scholarly journals Quality of seclusion medical review according to trust guidelines

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S219-S219
Author(s):  
Shumaila Shahbaz ◽  
Richard Ward
Keyword(s):  
Mental Health ◽  
Management Plan ◽  
Junior Doctors ◽  
List Type ◽  
Medical Review ◽  
Record Keeping ◽  
Code Of Practice ◽  
Medication Side ◽  
Review Form

AimsWe accessed whether medics are following Trust Policy while conducting seclusion medical review and identify the strengths in quality of seclusion medical review and identify the areas which need improvements to improve our quality and standards of patient's care and safety and to reduce risks.BackgroundThe Mental Health Act Code of Practice sets an expectation for mental health services for restrictive interventions (use of restraint, seclusion and rapid tranquilisation) by following good standards. Medical reviews provide an opportunity to evaluate and amend seclusion management plan. This clinical audit was undertaken by looking at quality of record keeping about seclusion review by junior doctors, staff grades and consultants at different times (day, night, and weekend).MethodData analysis was carried out by using Microsoft Excel. The audit had Humber Teaching NHSFT approval. We assessed electronic healthcare records. Data collection was carried out or retrospectively in 2019(n = 40) using following parameters: 1)A review of patient's physical and psychiatric health.2)An assessment medication prescribed and adverse effects of medication.3)A review of observations required.4)An assessment of the risk posed by the patient to others.5)An assessment of any risk to the patient from deliberate or accidental self-harm.6)An assessment of need for continuing seclusion, and whether it is possible for seclusion measures to be applied more flexibly, or in a less restrictive manner.7)Time of Seclusion Review: Within first hour after seclusion and then every 4 hours until internal MDT. After MDT twice a day.8)Record Keeping.ResultKey Successes (above 80%)Time of seclusion review (with in first hour or when required)Record keeping (accurate time and place for clinical notes).Plan for continuing need for seclusion.Good documentation of Risk to self and risk to others.Good documentation of mental state examination.Comments on physical health although it can be improved.Key Concerns(Less than 60%):Prescribed Medications.Medication side effects.Physical ObservationsConclusionMedics are missing some important parts in seclusion medical review. We developed a template for seclusion medical review according to trust guidelines which are based on Code of Practice and to incorporate in already existing seclusion review form. We also delivered teaching and training to doctors and also showed junior doctor's an example of documentation. We will re-audit in 1 years’ time to see improvement.

scholarly journals Junior doctors in their first year: mental health, quality of life, burnout and heart rate variability

2013 ◽  
Vol 3 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Marcus A. Henning ◽  
John Sollers ◽  
Joanna M. Strom ◽  
Andrew G. Hill ◽  
Mataroria P. Lyndon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
First Year ◽  
Junior Doctors ◽  
Health Quality ◽  
Health Quality Of Life

scholarly journals Evaluating mental health services. A world perspective

1997 ◽  
Vol 6 (S1) ◽  
pp. 239-245
Author(s):  
Norman Sartorius
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
World Wide ◽  
List Type ◽  
Type Number ◽  
Evaluative Research ◽  
World Perspective

Evaluations of mental health services are much in demand. Their results are supposed to help in improving the quality of mental health care and in making them economically better viable.Yet, world-wide there is: 1)little agreement about the content of terms such as evaluation, mental health service, outcome of an activity although these and other terms are widely used;2)uncertainty about the best use of results of evaluative research;3)lack of consensus about who should evaluate what and by what method.

Documentation and Record Keeping Are Burdens to Be Completed as Quickly as Possible

2019 ◽  
pp. 117-122
Author(s):  
Jeffrey E. Barnett ◽  
Jeffrey Zimmerman
Keyword(s):  
Mental Health ◽  
Quality Care ◽  
Mental Health Practitioners ◽  
Record Keeping ◽  
Legal Obligations ◽  
Health Practitioners ◽  
Care Information ◽  
Clinical Records

Documentation and record keeping are not known as the most enjoyable aspects of being a mental health clinician. Yet, as this chapter explains, they play a vital and important role in meeting one’s ethical and legal obligations. Further, it is explained how timely, thorough, effective documentation can help mental health practitioners to fulfill their obligation to provide the highest possible quality of care. Information is also provided on how clinical records may be needed in the future, and the risks associated with minimal or absent documentation. The role of documentation as a risk management strategy, to meet legal requirements, and to assist in providing high-quality care are each addressed. Specific guidance is provided on the needed components of effective documentation.

scholarly journals Quality Improvement in Ambulatory Mental Health Settings

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Cauterman ◽  
S. Woynar ◽  
S. Vergnaud
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Information Sharing ◽  
List Type ◽  
Patient Pathway ◽  
Initial Appointment ◽  
Mental Health Settings ◽  
Discharge From Hospital ◽  
Pilot Intervention

Eight ambulatory Mental Health Settings have been commited in a national pilot intervention aiming at improving the quality of the service they deliver from April 2006 to december 2007. This twenty months intervention allowed teams to set operational bjectives, to describe their organization, to implement an actions’plan and to evaluate their results.The main operational objectives they chose were the following:•Delay for an initial appointment.•Delay for an appointment following a discharge from hospitalization.•Rate of non attendance.The framework to analyse their organisation included a focus on Human ressources, on Operations, on Strategy and on Information Sharing.The main findings were awide variations in performance from a setting to one another (median delay for a first appointment with a psychiatrist ranging from one to seven weeks, paid psychiatrist working time for a single appointment ranging from 0.6 to 2.5 hours...), lack of formalisation of processes (including major processes as intake, discharge from hospital...), the absence of objectives set by the managemers.Actions’plans included very basical actions as setting dashboards and objectives, setting strategy to decrease non attendance, sharing diaries, reorganising meetings, mapping patient’ pathway.Finally, some results were obtained as:•reduction of delays for first appointments (4 settings amongs 8);•reduction of delays for a appointment after hospital discharge (1 amongst 8).Furthermore, this pilot intervention allowed to create and develop tools, method and experience for accompaining other settings. Ten new volunteers are involved since july 2008.

scholarly journals International professional practices in mental health, organization of psychiatric care, and COVID-19: A survey protocol

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261818
Author(s):  
Laurence Fond-Harmant ◽  
Hélène Kane ◽  
Jade Gourret Baumgart ◽  
Emmanuel Rusch ◽  
Hervé Breton ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Well Being ◽  
Digital Tools ◽  
List Type ◽  
Ongoing Research ◽  
Numerical Tools ◽  
The Impact

Objective Our project aims to provide: an overview of the impact of the COVID-19 pandemic on the field of mental health professionals in 23 countries; a model of recommendations for good practice and proposals for methods and digital tools to improve the well-being at work of mental health professionals and the quality of services offered during crisis and post-crisis periods; an in-depth ethics review of the assessment of the use of numerical tools for psychiatry professionals and patient support, including teleconsulting. Methods This is a large international survey conducted among 2,000 mental health professionals in 23 countries over a 12-month period. This survey will be based on 30 individual interviews and 20 focus group sessions, and a digital questionnaire will be sent online to 2,000 professionals based on the criteria of gender, age, professional experience, psychiatric specialty, context of work in psychiatry, and geographical location. Regarding the development of telepsychiatry during the COVID-19 pandemic, a pilot study on the use of digital tools will be carried out on 100 clients of psychiatry professionals in France and Belgium. Discussion-conclusion This study will contribute to the co-construction of an international organization and monitoring system that takes into account psychiatric health professionals as major resources to fight against the COVID-19 pandemic and to develop efficient processes for preparing and anticipating crises by reducing psychosocial risks as much as possible. This project also aims to design tools for remote medicine and to develop the use of numerical tools for monitoring and supporting professionals and helping professionals to build the conditions for satisfactory operational work during crises and post-crisis situations, using adapted organizational methods. Our ongoing research should support professionals in the search for existing concrete solutions to cope with emergency work situations while maintaining an optimal quality of life.

scholarly journals QI project: Improvement in quality of Seclusion Medical Review

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S218-S219
Author(s):  
Shumaila Shahbaz ◽  
Richard Ward
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Patient Care ◽  
Mental State ◽  
Improve Patient Care ◽  
Medical Review ◽  
Record Keeping ◽  
Review Management ◽  
State Examination

AimsTo establish the improvements in the quality of seclusion medical review after introducing a template to complete the review.BackgroundThe Mental Health Act – Code of Practice outlines the standards of patient care while in seclusion. It also emphasis that supportive engagement/observation schedules should be reviewed in person and continued at the point an episode of seclusion was initiated.Furthermore, NICE also set up standards to monitor side effect profile while prescribing psychotropic for such patients and regular management review. It also gives importance to staff training to ensure these standards.To improve the quality of the seclusion medical review, we completed an audit in July 2019 to ascertain whether medics are following Trust Policy.We identified good results (above 90%) in the following areas:Time of seclusion reviewRecord keepingManagement planGood documentation of risk, mental state examination and physical health.We also noticed that the following areas can be improved:Prescribed Medications. (60%)Medication side effects. (40%)Physical Observations (40%)We used the following audit standards for our audit after our last audit and a template was designed and after discussion with medics incorporated into the existing documentation template.Time of reviewReason and duration for seclusionPsychiatric diagnosisMental State Examination/BehaviourPhysical health (including physical observations)/EnvironmentMedication (prescribed, rapid tranquilisation, side effects, or adverse effects)Risk (to self-DSH or accidental) (risks to others)Plan :(frequency of physical obs./medical review, management, restrictions, exit plan for terminating seclusion, patient's capacity to understand it)MethodWe considered the following aspects:Retrospective data collection from 01.03.2020 to 30.08.2020.Sample selection: random selection of mixture of clinicians on different times and days of the week.Data analysis was carried out by using Microsoft Excel.ResultWe noticed a marked improvement in the quality of seclusion medical review (between 95% and 100%) after introducing a template for it. There were no major concerns identified during the re-audit.ConclusionTo continue to use the template for Seclusion Medical Review which has shown significant improvement in the quality of the reviews which will improve patient care.It also helped us to deliver person centred care and safe practice.To continue teaching and training of doctors.This QIP project motivated nurses to do an audit on nursing seclusion review and made necessary changes.

scholarly journals Changes in the Health of Adolescent Athletes: A Comparison of Health Measures Collected Before and During the CoVID-19 Pandemic

2021 ◽  
Author(s):  
Timothy A. McGuine ◽  
Kevin Biese ◽  
Scott J. Hetzel ◽  
Labina Petrovska ◽  
Stephanie Kliethermes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Physical Activity ◽  
Online Survey ◽  
Depression Symptoms ◽  
List Type ◽  
Adolescent Athletes ◽  
Symptoms Of Depression ◽  
Health Measures

ABSTRACTContextIn the spring of 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of CoVID-19. The changes that took place to the physical and mental health among young athletes during this time remain unknown, however.ObjectiveIdentify changes in the health (mental health, physical activity and quality of life) of athletes that occurred during the CoVID-19 pandemic.DesignCross sectional study.SettingSample recruited via social media.Patients or Other Participants3243 Wisconsin adolescent athletes (age=16.2±1.2 yrs., female=58% female) completed an online survey in May 2020 (DuringCoVID-19). Health measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n=5231, age=15.7±1.2, 47% female) collected in 2016–2018 (PreCoVID-19).Main Outcome Measure(s)Demographic information included: sex, grade and sports played. Health assessments included the Patient Health Questionnaire-9 Item (PHQ-9) to identify depression symptoms, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for health related quality of life (HRQoL). Univariable comparisons of these variables between groups were made via t-tests or chi-square tests. Means and 95% confidence intervals (CI) for each group were estimated by survey weighted ANOVA models.RESULTSCompared to PreCoVID-19, a larger proportion of the During-CoVID-19 participants reported rates of moderate to severe levels of depression (9.7% vs 32.9%, p<0.001). During-CoVID-19 participants reported 50% lower (worse) PFABS scores (mean:12.2 [95%CI: 11.9, 12.5] vs 24.7 [24.5, 24.9] p<0.001) and lower (worse) PedsQL total scores compared to the PreCoVID-19 participants (78.4 [78.0, 78.8] vs. 90.9 [90.5, 91.3] p<0.001).CONCLUSIONSDuring the CoVID-19 pandemic, adolescent athletes reported increased symptoms of depression, decreased physical activity and decreased quality of life compared to adolescent athletes in previous years.Key pointsAdolescent athletes during CoVID-19 were three times more likely to report moderate to severe symptoms of depression compared to data collected prior to CoVID-19.Adolescent athletes during CoVID-19 reported significantly lower physical activity and quality of life scores compared to high school athletes prior to the CoVID-19 pandemicPost CoVID-19 policies should be implemented to improve the health of adolescent athletes in the US.

scholarly journals Scottish place of safety legislation: local audit of Section 297 Mental Health (Care and Treatment) (Scotland) Act 2003

2011 ◽  
Vol 35 (5) ◽  
pp. 185-189 ◽  
Author(s):  
Amy M. Macaskill ◽  
Barbara A. Brodie ◽  
Brian Keil
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Completion Rates ◽  
Code Of Practice ◽  
Lack Of Information ◽  
Documented Information ◽  
Care And Treatment ◽  
Standard Documentation

Aims and methodFollowing recommendations made by our 2004–2005 audit, we carried out a re-audit of the local Section 297 protocol in 2007–2008. Our aim was to establish the quality of documented information provided by the police; adherence to the protocol; completion rates of documentation; and rates of notification to the Mental Welfare Commission for Scotland, in keeping with the standards set in the Code of Practice of the Mental Health (Care and Treatment) (Scotland) Act 2003.ResultsWe reliably traced 84 POS1 forms completed in accordance with the protocol. The audit identified a rate of 74–89% notification to the Mental Welfare Commission for Scotland. By comparison, there is a surprisingly wide variation in notification rates across Scotland. Good-quality information was given by the police, despite receiving no additional training.Clinical implicationsThis audit highlights a serious lack of information about place-of-safety legislation in Scotland. For patients in the catchment area, the joint protocol and use of standard documentation has significantly standardised patient care. Other health boards and police forces should consider this as they implement legislation.

scholarly journals M244. PENNSYLVANIA FIRST-EPISODE PROGRAM EVALUATION OF COORDINATED SPECIALTY CARE: SIX- AND 12-MONTH OUTCOMES

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S228-S229
Author(s):  
Monica Calkins ◽  
Megan Westfall ◽  
Irene Hurford
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Program Evaluation ◽  
Side Effect ◽  
Rating Scale ◽  
Specialty Care ◽  
First Episode ◽  
Medication Side

Abstract Background Interest in early intervention for first-episode psychosis (FEP) has increased globally in recent decades in response to evidence that multi-component programs may reduce individual and societal burden of psychotic disorders. In 2016, the Pennsylvania (PA) Office of Mental Health and Substance Abuse Services (OMHSAS) provided funding to develop a statewide Program Evaluation (PE) initiative. PA-FEP-PE assesses benefits of nine PA coordinated specialty care (CSC) programs both individually and in aggregate. We previously (SIRS 2019) presented preliminary data from initial participants. We now present data from 598 participants enrolled across PA. Methods Our CSC programs serve youth age 12–34 experiencing early psychosis onset between 12–24 months before admission. Services, including pharmacotherapy, CBT-based psychotherapy, case management, supported employment and education, peer support, and multi-family groups and psychoeducation, are offered for &gt;=2 years. Participant characteristics at referral, admission, follow-up and discharge are collected via standardized computerized (REDCap) forms. The computerized clinical battery, administered at admission and at 6-month follow-up intervals, is composed of measures selected for domain coverage, clinical utility, reliability/validity (from the PhenX toolkit), practical utility, low burden, and high utility to multiple stakeholders. Domains include symptoms and diagnosis (Brief Psychiatric Rating Scale, Beck Depression Inventory-7, Hopelessness Scale, Self-Esteem-Scale-Revised, Loneliness Scale, Defeatist Beliefs Scale, Post-Traumatic Stress Disorder Symptom Scale), psychosocial functioning and recovery (Global Function Role and Social Scales, Psychosis Recovery Assessment Questionnaire, Quality of Life Functional Assessment, Systematic Clinical Outcome Routine Evaluation), medication side effect monitoring (Extrapyramidal Symptom Rating Scale, Glasgow Antipsychotic Side Effect Scale), and service quality and satisfaction (Youth Services Survey). Results Between 1/1/17-7/1/19, 1,917 referrals were received, of whom 598 participants (mean age=21.1 SD=4.5; 35% female; 45% Caucasian, 41% African-American) were enrolled. Unspecified/other psychotic disorder was the most common diagnosis at admission (48%). Mean age at psychosis onset was 20.2 years (SD=4.6). An average 13.7 (SD=21.8) months lapsed between symptom onset and admission. The majority (78%) of participants had prior hospitalizations. At admission, participants showed moderate severity of psychiatric symptoms, serious impairment in global role and social functioning, and 72% reported experiencing &gt;=1 traumatic events. At 6-month follow-up, participants (n=142) exhibited several significant improvements, including decreased hospitalizations and hospitalization days, suicidal ideation, substance use, overall psychopathology, and positive psychosis symptoms, and increased employment and school enrollment, global role and social function, self-rated quality of life, medication side effects, and satisfaction with mental health services. Individuals who engaged for 12 months (n=60) continued to maintain significant improvement in clinical features. Discussion PA-FEP-PA is a comprehensive model yielding clinical and functional improvements after 6 and 12 months of CSC participation. Continued data collection will enable increased power to analyze population and site differences to illuminate mediators and moderators underlying individual variations and improve personalized prediction of salient outcomes. Further, the PA-FEP-PE model offers PA CSC programs a collaborative learning network for ongoing quality improvement.

scholarly journals Implementing out of hours MDT safety huddles at the Ladywell Unit, Lewisham, South London and the Maudsley (SLAM) NHS Foundation Trust

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S229-S230
Author(s):  
Su Yeoh ◽  
Natavan Babayeva ◽  
Hugh Williams ◽  
Emma Jones
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Best Practice ◽  
Management Plan ◽  
Slight Reduction ◽  
List Type ◽  
Physical And Mental Health ◽  
Out Of Hours ◽  
Team Cohesiveness ◽  
Mental And Physical Health

Aims•For 100% of patients admitted OOH (Friday 5pm – Sunday 9am) to have a multi-disciplinary review of their treatment•For 100% of patients with deteriorating physical and mental health to be discussed•To improve multi-disciplinary team (MDT) morale, working relationships and team cohesiveness OOHBackgroundIn most specialties, the standard of best practice is that patients admitted to the ward out of hours (OOH) receive a senior review over the weekend. However this does not usually take place in Psychiatry, and patients routinely wait until Monday to be seen by the ward team. This has been highlighted as problematic in cases where patients are agitated and not receiving any treatment for > 24 hours.We trialled a weekend teleconference safety huddle in Lewisham involving the on call consultant, registrar (SpR), core trainee (CT) and duty senior nurse (DSN).MethodThe weekend huddles were through a teleconference line, with participants dialling in at 9.45am.Issues discussed: 1)Management plan for newly admitted patients OOH.2)Plan for patients with deteriorating mental health or escalating level of aggression.3)Plan for patients with deteriorating physical health.Feedback was collected from CTs, SpRs and consultants focusing on whether the huddle made any difference to the speed of care, cohesiveness of the OOH team, and whether it was generally helpful or not.Result54% of CTs (n = 11) felt that patients admitted OOH had an MDT review, and 90% felt that patients with deteriorating mental and physical health were discussed and a plan put in place. 80% of CTs, 63% of SpRs (n = 8) and 67% of consultants (n = 6) agreed it improved team cohesiveness. 90% of DSNs felt safer and more supported in decision-making OOH.80% of CTs, 63% of SpRs and 83% of consultants found weekend huddles helpful.Data were also collected on violent incidents OOH, and there was a slight reduction in the number of violent incidents in the weeks following introduction of the huddle.ConclusionIntroducing safety huddles in Lewisham has facilitated the prompt discussion of the management of patients admitted OOH, and of those with deteriorating mental and physical health. It has also fostered a greater sense of cohesiveness in the MDT team.In light of this feedback, safety huddles have now been established as part of the weekend schedule in Lewisham, and are being rolled out to other boroughs within SLaM.

Sign in / Sign up

Export Citation Format

Share Document