scholarly journals The results of a multi-centre audit of the prescribing of antipsychotic drugs for in-patients in the UK

2002 ◽  
Vol 26 (11) ◽  
pp. 414-418 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Chike Okocha ◽  
Richard Duffett ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
National Guidelines ◽  
Consensus Statements ◽  
High Doses ◽  
The Uk ◽  
Audit Standards

Aims and MethodForty-seven UK mental health services participated in a 1-day audit of prescribing of antipsychotic drugs. Audit standards were derived from national guidelines and consensus statements.ResultsOf the 3132 patients, 20% were prescribed a total dose of antipsychotic medication above that recommended by the British National Formulary. The majority of case notes failed to record an indication for high-dose prescribing or that the patient had been informed; only 8% had undergone an electrocardiogram. Forty-eight per cent of patients were prescribed more than one antipsychotic drug.Clinical ImplicationsAntipsychotic prescribing for in-patients often runs counter to existing guideline recommendations. It is likely that many patients who are prescribed high doses or polypharmacy are unaware that their prescription is out of line with guideline recommendations and is inadequately monitored.

scholarly journals Variation between services in polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 418-420 ◽  
Author(s):  
Maria Harrington ◽  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Clinical Practice ◽  
Antipsychotic Drugs ◽  
Service Level ◽  
Case Mix ◽  
Clinical Implications ◽  
High Dose ◽  
Prescribing Practice ◽  
Acute Psychiatric Wards ◽  
High Doses

Aims and MethodA 1-day census provided an opportunity to examine the variation between 44 mental health services in the frequency of prescribing high doses and polypharmacy of antipsychotic drugs to in-patients on acute psychiatric wards.ResultsThe proportion of patients prescribed a high dose ranged 0–50% and simultaneous use of more than one antipsychotic drug ranged 12–71%. A number of case-mix variables explained 26% and 40%, respectively, of the variance between services on these two indicators of prescribing practice.Clinical ImplicationsServices with high rates of prescription of high dose or polypharmacy might consider a review of clinical practice and of service-level factors that might affect prescribing.

scholarly journals The influence of patient variables on polypharmacy and combined high dose of antipsychotic drugs prescribed for in-patients

2002 ◽  
Vol 26 (11) ◽  
pp. 411-414 ◽  
Author(s):  
Paul Lelliott ◽  
Carol Paton ◽  
Maria Harrington ◽  
Maria Konsolaki ◽  
Tom Sensky ◽  
...  
Keyword(s):  
Mental Health ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Clinical Implications ◽  
High Dose ◽  
Patient Factors ◽  
Younger Age ◽  
Patient Variables ◽  
Unexplained Variance ◽  
High Doses

Aims and MethodA1-day census, involving 3576 psychiatric in-patients prescribed antipsychotic medication, was conducted as a prelude to a multi-centre audit. The aim was to explore the extent to which a number of patient variables explain antipsychotic polypharmacy and the use of high doses of these drugs.ResultsPrescriptions of more than one type of antipsychotic drug were made for 50.5% of patients. Patient factors that influenced the probability of polypharmacy were: younger age, being male, detained under the Mental Health Act and on a rehabilitation or forensic ward, and a diagnosis of schizophrenia. The effect of ethnicity was not significant. Polypharmacy was the most powerful factor influencing the probability of being prescribed a high dose. Identified patient variables accounted for only 18% of the variance in dose prescribed.Clinical ImplicationsThe patient and clinician factors that account for the unexplained variance need to be identified.

scholarly journals Polypharmacy and high-dose antipsychotics at the time of discharge from acute psychiatric wards

2011 ◽  
Vol 35 (8) ◽  
pp. 288-292 ◽  
Author(s):  
Tongeji E. Tungaraza ◽  
Uzma Zahid ◽  
Bhanumurthy Venkataramaiah
Keyword(s):  
Small Proportion ◽  
Psychiatric Ward ◽  
Clinical Implications ◽  
High Dose ◽  
National Formulary ◽  
Antipsychotic Medications ◽  
Acute Psychiatric Wards ◽  
High Doses ◽  
Acute Psychiatric Ward ◽  
Discharge Summaries

Aims and methodTo determine the extent of prescribed antipsychotic polypharmacy and high-dose antipsychotics at the time of discharge from an acute psychiatric ward. Copies of discharge summaries for patients between the ages of 18 and 65 were examined; only those that had antipsychotic medications at the time of discharge were included. Names and doses of antipsychotics and all other medications concurrently prescribed were recorded.ResultsA total of 651 discharge summaries were included in the study. Nearly a quarter of individuals were discharged on one antipsychotic as the only medication to take home; only 6.8% were discharged on a high-dose antipsychotic and of those on combinations 59.6% were on depot medications. Combining antipsychotics significantly predicted the use of high dose.Clinical implicationsMost patients were discharged on doses of antipsychotics within the British National Formulary limits; however, a small proportion is still sent home on high doses of antipsychotics. Combining antipsychotics remains the strongest predictor of high-dose antipsychotic use; clinicians need to be aware of this.

London Fire Brigade's screen and treat approach to the Grenfell Tower incident

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Craig Steel ◽  
Zoe Travers ◽  
Lynette Meredith ◽  
Deborah Lee ◽  
Michael Conti ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Methodology ◽  
Stress Disorder ◽  
National Guidelines ◽  
Line Managers ◽  
Content Type ◽  
Health Response ◽  
The Uk ◽  
Post Disaster ◽  
Practical Implications

PurposeThe purpose is to report on the mental health response to the Grenfell incident within the London Fire Brigade (LFB).Design/methodology/approachThe LFB implemented screening for the symptoms of posttraumatic stress disorder (PTSD) at 28 days, 3 months and 6 months for all personnel directly involved in the incident.FindingsThe prevalence of PTSD within frontline personnel was 13.4% at 28 days, falling to 7.6% at 6 months. The LFB's internal Counselling and Wellbeing Service offered treatment to those scoring above the cut-off for PTSD along with accepting self-referral and referrals from line managers and occupational health. There were 139 referrals within the 12-month period following the incident.Research limitations/implicationsThe outcomes for those who engaged in treatment are broadly in line with other studies evaluating post-disaster interventions. Issues for consideration within national guidelines are discussed.Practical implicationsThe screen and treat approach adopted by LFB was shown to be a feasible approach to use within such a scenario.Originality/valueThe current study reports on a screen and treat approach to one of the largest single incidents in the UK in recent years.

scholarly journals Civil and forensic patients in secure psychiatric settings: A comparison

2017 ◽  
Vol 41 (3) ◽  
pp. 156-159 ◽  
Author(s):  
Nuwan Galappathie ◽  
Sobia Tamim Khan ◽  
Amina Hussain
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Clinical Implications ◽  
Treatment Needs ◽  
Forensic Patients ◽  
Adult Services ◽  
Frequent Episodes ◽  
Self Harm ◽  
Male Patients ◽  
The Uk

Aims and methodTo evaluate differences between male patients in secure psychiatric settings in the UK based on whether they are detained under civil or forensic sections of the Mental Health Act 1983. A cohort of patients discharged from a secure psychiatric hospital were evaluated for length of stay and frequency of risk-related incidents.ResultsOverall, 84 patients were included in the study: 52 in the forensic group and 32 in the civil group. Civil patients had more frequent incidents of aggression, sex offending, fire-setting and vulnerability, whereas forensic patients had more frequent episodes of self-harm.Clinical implicationsSecure hospitals should ensure treatment programmes are tailored to each patient's needs. Civil patients require greater emphasis on treatment of their mental illness, whereas forensic patients have additional offence-related treatment needs. Regular liaison between forensic and general adult services is essential to help ensure patients can return to appropriate settings at the earliest opportunity in their recovery.

scholarly journals High-dose antipsychotic medication

1996 ◽  
Vol 20 (11) ◽  
pp. 676-680 ◽  
Author(s):  
Peter L. Cornwall ◽  
Fuad Hassanyeh ◽  
Caprice Horn
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Clinical Practice ◽  
Antipsychotic Medication ◽  
Antipsychotic Drugs ◽  
Maximum Dose ◽  
High Dose ◽  
National Formulary ◽  
Physical Status ◽  
High Dose Treatment

We audited the use of high-dose antipsychotic drugs in patients admitted to a special (intensive) care unit over two periods. Five out of 57 patients in the first sample and three out of 62 in the second were treated with a single antipsychotic drug above the British National Formulary maximum dose. The proportion of patients treated with antipsychotic drugs such that the total dose in chlorpromazine equivalents was greater than 1000 mg, fed. The audit showed improvements in clinical practice, particularly with respect to the onset of, indication for and outcome of high-dose treatment and in monitoring the patients' physical status.

scholarly journals Availability and acceptability of home treatment for acute psychiatric disorders

2000 ◽  
Vol 24 (5) ◽  
pp. 169-171 ◽  
Author(s):  
Andrew J. Owen ◽  
S. P. Sashidharan ◽  
Lyse J. Edwards
Keyword(s):  
Mental Health ◽  
Response Rate ◽  
Postal Survey ◽  
Home Treatment ◽  
Clinical Implications ◽  
Health Authorities ◽  
Low Levels ◽  
The Uk ◽  
Do So ◽  
Future Plans

Aims and MethodsTo ascertain current levels of access to home treatment for those with acute mental illness and future plans of trusts and purchasing authorities to provide such services. Also, to assess the attitudes of these organisations towards this form of treatment. A postal survey of all mental health trusts and purchasing authorities within the UK was carried out.ResultsOne hundred and seventy-two trusts and 82 health authorities returned questionnaires, representing a response rate of 75% and 67% respectively. Only 27 (16%) of trusts provided home treatment but 58 (40%) had plans to do so. All health authorities and 97% of trusts were in favour of the principle of providing home treatment.Clinical ImplicationsDespite the low levels of provision of home treatment trusts and health authorities were strongly in favourof it. There is likely to be a large increase in its availability over the next 12 months.

scholarly journals From a sector-based service model to a functional one: qualitative study of staff perceptions

2009 ◽  
Vol 33 (9) ◽  
pp. 329-332 ◽  
Author(s):  
Golam Khandaker ◽  
Srinivasarao Cherukuru ◽  
Claire Dibben ◽  
Manaan Kar Ray
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Qualitative Study ◽  
Junior Doctor ◽  
Clinical Implications ◽  
Service Model ◽  
Staff Perceptions ◽  
Clinical Leadership ◽  
Effective Change ◽  
The Uk

Aims and MethodAn increasing number of mental health trusts in the UK are replacing the geographically sectorised model of service delivery with a functional one. We conducted a qualitative study of staff perception concerning this reorganisation in our Trust, to inform effective change management locally and elsewhere.ResultsPerceived benefits were quick decision-making, positive risk management and improvement in clinical leadership. Dedicated consultant time would lead to improvements in junior doctor training. Concerns included lack of continuity of care, disagreement between teams and de-skilling of staff. Communication was seen as the key to overcoming these difficulties.Clinical ImplicationsDetailed communication from management about the practicalities and reasons for change could facilitate effective transition.

scholarly journals Assessing DNA rates for new referrals in older adults

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S179-S179
Author(s):  
Aamina Cheema ◽  
Nasir Pasha ◽  
Giorgi Gurieli
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Older Adult ◽  
Waiting Time ◽  
Initial Assessment ◽  
National Guidelines ◽  
Asthma Attack ◽  
Retrospective Audit ◽  
Initial Appointment ◽  
The Uk

AimsTo assess DNA rates for initial assessment medical appointments offered for new referrals within an Older Adults CMHT.To establish any correlation between waiting time and DNA rates.To establish if the initial appointments offered were in keeping with the National guidelines (18 weeks) and our local Trust policy (1-4 weeks).BackgroundIn the Uk 15% of adults 60 and above suffer from a mental disorder. Despite the increasing mental health burden, analysis indicate that a quarter of mental health trust received less investment from 2017 to 2018. Financial pressures have also increased appointment waiting time. The NHS has stated that by 2023 there will be a 4-week waiting time for older adult mental health services. Current national guidelines state that initial referrals should be seen within 18 weeks.MethodThis is a retrospective audit looking at all first time referrals to an Older Adult CMHT in East Birmingham. 110 patients were included in this audit. Factors recorded included age, gender, reason for referral, waiting time for appointment, and whether this complies with guidelines.Electronic patients' notes (RIO) were used for data collection.ResultOut of 110 new referrals 11 were not offered any appointments. Out of the remaining 99, 13 cancelled and 8 did not attend.In total, 78 attended the initial appointment offered, out of which 77 were seen within 18 weeks as per national guidelines. 43 patients were seen within the 4-week period (trust policy). 1 patient was offered an appointment at 19 weeks and 3 days from the referral date. The patients who did not attend their appointments were followed up except for one, to find out the reasons of the DNA. This included 2 (physically unwell), 1 (unaware of appointment), 1 (refused), 1 (forgot), 1 (couldn't get to clinic), 1 (asthma attack). Another appointment was offered to those who could attend.ConclusionThere was no significant correlation between a longer waiting time and an increased DNA rate for first appointments. Even though the time for an initial appointment was within the NHS guidelines, only 56% of the appointments met our Trust's policy of a 4 week wait.When discussing the results with the relevant team it was clear that a number of factors affected the waiting time including: number of available clinicians and a large catchment area.

scholarly journals Drayton Park, an alternative to hospital admission for women in acute mental health crisis

2000 ◽  
Vol 24 (3) ◽  
pp. 101-104 ◽  
Author(s):  
Helen Killaspy ◽  
Joy Dalton ◽  
Shirley McNicholas ◽  
Sonia Johnson
Keyword(s):  
Mental Health ◽  
Hospital Admission ◽  
Mental Health Problems ◽  
Clinical Implications ◽  
Mental Health Crisis ◽  
Safe Alternative ◽  
Health Crisis ◽  
Case Files ◽  
The Uk ◽  
Depressive Episodes

Aims and MethodTo describe Drayton Park, the first women-only residential mental health crisis facility in the UK and to investigate whether it is succeeding in its remit of providing a viable alternative to hospital admission. We randomly selected case files from 100 women admitted to Drayton Park since its opening and examined variables including demographic details, the reasons for referral, diagnosis and the source of referral.ResultsOur findings show that the service is able to respond quickly to referrals and appears to be functioning safely. The women admitted have a relatively short length of stay, half suffer from depressive episodes and one-third have a relapse of schizophrenia or bipolar disorder.Clinical ImplicationsThis project appears to be succeeding in providing a safe alternative to hospital admission for women with severe and enduring mental health problems.

Sign in / Sign up

Export Citation Format

Share Document