scholarly journals A quality improvement project: documentation of liaison psychiatry patient reviews in the John Radcliffe Hospital, Oxford

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S223-S224
Author(s):  
Alice Talks ◽  
Susan Shaw ◽  
Tomasz Bajorek ◽  
Lindsay Carpenter ◽  
Anya Topiwala
Keyword(s):  
Electronic System ◽  
Primary Diagnosis ◽  
Trial Period ◽  
Audit Tool ◽  
Electronic Documentation ◽  
Liaison Psychiatry ◽  
Improvement Project ◽  
John Radcliffe Hospital ◽  
Medication Changes

AimsAssess how current practice reflects recommendations from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Treat as One: bridging the gap between mental and physical healthcare report (January 2017).Develop template for electronic documentation of liaison psychiatry reviews and implement for trial period.Re-audit after trial period to assess for change in quality of documentation.BackgroundThe John Radcliffe Hospital (JR) is a tertiary centre and has a large liaison psychiatry department with 14 consultants. Patient reviews by the liaison team are documented using a blank note type, on an electronic system used by all specialties within the hospital trust. The NCEPOD Treat as One report makes recommendations for the content of documentation of liaison psychiatry reviews which aim to improve communication between specialties.Method86 patients referred to liaison psychiatry at the JR in September 2018 were randomly selected. Four liaison psychiatry consultants appraised the quality of documentation of anonymized reviews by consultant colleagues. The audit tool was a questionnaire containing 12 questions developed by the four consultants based on the NCEPOD Treat as One report. Data were collated from these questionnaires. The template for electronic documentation was developed to reflect the report recommendations and after discussion with the liaison psychiatry team. The template has been implemented and is used for all initial patient reviews.ResultThe 12 questions of the audit tool can be divided into two groups: assessment and management. As part of the assessment, the majority of reviews included a primary diagnosis (77.9%) and reason for referral (66.3%). Other aspects of the assessment were documented in the minority of reviews: mental capacity (19.8%), need for DOLS (2.3%), risks (27.9%) and risk management (7%). Regarding the management, the majority of reviews included: clear plan with numbered/bullet points (61.6%), medication changes (51.4%), useful plan (73%) and answered the reason for referral (69.8%). Other aspects of the management were documented in the minority of reviews: each action point assigned (47.7%) and non-medical MDT advice (18.6%).ConclusionThe main area for improvement in documentation of assessment agreed by the liaison team is risk. The main areas agreed for improvement in documentation of management are medication changes, assigning action points to individuals, and including advice for non-medical MDT members. The next step is re-audit, planned for March 2020.

Arrangement of Archives of Cloud Computing Based and Utilization of Microsoft Access

2018 ◽  
Vol 1 ◽  
pp. 198
Author(s):  
Lusy Tunik Muharlisiani ◽  
Henny Sukrisno ◽  
Emmy Wahyuningtyas ◽  
Shofiya Syidada ◽  
Dina Chamidah
Keyword(s):  
Cloud Computing ◽  
Public Service ◽  
Human Life ◽  
Electronic System ◽  
Main Function ◽  
Scientific Publications ◽  
Data Manipulation ◽  
Administrative Management ◽  
Microsoft Access

Service at the “Kelurahan” is a very important part in determining the success of development, especially in public service. The problem faced is the lack of skill level of the “Kelurahan” apparatus with the more dynamic demands of the community and the archive management system is still conventional and manual that is writing the identity of the archive into the book agenda, expedition, control card, and borrowed archive card, so it takes a more practical electronic system, effective and efficient so required to develop themselves in order to improve public services. Conventional administration and archive management must be transformed into cloud-based computing (digital), for which archiving managers should always be responsive and follow these developments and wherever possible in order to utilize for archival activities, with greater access expected archives are evidence at once able to talk about historical facts and events and be able to give meaning and benefit to human life, so archives that were only visible and readable at archival centers can now be accessed online, and even their services have led to automated service systems. Using Microsoft Access which its main function is to handle the process of data manipulation and manufacture of a system, this system is built so that the bias runs on Cloud which means Cloud itself is a paradigm in which information is permanently stored on servers on the internet and stored. The purpose of this program is the implementation of administrative management that has been based cloud computing (digital) and is expected to be a solution in managing the archive so that if it has been designed and programmed, it can be stored in the computer and benefi- cial to the “Kelurahan” apparatus and add in the field of management archives in the form of improving the quality of service to the community, can facilitate and scientific publications.

scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p < 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Lee ◽  
A MacLeod ◽  
A Bradley
Keyword(s):  
Royal Infirmary ◽  
Improvement Project ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
Vte Prophylaxis ◽  
Care Services ◽  
Documentation Quality ◽  
Patient Documentation ◽  
Patient Handovers

Abstract Introduction Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement. Method Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance. Results When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients. Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%). Conclusions These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications. A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.

Do we achieve the Montgomery standard for consent in orthopaedic surgery?

2021 ◽  
pp. 1-7
Author(s):  
Xenia N Tonge ◽  
Henry Crouch-Smith ◽  
Vijay Bhalaik ◽  
William D Harrison
Keyword(s):  
Treatment Options ◽  
Information Provision ◽  
Common Source ◽  
Health Board ◽  
Improvement Project ◽  
Specific Patient ◽  
Written Information ◽  
Orthopaedic Patients ◽  
Recorded Data

Aims/Background The Montgomery v Lanarkshire Health Board (2015) case set a precedent that has driven the modernisation of consenting practice. Failure to demonstrate informed consent is a common source of litigation. This quality improvement project aimed to provide pragmatic guidance for surgeons on consent and to improve the patient experience during decision making. Methods Elective orthopaedic patients were assessed and the quality of documented consent was recorded. Data were collected over two discrete cycles, with cycle 1 used as a baseline in practice. The following criteria were reviewed: grade of consenting clinician, alternative treatment options, description of specific risks, place and timing of consent and whether the patient received written information or a copied clinic letter. Cycle 1 results were presented to clinicians; a teaching session was provided for clinicians on the standard of consent expected and implementation of a change in practice was established with a re-audit in cycle 2. Results There were 111 patients included in cycle 1, and 96 patients in cycle 2. Consent was undertaken mostly by consultants (54%). Specific patient risks were documented in 50% of patients in cycle 1 and 60% in cycle 2. Risks associated with a specific procedure were documented in 42% in cycle 1 and 76% in cycle 2, alternative options in 48% (cycle 1) and 66% (cycle 2). A total of 14% of patients in cycle 1 and 8% in cycle 2 had documented written information provision. Copied letters to patients was only seen in 12% of all cycles. Documentation from dedicated consenting clinics outperformed standard clinics. Conclusions Highlighting poor documentation habits and refining departmental education can lead to improvements in practice. The use of consenting clinics should be considered and clinicians should individually reflect on how to address their own shortcomings. Other units should strongly consider a similar audit. This article provides stepwise advice to improve consent and specifics from which to audit.

Impact of Training on Livestock Technology Transfer for Rural Poor Farmers Livelihood Improvement in Bangladesh

2021 ◽  
Vol 19 (1) ◽  
pp. 223-235
Author(s):  
MA Hossain ◽  
MS Islam ◽  
A Akhter ◽  
M Rashiduzzaman
Keyword(s):  
Baseline Survey ◽  
Rural Poor ◽  
Flock Size ◽  
Improvement Project ◽  
Feeding Management ◽  
Livelihood Improvement ◽  
Logistic Support ◽  
The Impact ◽  
Farming Households

The study was conducted to evaluate the impact of training facilitated by Nuton Jibon Livelihood Improvement Project (NJLIP) under Social Development Foundation (SDF) for transfer livestock technologies and livelihood improvement for rural poor farmers in Bangladesh. A total of 650 farming households were selected by baseline survey during January 2018 to June 2018.The training and non-training beneficiaries were primary level educated and their family size (4.52) was little lower than the national average (4.9). Average age was 36.73 and 35.12 years for training and non-training farmers, respectively. The rate and amount of loan was found higher with respondent received training than without training. Adoption rate of technologies was higher than the level of idea on the concept of housing, feeding, breeding and marketing. The training beneficiaries improved knowledge and skill on feeding, management and health care of livestock and poultry. Training and demonstration are considered two strong tools for adoption and dissemination of livestock technology. Herd and flock size was increased by training beneficiaries than non-training beneficiaries. Beneficiaries having training on various IGAs have expanded their land and asset possession to a greater extent compared to non-training beneficiaries. Housing and sanitation condition of training beneficiaries were higher than non-training beneficiaries. Increased annual income of training and non-training households was 19.43% and 13.30% where income from different IGAs of livestock was 32.19% and 14.53%, respectively. Livestock were not extremely price sensitive but more sensitive on non-price factors logistic support like institutional support, quality of input and availability of input. Thus, training was treated as vital tools for transfer livestock technologies to influence the poor farmer’s livelihood improvement of training household than non-training household. SAARC J. Agric., 19(1): 223-235 (2021)

scholarly journals Hospitalizations leading causes for maternal disorders

2014 ◽  
Vol 48 (3) ◽  
pp. 401-408 ◽  
Author(s):  
Thaise Castanho da Silva Veras ◽  
Thais Aidar de Freitas Mathias
Keyword(s):  
Health Care ◽  
Descriptive Study ◽  
Primary Diagnosis ◽  
Obstetric Complications ◽  
Healthcare Team ◽  
Regional Health ◽  
Hospital System ◽  
Unified Health System ◽  
Diagnosis Age

Presenting the rates of obstetric admissions of women living in Paraná in 2010.Method: A descriptive study in which the admission information of the hospital system of the Unified Health System was analyzed. Data from women aged between 10 to 49 years available on the DATASUS website were analyzed, using percentage and according to primary diagnosis, age and Regional Health area.Results: The Rate of Obstetric Complications (RtOC) was 38%, increasing with the age of women. Complications of labor and delivery (10.5%), and pregnancy with abortive outcome (9.1%) were the diagnoses with highest RtOC. The RtOC ranged between 8.4% in Telêmaco Borba, until 62.6% in Ponta Grossa.Conclusion: The healthcare team should monitor the rates of admissions for obstetric complications as these indicate the quality of health care of women, mainly focused on labor, delivery and women of older age.


scholarly journals Improving quality and assessment of referrals to the Enfield Crisis Resolution and Home Treatment Team (ECRHTT)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S202-S202
Author(s):  
Margarita Kousteni ◽  
John Cousins ◽  
Ajay Mansingh ◽  
Maja Elia ◽  
Yumnah Ras ◽  
...  
Keyword(s):  
Home Treatment ◽  
Absolute Difference ◽  
List Type ◽  
Treatment Team ◽  
Crisis Resolution ◽  
Post Intervention ◽  
Improvement Project ◽  
Consultant Psychiatrist ◽  
The Impact

AimsTriaging referrals to crisis resolution and home treatment teams is a significant undertaking requiring experienced and dedicated staff. We observed that the volume of inappropriate referrals to ECRHTT was high, and that staff processing these often felt inexperienced or lacking in confidence to discharge them back to the referrers and signpost them to appropriate services.The aims of this quality improvement project (QIP) were: a)to reduce the number of inappropriate referrals received by the teamb)to reduce the number of inappropriate referrals accepted by the teamThis would significantly improve access and flow to the service and facilitate better patient care.MethodA pilot study was first completed of the quality (appropriateness/ inappropriateness) and source of all referrals to ECRHTT in January 2019 (n = 177).Subsequently, the consultant psychiatrist for ECRHTT based himself within the assessment team. He was able to closely monitor the referrals, at the same time as providing medical input to patients at their first point of contact. To evaluate the impact of this intervention, the percentage of inappropriate referrals accepted pre- and post-change was compared by re-auditing all referrals received in February 2019 (n = 175).Further interventions were instigated to improve referral quality. These included continuation of psychiatric medical input to the assessment team, teaching sessions for GPs and the crisis telephone service, and weekly meetings with psychiatric liaison and community mental health teams (CMHTs). Change was measured by reassessing the quality of all referrals made to ECRHTT in February 2020 (n = 215).Result46.9% of inappropriate referrals to ECRHTT were accepted in January 2019 compared to 16.9% in February 2019 following the addition of medical input to the assessment team. The absolute difference was 30% (95% CI: 14%–44%, p < 0.001).71% of referrals from GPs were inappropriate in January 2019 compared to 36% in February 2020 post-intervention (difference 35%, 95% CI: 8.84%–55.4%, p < 0.05). Inappropriate referrals from CMHTs decreased from 55.5% to 12% (difference 43.5%, 95% CI: 9.5%–70.3%, p < 0.05). Overall, the percentage of inappropriate referrals fell from 38% to 27.4%, a difference of 10.6% (95% CI: 1.3%–19.8%, p < 0.05). The percentage of inappropriate referrals from liaison teams did not change significantly.ConclusionThis piece of work shows that better engagement with referral sources significantly improved the quality of referrals made to ECRHTT. Interventions included medical input at the point of referral, teaching sessions for general practitioners as well as ongoing liaison with referring teams.

scholarly journals Audit of documentation of observations on mental health services for older people (MHSOP) wards following implementation of nervecentre

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S215-S215
Author(s):  
Nitya Rathi
Keyword(s):  
Original Data ◽  
Early Warning Score ◽  
Inclusion Criteria ◽  
Electronic Documentation ◽  
Desktop Computers ◽  
National Guidance ◽  
National Early Warning Score ◽  
Paper Documentation ◽  
Almost All

AimsNervecentre is an application that can be used on mobile devices and desktop computers to record and view physical observations amongst other tools. An audit had been done previously assessing the practice of recording observations using paper documentation. That audit had recommended the use of Nervecentre to improve the recording of observations. This audit was undertaken following the introduction of Nervecentre for documentation of physical observations. The aims were to evaluate if the transition to electronic documentation of NEWS (National Early Warning Score) observations on Nervecentre has improved practice in comparison to paper documentation and to evaluate if our practice could be improved by implementing electronic observations for psychiatric observations in addition.MethodData were collected over a 10-day period looking at all the documented observations from all inpatients on the MHSOP wards that met the inclusion criteria. Data were collected on the recording of psychiatric observations (recorded on paper charts) and physical observations (recorded on Nervecentre). The data were collated and analysed. The new data were compared to the original data from prior to the introduction of NerveCentre and the findings were presented at a local meeting.ResultThis audit has highlighted that the documentation of physical observations on MHSOP wards has greatly improved since Nervecentre was introduced. There was an improvement in recording of physical observations in almost all domains measured. NEWS scores were correctly documented 100% of the time compared to 87% previously. Raised NEWS scores were correctly escalated to a senior and reviewed 80% of the time compared to 0% previously. It has also highlighted that the quality of documentation regarding psychiatric observations could be improved as we are not currently meeting local or national guidance.ConclusionThe most likely cause for the improvement in the recording of the physical observations is the implementation of Nervecentre. Nervecentre prompts users when observations are due, removes the risk of calculation errors and allows for observations to be directly escalated. Implementing Nervecentre for psychiatric observations may similarly improve the quality of these observations therefore improving patient safety.

scholarly journals Improving facilitation of ECT treatment for patients in an acute medical hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S42-S42
Author(s):  
Vatsala Mishra ◽  
Chun Chiang Sin Fai Lam ◽  
Marilia Calcia ◽  
Isabel McMullen
Keyword(s):  
Patient Safety ◽  
Clinical Outcomes ◽  
Psychiatric Patients ◽  
Severe Depression ◽  
Liaison Psychiatry ◽  
Improvement Project ◽  
Initial Intervention ◽  
Delayed Recovery ◽  
Medical Teams ◽  
Operational Aspects

AimsA Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.MethodThe first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.ResultIn the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.ConclusionCreating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.

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