◽  
Lisa Shaw
Keyword(s):  
Mental Illness ◽  
Quality Improvement ◽  
Severe Mental Illness ◽  
Symptom Relief ◽  
Quality Improvement Project ◽  
Community Treatment ◽  
Care Utilization ◽  
Outpatient Services ◽  
Program Outcomes ◽  
Improvement Project

INTRODUCTION: Programs for assertive community treatment (PACT) serve persons with severe mental illness who have been unsuccessful with traditional outpatient services. Many PACT clients struggle to obtain symptom relief with medications that often have poor efficacy and undesired side effects, which can result in nonadherence, relapse, and increased health care utilization with associated costs. AIMS: This quality improvement project aimed to improve client and PACT program outcomes by incorporating pharmacogenomic testing into the psychopharmacological decision-making process. METHODS: The project used a pre–posttest design with each client serving as their own control to evaluate changes in clients’ symptoms and program outcomes resulting from pharmacogenomics-guided medication management. RESULTS: Following project implementation, clients’ symptoms were decreased and both engagement in care and stability in the community increased. Psychiatric hospitalizations and associated costs decreased. CONCLUSIONS: This project suggests utility for using pharmacogenomics testing to personalize care for persons with severe mental illness.

scholarly journals 55 Quality Improvement Project to Assess How Informed Patients are About do not Attempt Cardiopulmonary (DNACPR) Decisions?

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
P Jayasuriya ◽  
Y Amanullah ◽  
A Kumar ◽  
C Hookey
Keyword(s):  
Quality Improvement ◽  
Medical Staff ◽  
Quality Improvement Project ◽  
Next Of Kin ◽  
Geriatric Ward ◽  
Improvement Project ◽  
Information Leaflets ◽  
Journal Clubs ◽  
Weekly Journal

Abstract Introduction Despite growing evidence regarding DNACPR decisions, there is a paucity of information given to patients regarding resuscitation decisions. The main aim of this quality improvement project was to assess and improve patients’ and their relatives’ understanding about DNACPR decisions. Intervention We initially surveyed 30 inpatients or their next-of-kin (if the patient lacked capacity) in a geriatric ward who had DNACPR decisions in place. Although, 86% knew the implications of a DNACPR decision, only 50% knew that a DNACPR decision would not limit them from receiving other treatment. 66% reported that the information given by the healthcare professional is “too little”. 35 questionnaires were also given to doctors of all grades to assess their practice of DNACPR discussions and barriers for discussion. Majority (95%) of doctors knew what should be included in a DNACPR discussion. Medical staff not considering DNACPR discussions during assessment, medical staff not comfortable to make the DNACPR decision and the fear of distressing the patient are the three main issues that were highlighted as barriers. 17% of doctors reported that they would have attended a cardiac arrest at least on 2-5 occasions for a patient when resuscitation was futile. We presented this data and educated doctors on effective DNACPR discussions using video demonstrations in weekly journal clubs. All doctors were informed to distribute DNACPR Improvement After the intervention, only 80% understood the DNACPR discussion. 76% knew that DNACPR does not limit them from receiving other treatment. 73% reported that this was not stressful and 76% were satisfied with the discussion and reported that their questions were answered adequately. 11 out of 30 patients had received the information leaflets and all found it useful. Discussion Although after the intervention the percentage who understood the DNACPR decision had reduced compared to the initial audit, there was a 20% improvement in who knew that DNACPR decisions did not limit other treatment. We hope to extend this study by carrying out training sessions for doctors to improve the quality of these conversations and thereby enhance adherence to expected practice in DNACPR decision making.

817 A Proactive Feeding Regimen on Meeting Caloric Goals with Continuous Enteral Nutrition Support: A Quality Improvement Project

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S247-S248
Author(s):  
Elizabeth Lu
Keyword(s):  
Quality Improvement ◽  
Enteral Nutrition ◽  
Total Body Surface Area ◽  
Quality Improvement Project ◽  
Nutrition Support ◽  
Burn Patients ◽  
Improvement Project ◽  
Impaired Wound Healing ◽  
Protocol Group ◽  
Increased Risk

Abstract Introduction Severe burn injuries are characterized by elevated metabolic demands. Numerous studies have documented iatrogenic underfeeding of critical care patients, which can lead to malnutrition, impaired wound healing, weakened immune response, and increased risk of infections. Enteral nutrition (EN) support is often utilized to help meet the increased caloric demands of burn patients. However, discrepancies between prescribed and delivered EN can occur due to frequent interruptions, delays initiating EN, gradual advancement of EN rate, and/or physician directed changes. The objective of this quality improvement project is to assess whether a proactive calculation of EN regimens can improve the provision of calories compared to a traditional calculation method. Methods A retrospective review of patients in a pediatric acute burn unit that received continuous EN for greater than three days was performed. The pre-protocol group consisted of patients from January 1st, 2017 to November 30th, 2017 who had continuous EN rates calculated by the dietitian based on 24 hours per day. This group was compared to patients from September 1st, 2018 to July 31st, 2019 who had EN rates calculated by the dietitian based on 23 hours per day (post-protocol group). Periods in which parenteral nutrition was administered or the EN regimen was prescribed in a non-continuous fashion were excluded. The primary outcome measure was the percentage of admissions in which patients met at least 85% of calorie estimations. This project was undertaken as a Quality Improvement initiative and, as such, was not formally supervised by an Institutional Review Board. Results A total of 132 patients (73 pre- and 59 post-protocol) from 134 separate inpatient admissions (73 pre- and 61 post-protocol) were identified. The average total body surface area burn was 40.9% (SD 18.8) vs. 49.4% (SD 19.8) and average age was 8.6 years (SD 5.9) vs. 7.9 years (SD 5.4) in the pre- and post-protocol groups, respectively. Continuous EN ran for an average of 20 hours a day (SD 2.2, median = 21) vs. 21 hours a day (SD 2.7, median = 22) in the pre- and post-protocol groups, respectively. The average number of days on continuous EN was comparable in both groups. The post-protocol group had 75% of admissions meet at least 85% of calorie estimations compared to the pre-protocol group with 52% of admissions having met the goal. Conclusions Due to the heightened metabolic demands of burn patients and the barriers to meeting caloric goals, it is important to minimize calorie deficits with EN support. Although a seemingly small change, calculating continuous EN rates based on 23 hours per day can yield improved caloric provisions compared to rates based on 24 hours per day. Applicability of Research to Practice A proactive approach to calculating continuous EN support should be considered to help decrease caloric deficits.

scholarly journals Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S38-S39
Author(s):  
Fraser MacNicoll ◽  
Mong Sun Tung ◽  
Brion McGowan
Keyword(s):  
Quality Improvement ◽  
Old Age ◽  
Quality Improvement Project ◽  
Assessment Process ◽  
Early Warning Score ◽  
Post Intervention ◽  
Improvement Project ◽  
Physical Deterioration ◽  
Increased Risk ◽  
Old Age Psychiatry

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

scholarly journals Improving patient access to medication information: a quality improvement project on patient-centred prescribing

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S225-S225
Author(s):  
Anna Todd ◽  
Rosy Blunstone
Keyword(s):  
Quality Improvement ◽  
Good Practice ◽  
Ward Round ◽  
Discussion Groups ◽  
Quality Improvement Project ◽  
Routine Practice ◽  
Improvement Project ◽  
Information Leaflets ◽  
Medication Information ◽  
The Impact

AimsWard rounds are sometimes the only opportunity for patients to discuss medication. Patient and professional feedback on an acute male inpatient ward in South London highlighted a demand for more medication information outside the formal ward round setting. We aimed to have 100% of patients meet our criteria for “Patient-Centred Prescribing” on the ward by March 2021. To fulfil criteria, all patients are offered: (1) ward round discussion, (2) written patient information leaflets (PILs), (3) informal discussion groups, all regarding medication.The principles of this quality improvement project (QIP) were drawn from definitions of patient-centred care and standards of good practice; patients should have access to a variety of information formats, relevant to the individual, and the knowledge gained empowers patients.Patient experience data revealed that 30% of clients answered passively to the question, “Do you feel involved in your care?” We hypothesized that medication discussion groups positively impact patients’ wellbeing, by providing a safe space that facilitates conversation surrounding medication issues.MethodWe conducted weekly audits on patients whose admission duration was >7 days, and recorded fulfilment of the above criteria. At week 1, we introduced a program of weekly medication discussion groups led by members of the wider multi-disciplinary team covering a broad topic range. At week 6, we developed a rolling rota of the discussion groups and posters were displayed in advance. At week 14, all patients were offered PILs through a 1:1 interaction and this continued as routine practice. Medication discussion group feedback was obtained via questionnaires and “The Blob Tree”, a psycho-emotional assessment tool commonly used in healthcare settings.ResultIn 19 weeks, the median percentage of patients who fulfilled our criteria for Patient-Centred Prescribing was 92.86%. After 11 medication discussion groups, 79.3% of questionnaire responders wanted further sessions. 88% of “The Blob Tree” responses collected inferred a positive emotional response after the group discussions and half of those noticed an improvement in their emotional state.ConclusionThis QIP was overall a success; it fulfilled a requirement to meet good standards in information sharing and became embedded in the fabric of the ward, continuing to run as part of the activities program. It demonstrated the impact of education on patients’ mental wellbeing through empowerment and peer support. As a by-product it established multidisciplinary connections and improved therapeutic relationships. Challenges included patient engagement secondary to acute mental illness or negative symptoms and maintaining project momentum following a COVID-19 outbreak.

scholarly journals TP5.2.14 A quality improvement project: Engaging and educating our thyroidectomy patients

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adetayo Aderombi ◽  
Yasmin Mahfouz ◽  
Fiona Wu ◽  
Kevin Beatson ◽  
Ibrahim Ahmed
Keyword(s):  
Quality Improvement ◽  
Health Literacy ◽  
Total Thyroidectomy ◽  
Elective Surgery ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Information Leaflets ◽  
Operative Complications ◽  
Improve Health ◽  
Post Operative Complications

Abstract Aims Hypocalcaemia can occur in up to 30% of patients post-total thyroidectomy. Severe hypocalcaemia can lead to life-threatening tetany and seizures. As part of the consent process, risks are discussed typically face-to-face, often with the aid of anatomy illustrations. As tele-consultations become increasingly commonplace, patient-information leaflets (PILs) can be invaluable in enhancing informed consent, and empowering patients regarding their own care. We performed a quality improvement project to assess the feasibility and effects of distributing PILs following consultations to improve patients’ understanding of post-operative complications (specifically hypocalcaemia). Methods A retrospective review of post-total thyroidectomy patients was performed from January 2019 to January 2020. A telephone survey was conducted to assess each patient’s understanding of post-operative complications. As tele-consultations began to be utilised during the COVID-19 pandemic, we designed a simple PIL to distribute to patients awaiting elective total thyroidectomy aiming to improve health literacy. Following distribution of PILs, the survey was repeated to evaluate feasibility and effectiveness. Results Conclusions A simple and inexpensive intervention, PILs can be distributed to patients awaiting elective surgery to improve health literacy, and reduce potential patient harm.

scholarly journals Patient Information Leaflets

The Physician ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. c6
Author(s):  
Venkateshwaran Sivaraj
Keyword(s):  
Quality Improvement ◽  
Sexual Health ◽  
Patient Information ◽  
Quality Improvement Project ◽  
Qr Code ◽  
Improvement Project ◽  
Patient Information Leaflets ◽  
Information Leaflets ◽  
Health Clinics ◽  
Sexual Health Clinics

An innovative approach to delivering patient information leaflets for STI and contraception through QR code to smartphones was initiated as a quality improvement project in our sexual health clinics. 

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