3600 results in BJPsych Open
Case Based Learning in Psychiatry: Use of Interactive Presentation Software and Fictional Narrative
- Gareth McGuigan, Scott Barr, Megan Robertson, Syeda Ghouri, Ayemyat Doris
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S111
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Undergraduate Psychiatry placements often struggle to provide the bedside teaching familiar to students from other specialties. Efforts to reproduce this experience in tutorials can be impaired by lack of interactivity, high student-to-teacher ratio, and use of mostly didactic pedagogy. Psychiatry trainees have provided weekly tutorials in ‘Clinical Skills' to University of Glasgow students on Psychiatric placement for several years. Unfortunately, these tutorials suffered from poor attendance, poor engagement, and difficulty recruiting facilitators. We created an afternoon of teaching structured around three presentations of a fictional patient in a narrative fashion aimed at solving these issues and providing excellent experience for students.
MethodsTogether with Glasgow University tutors, we selected Learning Objectives that would benefit from additional formal teaching. We then created a fictionalised patient narrative incorporating presentations of self-harm, delirium and postnatal depression. Teaching materials were created using mentimeter.com to allow for maximal engagement and interactivity. The content included brief summary slides, groupwork, Word-Clouds, anonymous quizzes, and simulated clinical encounters/roleplay. Custom illustrated vignettes accompanied each scenario to increase verisimilitude. The day is delivered by three Psychiatry trainees to up to forty students in their penultimate week of placement. Feedback is gathered digitally and anonymously on the day.
Results77/80 students invited attended. 71 (92%) completed feedback: 100% ranked the day positively - either “very helpful” (85.9%) or “somewhat helpful” (14.1%). Students advised it was “extremely useful” preparation for both clinical placements (73.2%) and exams (88.7%). All attendees provided free-text remarks; quotes include “One of the best teaching days I've been to” and “Best teaching of the block”. 84.5% felt “very involved” in the day and the word “interactive” was used 30 times in freetext. When asked on what could be improved, the most common response was “another session” (34%).
ConclusionRecruitment to Psychiatry relies on positive experiences during placement. Retention of Psychiatrists relies on providing rewarding and varied working experiences. Our hope is that successful events like this support both aims. The creative use of narrative, illustrated vignettes, roleplay and interactive questions afforded excellent engagement and enjoyable experiences for student and facilitator, as reflected in the feedback.
Going forward, we plan to refine this case and develop another. We are seeking review and design input from patient representatives and EDI experts. Comparison of students' exam outcomes and feedback from the replaced tutorials is also planned. Use of this format across other specialties is also being pursued.
The Chicken or the Egg? Understanding the Temporal Relationship Between Severe Mental Illness and Neurological Conditions in a UK Primary Care Cohort
- Ella Burchill, Jonathan Rogers, David Osborn, Joseph Hayes, Naomi Launders
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S2
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A significantly higher prevalence of neurological conditions has been found both before and after a diagnosis of schizophrenia, bipolar disorder and other psychotic illnesses compared with the general population.
We aimed to understand the cumulative prevalence of 16 neurological conditions in people with severe mental illness (SMI) from 5 years before to 5 years after their SMI diagnosis. We hypothesised that individual neurological conditions would have differential temporal relationships relative to SMI diagnosis.
MethodsIn a longitudinal matched study, we identified a cohort of patients aged 18–100 years from Jan 1, 2000, and Dec 31, 2018, from the UK Clinical Practice Research Datalink (CPRD). Neurological conditions were classified using ICD–11 criteria into umbrella clusters of disease. Outcome of interest was a diagnosis of SMI. Each SMI patient was matched 1:4 to patients without SMI in the CPRD cohort, matching for sex, 5-year age band, primary care practice and year of practice registration. The cumulative prevalence of 16 neurological conditions was recorded cross-sectionally at 5, 3, 1 years prior to SMI diagnosis, at SMI diagnosis (index), and 1, 3 and 5 years after SMI diagnosis. Logistic regression modelling aided comparison of differential prevalence of neurological conditions, adjusting for sociodemographic variables, and with further adjustment for body mass index, smoking, alcohol and non-prescription drug use. Multiple imputation was applied in cases of missing data.
ResultsWe identified 68,789 patients with SMI, matched to 274,827 controls. The median age was 40.9 years, 49.05% of the overall cohort were female (33,783 SMI patients, 134,740 controls), and the majority were of White ethnicity (35,228, 51.2% SMI patients, 125,518, 45.7% controls). The most prevalent neurological conditions across seven timepoints were cerebral palsy, cerebrovascular disease, dementia, epilepsy, multiple sclerosis, paralysis and Parkinson's disease. Conditions with the highest fully adjusted odds ratios (ORs) for SMI diagnosis were dementia 3 years after SMI diagnosis (5.32, 95% CI 4.95–5.71) and Parkinson's disease 5 years after SMI diagnosis (4.26, 95% CI 3.68–4.94).
ConclusionAll 16 neurological conditions have higher prevalence in the SMI cohort compared with controls, with different prevalence patterns observed over the 10-year study period. A consistently lower OR for schizophrenia compared with other SMI warrants further exploration, as neurological conditions risk being under-recorded.
A greater understanding of the temporal relationship between SMI and neurological conditions may help promote earlier diagnosis, increased screening and better holistic management of both conditions.
Introducing Step-Down Summaries to the Intensive Psychiatric Care Unit
- Ewan Mahony, Zoe Johnston
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S10-S11
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The intensive psychiatric care unit (IPCU) is a 10-bedded unit which houses some of the most unwell psychiatric inpatients, generally those with psychosis and mania who require enhanced care and restriction. Admissions can be long and involve high levels of clinical complexity. This project identified the need for clear communication at the point of discharge with regards to rationale for decision making, mental health act status, risk and outstanding issues. The aim was to develop and test a tool for communicating this: the step-down summary.
MethodsThree plan, do, study, act cycles were run. The first involved creating a draft proforma and testing this with 3 complex patients, gathering qualitative feedback from receiving clinicians. The proforma was then improved and a full-scale trial including all patients with stays of 2 weeks or more was conducted, a total of 18 patients. Data were collated on the timing of summary completion and further improvements to the proforma were made based on consultant feedback. Finally, a third cycle was run to establish whether the new process was sustainable between rotating trainees.
ResultsInitial feedback was positive with clinicians highlighting that the summaries saved time reading extensive notes, clearly identified outstanding tasks, and helped with final discharge document writing. It became clear that there was a need to agree a cut-off time of how long a patient should be in IPCU to merit a stepdown summary. Of the 18 patients who met this cut-off in the 2nd cycle all had a stepdown summary at the point of transfer with 89% of these fully complete before their next clinical review. During the 3rd cycle, there were 19 relevant patients only one of whom did not have a summary, due to their transfer coinciding with trainee leave. Feedback remained positive, highlighting that the summaries avoided duplication of work.
ConclusionOverall, the use of stepdown summaries proved useful to receiving clinicians in both communicating important information and in saving further time when later creating final discharge documents. It was sustainable between trainees, however there remained an issue with these not being produced during trainee leave. It may be useful to consider alternate clinicians who can support with the production of summaries to minimise this as well as measuring more clear clinical outcomes, such as the repetition of investigations. This would support an expansion to other UK IPCUs.
Assessing the Impact of the 2024 National Student Psychiatry Conference on Medical Student Career Aspirations and Subspecialty Interest
- Dayo Taslim, Karthik Venkateswaran, Oscar Han, Abdullah Ahmad
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S120-S121
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The 2024 National Student Psychiatry Conference, hosted at the University of Sheffield with the theme 'Me, Myself and I,' explored the intersection of the ‘self' and the ‘other.' It delved into the dynamics of individuals in the context of their lived experiences, environment, and emerging paradigms within psychiatry and beyond. Talks and workshops aimed to heighten attendees’ interest in psychiatry by challenging societal stigma and traditional norms and expanding their perspectives of psychiatry.
MethodsThe pre-conference questionnaire included attendees’ year of study, university/NHS trust affiliation, current likelihood of pursuing psychiatry and career aspirations, knowledge of conference themes, and ten subspecialties represented at the conference via a faculty carousel. The post-conference questionnaire enquired about changes to the above aforementioned factors, to explore changes in career aspirations. Standardized dropdown options were used in both forms to facilitate data evaluation.
Results71 attendees were included in the final evaluation; 17 were excluded due to duplication or not completing both forms. Of the attendees, 31% were in their pre-clinical years, 56% were in their clinical years, and 4% were doctors. 9% of the participants were non-medical attendees.
Demographics of attendees included a majority from Yorkshire and Humber (52%), Midlands (11%), South England (6%), North England (10%), North East (8%) and Others (13%).
21% of attendees had been to a prior psychiatry-related conference and 34% were currently taking part in or had completed a psychiatry-related project in the past.
The level of interest in attendees aspiring to pursue psychiatry increased from 62% to 72%. An increased interest in medical psychotherapy (82%), forensic psychiatry (68%), and perinatal psychiatry (67%) after the faculty carousel was observed.
Following the conference, 97% reported increased knowledge of each theme. Findings from the faculty carousel revealed that, on average, over 90% of attendees reported an increased understanding of each speciality represented.
ConclusionThe National Student Psychiatry Conference plays a significant role in increasing exposure of psychiatry to medical students and increasing their understanding of the diverse career paths within the speciality. The conference fosters networking opportunities and facilitates meaningful connections within the field, positively influencing attendees' considerations and perceptions.
Knowledge of Psychogenic Polydipsia Within Mental Health Services
- Ewelina De Leon, Louise Dunford, Graeme Yorston
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, pp. S30-S31
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Psychogenic polydipsia (PP) is a term used to describe a repetitive behaviour that characterises compulsivity in psychiatric patients resulting in excessive fluid consumption. It is a common clinical problem in patients with severe mental illness, learning disability, autism and acquired brain injury. Up to 20% of patients with schizophrenia have polydipsia, and many develop hyponatraemia and water intoxication, which can lead to irreversible brain damage or death.
Psychogenic polydipsia may not be obvious to staff in a busy care setting, leading to delayed identification and appropriate care.
The objective of this study is to assess the existing knowledge of psychogenic polydipsia among mental health staff and promote greater awareness of the condition.
MethodsTo investigate the understanding of psychogenic polydipsia among healthcare staff, an online survey has been chosen as the research method. This survey will help identify any knowledge deficiencies in this area. It consists of both closed and open-ended questions, allowing for quantitative and qualitative analysis. The open-ended questions are designed to provide an opportunity for participants to share their individual experiences. Additionally, the survey will collect information on participants' age groups, years of experience in mental health services, and level of expertise. The survey was created using Qualtrics online survey software. Participant recruitment will be conducted at St Matthews Healthcare, with an estimated sample size of n = 101. The collected data will be analysed using statistical software such as SPSS, NVivo, or other appropriate tools.
ResultsThe results of this study will be presented. Data are being collected and analysis will be completed in March. The abstract will be updated. These findings will serve as the basis for future recommendations and suggestions.
ConclusionComprehending patients' illnesses is a crucial aspect of providing quality healthcare. However, identifying psychogenic polydipsia has proven to be challenging within mental health settings. Failure to recognize excessive fluid intake can result in ineffective treatment, exacerbation of psychiatric symptoms, and in severe cases, coma or even death. The findings of this study have the potential to contribute to the creation of a training program for healthcare providers. Such a program would enable the development of improved care plans for patients who engage in excessive fluid consumption and are at risk of developing hyponatremia and water intoxication.
Ketamine Efficacy Across All Formulations in Treatment Resistant Depression in Adult Population: A Rapid Review
- Bikramaditya Jaiswal, Neha Singh, Benson Benjamin
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, pp. S47-S48
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The primary aim of this rapid review was to evaluate the evidence base for the efficacy of ketamine across all formulations and routes of administrations in the treatment of adult patients with treatment resistant depression (TRD).
MethodsThis rapid review retrieved controlled trials on use of ketamine across all of its formulations, including all isomers and across all routes of administration in TRD patients for achieving response and remission. This review included PubMed and PsycINFO databases. The retrieved studies were screened with the help of a screening tool and data were extracted by using data extraction forms by two authors. The studies were evaluated for quality of evidence, ethical issues and critically analyzed. Narrative synthesis was used for data synthesis.
ResultsThis review retrieved 10 placebo controlled randomized controlled trials (RCT) on intravenous (IV) ketamine, IV esketamine, intranasal (IN) ketamine and IN esketamine in TRD patients. IV ketamine and esketamine showed higher rates of remission and response in comparison with placebo groups in TRD patients. There was no significant improvement in response and remission rates in TRD patients on IN esketamine in comparison with placebo. The adverse effects in the intervention groups were of mild to moderate severity and short lasting mostly resolving within a day.
ConclusionThis review recommends IV ketamine and esketamine can help in achieving early response and remission in TRD patients and it seems to be a well-tolerated treatment option. Further studies are needed to assess these issues around safety, ease of administration and potential for dependence.
Audit on Monitoring of National Early Warning Scores 2 (NEWS2) in Old Age Patients
- Sadia Tabassum Javaid, Bethan Brace, Bethany Lee
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, p. S241
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NEWS 2 is integral to post-admission physical health monitoring, guiding baseline establishment and observation frequency decisions. MDT discussions, involving medics or nurses per guidelines, ensure tailored care. Trust Standard Operating Procedure (SOP) and Physical Health policy, provides detailed procedures for assessment, recording, and actions. Adhering to NEWS 2 and SOP 1.62a, aligned with Trust standards, facilitates prompt escalation in case of patient deterioration, reinforcing our commitment to superior healthcare.
AIM
• To evaluate if NEWS2 monitoring is done as per set Trust standards/guidelines.
• To identify areas of improvement in the use of this observational tool.
• To improve the services and care of patients.
MethodsWe conducted a comprehensive review of each section of NEWS 2 charts for 39 patients admitted to Ward 6 and 7 at Harplands Hospital over a 3-week period. Patient stays varied from 21 to 67 days. No pregnancies were noted; all patients were aged between 59–96, with a near equal gender distribution. Utilizing SPSS, we conducted data analysis, comparing results against Trust-set standards.
ResultsOf the 39 charts, 37 were completed at admission, with notable issues: 9 lacked demographics, 13 had date/time missing. Weekly NEWS was predominant, but challenges included 6 missing signatures, 9 illegible entries, and 12 incomplete sections (4 without connecting observations). GCS completion issues were identified in two charts if CPVS score was more than 3. Escalation patterns varied: scores 1–4 were often routed to a Registered Nurse before medics, while scores >4 were mainly escalated directly to medics. Most charts were uploaded to electronic records, yet the electronic versions were frequently left unfilled.
ConclusionIn conclusion, the implementation of NEWS charts at admission, consistent chart uploads to Lorenzo, and effective escalation practices underscore a commitment to patient monitoring. The detailed procedures, including demographics completion, trend identification, and weekly reviews, contribute to a comprehensive approach. The incorporation of printed patient information labels and targeted education sessions for ward teams further reinforces the emphasis on standardized and meticulous documentation practices, enhancing overall patient care and safety. Discussions with ward management will further support the ongoing success of these initiatives.
Above recommendation has been completed and Re-Audit in planned few months.
User Experience of Generating PSPDPs on Portfolio Online Amongst Psychiatry Trainees and Trainers
- Aradhana Gupta, Pallavi Chandra
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, p. S105
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The Royal College of Psychiatrists (RCPsych) introduced the new psychiatry training curriculum in February 2022. Since then there have been various updates in both the e-portfolio platform and curriculum requirements.
A survey was undertaken to understand issues experienced in navigating these changes by psychiatry trainees and supervisors within the Black Country Healthcare NHS Foundation Trust (BCHFT), specifically assessing the generation of Placement Specific Personal Development Plans (PSPDPs) for each training placement.
The aim of this study was to survey user experience and reflect on the results to identify how best to support trainees and supervisors in using PSPDPs, a key curriculum requirement, with greater ease and confidence.
MethodsThe survey comprised tailored questionnaires distributed to two cohorts- trainees (30) and supervisors (37) within the BCHFT. Anonymised responses were collected over one month. Likert scales were used to determine (a) confidence levels in setting up PSPDPs, (b) confidence in mapping activities to both PSPDPs and the curriculum, and (c) user-friendliness of RCPsych guidelines on this topic. Checklists and free-text responses were used to assess which support resources were being utilised by both groups. Suggestions were requested on how the whole process could be improved.
ResultsAmongst trainees (response rate 63%), 78% did not feel confident in setting up PSPDPs. 94.7% sought additional support in PSPDP setup, of which peer support was the most utilised (77.8%). Other resources included the RCPsych website and emails as well as supervisors. 58% of trainees lacked confidence in linking activities to PSPDPs and the curriculum. Only 10.5% of the trainees found the RCPsych Implementation Hub user friendly.
In the supervisor cohort (40% response rate), 64% of the trainers felt confident in guiding their trainees in setting up PSPDPs. 85% utilised support from various sources including the Implementation Hub (91.7%), trainees (58.3%) and peers (50%). 64.2% of supervisors found the RCPsych website user friendly.
ConclusionCommon themes that emerged were that both trainees and supervisors felt the process of setting up PSPDPs was quite complex, with a confusing web interface. Resources on the RCPsych website required better signposting. Both cohorts felt they would like additional training e.g. step by step videos and training sessions (local peer trainee and supervisor run sessions were found useful).
This feedback has identified the importance of arranging local training sessions to improve engagement. Additionally, we hope that relaying this feedback to RCPsych may influence future systemic changes.
A Qualitative Analysis of Contributory Factors to Serious Incidents Involving Adults With Learning Disabilities Receiving NHS Mental Healthcare
- Nusra Khodabux, Reza Kiani
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, pp. S52-S53
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This study aimed to analyse contributory factors to serious incidents (SIs) involving adult patients with intellectual disabilities receiving NHS care in a mental health trust. People with intellectual disabilities face considerable preventable harm and disparities in care. In-depth analysis of contributory factors to incidents involving adults with an intellectual disability, using human-factors based frameworks is lacking. Individual SI reports contain useful data, but learning is often limited without aggregated analysis.
MethodsThirty anonymized serious incident reports (2014–2023) from an NHS mental health Trust's intellectual disability service were analysed qualitatively using the Yorkshire Contributory Factors Framework, followed by reflexive thematic analysis (RTA) to identify patterns across the data. This enabled nuanced themes to emerge across errors at the sharp end and systems-level factors at the blunt-end.
ResultsAcross 30 reports, 606 discrete factors were identified. Situational factors such as behavioural escalations and staff competency gaps were most frequent (n = 187, 31%). Other factors included active failures, such as slips, lapses, mistakes, violations (n = 109, 18%), organisational influences (n = 107, 18%), communication breakdowns (n = 75, 12%), unfavourable working conditions (n = 62, 10%), cultural factors such as reluctance to voice safety concerns (n = 51, 8%), and external system factors (n = 15, 2%).
Using RTA, we identified recurring themes across incidents involving interactions between sharp-end human and blunt-end system factors, with broader issues shaping frontline performance. Patient marginalisation, excessive workloads, lack of resources, and cultures tolerant of shortcuts aligned to permit errors. Deficient coordination across fragmented healthcare systems and overdependence on non-permanent workers and bank staff obstructed comprehensive incident reviews. Failure to adequately probe cultural influences and external pressures further reflect the limited extent of investigational efforts.
ConclusionAdults with intellectual disabilities are subject to serious incidents caused by interacting human and system-level factors, including organisational, cultural and external factors. Addressing under-resourcing and improving investigation quality are paramount to enhancing safety of care for people with intellectual disabilities.
A Comparative Study of Sleep Parameters in Opioid Dependent Patients on Opioid Substitution Therapy: Findings From India
- Richa Tripathi, Ravindra Rao, Anju Dhawan
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
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- 01 August 2024, p. S89
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Sleep problems are common in opioid users and in patients receiving opioid agonist treatment. The aim of the present study was to study the pattern and prevalence of subjective sleep disturbances in opioid dependent subjects maintained on opioid agonist treatment (buprenorphine and methadone).
Methods: A cross-sectional observational study was conducted in a tertiary health care center in India. 106 adult opioid dependent male patients maintained on buprenorphine and 50 adult opioid dependent male patients maintained on methadone who were initiated on medication at least six months prior, on stable dose of medication for last one month and were adherent on medication for at least 50% occasions in last one month were included in the study.
ResultsThe mean age of the sample for buprenorphine-maintained group and methadone maintained group was 41.1 (SD: 14.3) years and 27.7 (SD: 7.8) years respectively. Tobacco, alcohol and cannabis were used by majority of the participants in both the groups. Most participants had used heroin by smoking before starting buprenorphine (n = 68, 64.1%) and methadone (n = 46, 88.5 %). The duration of use of illicit opioids was for median duration of 10 (IQR: 5, 22) years for buprenorphine group and 5 (IQR: 3, 7) years for methadone group.
In buprenorphine group, the participants had been on buprenorphine for a median duration of sixty (IQR: 17, 120) months. The mean current dose of buprenorphine was 10.2 (SD 3.8) milligram per day. The mean PSQI score was 6.6 (SD 3.4). About 63.2% (n = 67) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 403.5 (SD 94.8) minutes and median sleep latency was 35 (IQR 18.8, 62.5) minutes.
Similarly, in methadone group, the participants had been on methadone for a median duration of seventeen (IQR: 10, 22) months. The median current dose of methadone was 20 (IQR: 14, 36) milligrams per day. The mean PSQI score was 5.2 (SD 2.8). About 44.2% (n = 23) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 466.5 (SD 114) minutes and median sleep latency was 30 (IQR 15, 97.5) minutes. Subjective sleep problems were associated with past three months opioid use.
ConclusionThe methadone group had relatively younger population with early onset of substance use. They were on relatively lesser dose of methadone. This group also had lesser sleep problems than the buprenorphine group.
Optimising MDT Huddles: A QIP Approach to Improving Efficiency and Satisfaction in an Older Adults Psychiatric Ward
- Adnan-Mustafiz Chowdhury, Tharun Zacharia
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S132
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At Chelsham House – an older adults, acute inpatient dementia mental health ward – morning handover meetings (‘huddles’) lacked structure and consistency, resulting in extended, inefficient patient handover discussions and unclear task allocation. These issues consumed valuable clinical time and impacted the continuity and effectiveness of care. Recognising these challenges, a need to revamp the huddle format emerged, prioritising clear communication, effective task distribution, and team cohesion to enhance patient safety and care efficiency.
This project aimed to improve the efficiency and effectiveness of morning huddles at Chelsham House by reducing their average duration by 10% and enhancing multidisciplinary team (MDT) staff satisfaction regarding patient handover dialogues, task distribution, and accountability within 2 weeks.
MethodsThe intervention streamlined the huddle format by assigning a rotating MDT chairperson and task allocator, setting a strict 2-min per patient discussion target. New segments, such as a ward safety check and focused discussions on risks and discharge barriers within patient updates, were added. A task allocation board was implemented in the meeting room for assigning tasks. Staff surveys and data on meeting duration were collected pre- and post-implementation.
ResultsThe implementation led to a 16% reduction in huddle duration (from 64 to 54 minutes) and a 21% decrease in time spent per patient discussion (from 4.09 to 3.23 minutes). Staff surveys showed a significant increase in satisfaction regarding safety discussions (21%), task clarity (23%), and discharge planning efficiency (26%). The effectiveness of mental and physical health discussions was maintained, with a high average Likert score of 4.64 post-implementation, on a scale where 1 is ‘Strongly Disagree' and 5 is ‘Strongly Agree'.
ConclusionThis QIP achieved a notable 16% reduction in huddle duration, enhancing clinical operations on the ward. The progress, combined with improved staff satisfaction and maintained quality of discussions, underscores the QIP's success in boosting clinical efficiency and offers valuable insights for future initiatives in similar settings.
Patients' Experience of Using Virtual Consultations in Their Care During Their Inpatient Stay on Acute Mental Health Admission
- Ahmed Elshafei, Elizabeth Junaid, Umoh Ekwere, Fatima Maheen
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S192
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To obtain the views of patients regarding their experience of meetings where virtual media (video conferencing) has been used during their inpatient stay in the acute female admission ward.
MethodsData was collected via a questionnaire. Service users who met the inclusion criteria were past and current inpatients in the acute female psychiatric ward during the last six months. The sample of the service users included in the project was selected from all applicable cases via convenience sampling – those on the ward who consented and were able to engage, as well as past inpatients whom we contacted via telephone after their discharge who met these same criteria.
Verbal consent was obtained from all the patients who agreed to participate. Data was collected and analysed using Microsoft Excel.
Results13 patients in total completed the facilitated questionnaire which used 11 questions rated by Likert Scale as well as an open space area for further comments. Age ranges varied among participants with 39% age range 18–30, 38% aged 31–50 and 23% aged 51–65. 61% were of white British descent. Majority (38%) were admitted for schizophrenia, schizotypal and delusional disorders, 31% for disorders of adult personality, 23% for mood (affective) disorder and 8% for anxiety, dissociative, stress related, somatoform and nonpsychotic mental disorders.
Most patients rated the use of virtual consultations positively, with over ¾ of patients answering strongly agree or agree (positive response) to most questions. This included feeling able to express themselves effectively as in an in-person consultation, feeling that they received adequate care, feeling that the audio-visual quality was satisfactory and that their privacy was respected. One suggestion for improvement from the patients was to clarify the number of people in the room and how many students are present during the consultation.
ConclusionVirtual consultations were overall well received among the patients interviewed. Interventions that facilitate timeliness and privacy in consultations as well as training for staff in verbal and nonverbal communication skills for virtual consultations would be beneficial. Further surveys in groups underrepresented in the survey such as men, older people, ethnic minority groups, people with visual or hearing impairment and other mental disorders not present in the sample would help to give further insight into how virtual consultations are received and barriers by different groups.
Communication in Education – Improving Student Engagement With Mental Health Online Learning
- Yuki Takao, Sophie Butler
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S120
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Our mental health placement has a longitudinal design and students spend one day per week in psychiatry throughout their academic year, attending clinical placement and academic days on alternate weeks. Academic days include a small group tutorial, Balint group and self-directed learning, during which students are expected to complete a ‘virtual patient’ (VP) e-learning module. VPs align with the topic of their small group tutorial and are intended to facilitate their learning. Despite this, only a minority of students complete them. Our aim is to investigate and iteratively design interventions to improve uptake of learning.
MethodsUsing an iterative process, we explored potential reasons for low student uptake by reviewing routine feedback from faculty and students; most tutors and students were unaware of the e-learning. We hypothesised that increased faculty awareness and promotion of VP could lead to an increase in student access numbers. The intervention was therefore of improved communication amongst faculty by fortnightly newsletter emails which include the topic of the academic day, explanation around what is expected of students with the website link to the VP, and other useful resources tutors may wish to use. Emails are sent by medical education administrators in the week before the academic day to all tutors. Access logs for the previous (2022–2023) and current (2023–2024) academic year were obtained so comparison could be made pre- and post-intervention.
ResultsResults are available for 4 modules; thus far we are yet to see significant differences in engagement. There was a technical glitch for one module and for the other modules the difference in student access has been minimal (<5%). We also have qualitative feedback from 5/28 tutors. One was confused and thought they were being asked to do additional work, one requested for information about the VP without realising it was included in the newsletter email, and three said they found it helpful.
ConclusionFortnightly email newsletters is a simple and cost-effective way to possibly improve communication within faculty. It is likely difficult to promote student engagement with activities that their tutor is unaware of or perceives as invaluable. However there remain real challenges of using email as a communication tool for busy clinicians and is unlikely to make a difference as a stand-alone intervention. For future development we plan to include medical students and clinical supervisors as recipients in the mailing-list and spend time on a faculty development day to further explore this issue.
Review of Rapid Tranquillisation Guidelines Across NHS Trusts in England
- Claudia Chavasse, James O'Neill, Daniel Romeu, Alex Graham
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- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S12-S13
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Rapid tranquillisation – the parenteral administration of a sedating psychotropic – is frequently utilised to manage acute behavioural disturbances. Each mental health trust in England utilises independent guidelines for rapid tranquillisation, which vary geographically in both recommendations for therapeutic agents, as well as the format in which this information presented. Audits have identified that there is currently poor adherence to rapid tranquillisation protocol guidelines; this may be due to a lack of guideline clarity allowing for personal interpretation. This service evaluation aims to determine the clarity and uniformity of protocols outlined in mental health trust guidelines, in addition to analysing the outcomes of guideline testing to identify if there is consistency between policies, or whether outcomes varied depending on the trust guidelines used.
MethodsFive reviewers (of differing positions throughout clinical training) utilised 52 guidelines from each mental health trust in England, as well as Maudsley and NICE. These were assessed using the same fictional scenario, which simulated a common presentation in which the use of rapid tranquillisation is required. Reviewers deduced the most appropriate therapeutic agent according to the guideline, rated the clarity of each guideline and were invited to leave comments highlighting the guideline's useability.
ResultsSeven different management plans were generated by the majority of respondents from the 52 guidelines. Lorazepam was the most frequently selected therapeutic agent. Guidelines with better subjective ratings of clarity had more agreement between reviewers, but full agreement between reviewers was only present for 10 out of 52 guidelines. For 11 guidelines, consensual agreement between reviewers was not reached. Qualitative analysis of comments identified the inclusion of past medical history, drug history and flow charts as positive sub-themes. Redundant language, contradictions and the suggestion to seek senior intervention before trialling a second agent were viewed negatively. Many guidelines did not sufficiently emphasise the need for performing an ECG before administering therapeutic agents, such as haloperidol, which may lead to potentially fatal arrhythmias.
ConclusionThere is no national consensus on the most appropriate rapid tranquillisation agents, with the available evidence being interpreted variously by different trusts and organisations. Poor guideline comprehensibility impacts clinician adherence and allows for personal preference to influence choice of drug. Clear guidelines utilising flow charts to succinctly outline relevant doses and absolute contraindications were viewed favourably by reviewers. The findings of this project highlights to relevant stakeholders the attributes that should be implemented when improving guidelines for the future.
Prescribing Habits of Clinicians and Medication Journey of Patients Treated for Attention Deficit Hyperactivity Disorder (ADHD): Experience From a Large London Clinic
- Azizah Attard, Jessie Pang, Stephen Attard, Hugo de Waal
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S293-S294
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To understand the prescribing habits and trends of clinicians in a large ADHD clinic and the medication journey of patients from point of diagnosis to the point of agreeing a shared care plan with primary care services.
MethodsThis was a non-interventional retrospective study collecting information from anonymised electronic patient and prescription records. Following approval by the Clinical Governance body of the practice, in June 2023, all patients with a SCP between the years 2019 and 2021 were identified. Data collected included patient demographics, date that medication was started, discontinued, or switched along with associated reasons. Additionally, to better understand the time taken to gain publication of a SCP, the amount of clinician-patient facing time was recorded, including the number of brief follow-up appointments, number of repeat prescriptions and number of clinician to patient emails. Patient data was fully anonymised and any identifiable data removed.
ResultsAll but one patient was started on a stimulant medication immediately following diagnosis, in line with national prescribing guidance. Atomoxetine was the medication of choice for a patient with a previous history of stimulant intolerance. 74% (n = 95) of patients were started on lisdexamfetamine, 20% (n = 25) were started on methylphenidate long-acting formulations and five patients on short-acting methylphenidate agent.
Of the 95 patients initiated on lisdexamfetamine, 78 (82.1%) were continued on lisdexamfetamine until the point of publication of their Shared Care Policy (SCP), nine (9.5%) patients switched medication, 10 patients initiated additional fast-acting dexamfetamine tablets and two had a second agent added to their therapy (atomoxetine n = 1, methylphenidate n = 1).
Of 25 patients initiated on methylphenidate long acting, 18 (72%) continued this medication at the point of publication of SCP. Of 25 patients initiated on methylphenidate long acting, seven (28%) patients switched medication and two patients were initiated on an additional fast acting methylphenidate.
To successfully stabilise and publish 134 patients on a SCP, 404 brief follow up appointments of 15-minute duration were utilised, which totals 6060 minutes of patient facing time. Of 134 patients, most n = 41 (30.6%) had 2 brief follow-up appointments; 32 (23.9%) had 3 brief follow up appointments and 22 (16.4%) had 4 appointments. Two patients did not attend a follow up appointment, and one patient had 11 brief follow up appointments.
ConclusionStimulant medications were typically used as first line treatment however, of these 74% were started on lisdexamfetamine while only 20% were initiated on long acting methylphenidate. Those started on lisdexamfetamine were more likely to continue on this medication to the point shared care agreement than those started on methylphenidate, 28% of whom switched to an alternative, for a variety of reasons. Mean time to reading a shared care agreement was longer for those initiated on methylphenidate long acting compared to lisdexamfetamine.
The data show that for most patients the journey from initiation of a stimulant medication to a shared care agreement was a straightforward one, with the majority having either two or three follow up appointments.
More research is needed to better understand the apparent differences in pathway for those commenced on lisdexamfetamine and long acting methylphenidate.
Clinical Audit of Standard for Electronic Recording of Dementia Diagnostic Assessments in Stockton Mental Health Services for Older People
- Karyn Ohioma, Mani Krishnan, Rachael Rose, Oluwabukola Rosiji, Olusegun Temitope Sodiya
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S253
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This clinical audit aimed to assess if the recording of patients seen for their diagnostic appointments in memory clinic measures up to the minimum standards required in the delivery of dementia services. This standard mandated primarily that a minimum body of key information must be promptly recorded by clinicians, in patient electronic records within 24 hours, as stipulated by Trust and NICE guidelines.
MethodsThe first cycle was conducted from 16 October 2022 to 10 February 2023. In this cycle random sampling was used to select 25 patients on the caseloads of the mental health services for older people. Before the start of the second phase all diagnosing clinicians within the team were informed about the project and the expected improvements against which compliance would be audited. The second phase was conducted between 10 February 2023 to 31 March 2023 and another 25 patients on the caseloads were obtained via random sampling for the second cycle. Inclusion criteria for both phases were patients who had received a diagnostic assessment in these periods.
ResultsIn the first set of records, the minimum body of information was recorded in 90–100% of cases according to the team's recommended standards namely diagnostic information, prognostic information, treatment plans, post-diagnostic contact plans and documentations being made within 24hrs of consultation. In the Set 2 the minimum body of information was recorded in 95–100% records studied. That is, diagnosis, treatment, medication treatment plans (prescription plans), and post-diagnostic contact plans were covered in the diagnostic sessions. In particular, case note documentations were made within 24 hours in all but one of the records applicable.
ConclusionGiven that a diagnosis of dementia can be life-changing, not discussing prognostic information would not prepare patients and carers adequately with information on how to live well with dementia following their diagnosis. This could potentially lead to poor adjustment to the condition and anxiety for some. At a trust-wide level, this means there is still room for improvement for the trust as regards dementia care ideals recommended by NICE.
The Neurobiology of Depression, Burnout and Resilience Among Healthcare Students
- Hamid Alhaj, Abdul Rahman Al Midani, Zainab Alkokhardi, Rashid Abu Helwa, Almuzaffar Al Moukdad
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S17
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Adapting to academic and social demands may be challenging for university students. Healthcare students are thought to be at high risk of burnout and Major Depressive Disorder (MDD) due to the demands of their training and emotional toll of caring for patients. This risk extends well into physician years, suggesting the persistence of an abnormal psychological state developed during training years. We aimed to investigate the prevalence and severity of depressive symptoms, burnout, and resilience in healthcare students, examine their correlation with salivary cortisol levels, and assess how these factors change during examination periods.
MethodsThis longitudinal study investigated the mental health and salivary cortisol levels of medical, dental, or health science students in the UAE at two distinct periods, at the start of the academic semester, and within one week of the examination period. A total of 147 students (51% females) were included, and their demographics and education variables, including cumulative GPA (cGPA), were assessed. Depression, resilience, and burnout scores were measured using the Patient Health Questionnaire-9, Nicholson-McBride Resilience questionnaire, and Maslach Burnout Inventory-Student-Survey, respectively. Participants who met the criteria for MDD were identified. Time-dependent cortisol levels were modelled using functional data analysis and standardised cortisol levels were calculated. Data analysis was done using mixed effect models in R 4.1.2.
ResultsAmong participants, 12.2% screened positive for MDD at the beginning of the semester, increasing to 16.6% during the examination period. Depression scores were higher during the examination period (p = 0.011). Female gender was significantly associated with higher levels of depression (median difference = 3.00; p < 0.001) and burnout but lower levels of resilience (mean difference = 3.27; p < 0.001). cGPA below 75% (p = 0.009) and history of mental illness (p = 0.015) were associated with increased levels of depression. High cortisol responders (z-value > 1) developed higher depression scores (p = 0.033) compared with low cortisol responders (z-value < −1). Participants with higher resilience were less likely to develop depression and burnout (p < 0.003).
ConclusionThis study shows relatively high levels of depression among healthcare students in the UAE, particularly in females, students with history of mental illness, students with low cGPA, and students with high cortisol levels. Efforts to promote culturally appropriate resilience skills need to be developed to reduce distress and depression in this population.
Health and Social Care Staff Awareness of Menopausal Symptoms in Adults With Intellectual Disability: Results From a Survey
- Jack Wilson, Niall O'Kane, Bernice Knight, Angelica Lindsey-Clark, Jessdeep Rai
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S177
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Menopausal symptoms often go unrecognised in individuals with intellectual disability (ID). There is growing societal awareness of the impact of menopause on mental health, yet this has not been replicated in the ID population. In light of this, we wanted to establish the current levels of knowledge, confidence and skills of staff working in a specialist community intellectual disability service (CIDS). The findings from the survey may help identify ways of improving awareness of menopausal symptoms with individuals with ID.
MethodsWe performed a cross sectional survey of staff views and practice in relation to considering and discussing menopausal symptoms with individuals with ID. The survey was anonymous, and conducted on Microsoft Forms. A mixture of quantitative and qualitative data was captured. A QR code linking to the survey was disseminated to the whole team (60 staff) via email and in-person staff meetings.
ResultsThere was 50% (30/60) responses to the staff survey. The majority of respondents worked in either health (16/30) or social care (12/30). Two thirds of respondents either agreed or strongly agreed (20/30) that discussing menopausal symptoms was part of their role. 57% of respondents (17/30) felt confident discussing menopausal symptoms with service users, while 20% (6/30) felt neutral and 23% did not feel confident. 90% (27/30) of respondents either agreed or strongly agreed that they would benefit from teaching and training in the effects of menopause in our service users. Thematic analysis of the free text responses revealed that staff wanted to understand treatments available for menopause as well as improved easy read material explaining menopausal symptoms to individuals with ID.
ConclusionOur survey revealed a spectrum of confidence levels in discussing menopausal symptoms with service users, and a large appetite for further training and resources to aid these conversations. In light of the results from this survey, a Quality Improvement (QI) project has been initiated. Once QI change ideas have been tested, a repeat survey will be completed to compare staff views and confidence in this area and in this way measure the effectiveness of those changes.
A Re-Audit of the Assessment of the Nutritional Status of Patients Admitted to the General Adult Inpatient Wards in Mersey Care NHS Foundation Trust
- Declan Hyland, Faraaz Abulais, Ranjan Baruah
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, p. S236
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Obesity and malnutrition have increased prevalence in individuals with mental disorder. Patients with severe mental illness are at increased likelihood of developing weight-related comorbidities, particularly type II diabetes mellitus.
Admission to the psychiatric ward provides an opportunity to address, not only the patient's mental health issues, but also any physical health issues.
The aim of this re-audit was to assess whether patients were managed in compliance with the Mersey Care NHS Foundation Trust Nutritional Screening Protocol on eight general adult inpatient wards across the Trust.
MethodsData from the first five admissions (starting from 1st April 2023) to eight general adult inpatient wards in the Trust was collected and assessed.
A total of 40 inpatient admissions were identified. The results were collated and compared to the standard – Mersey Care's Nutritional and Hydration Policy.
Results36 patients (90%) had a Malnutrition Universal Scoring Tool (MUST) completed within 72 hours of admission. Of the four patients (10%) who didn't have a MUST score within 72 hours of admission, three were completed after 72 hours.
46% of patients had a MUST score of 0 (low risk), 31% a MUST score of 0 (high risk obesity), 10% a MUST score 1 (medium risk) and 13% a MUST score of 2 or above (high risk).
Of the five patients with a MUST score of 2 or above (high risk), three (60%) were compliant with all elements of the Nutrition Screening Tool Care Plan. Of the 12 patients with a MUST score of 0 (high risk obesity), seven (58%) were compliant with all elements. Of the four patients with a MUST score of 1 (medium risk), all were compliant with all elements.
Overall, 31 (79%) patients had every element of the Nutrition Screening Tool Care Plan completed.
ConclusionThere was significant assurance of systems and processes in place and working well to ensure compliance, with only minor issues of concern identified.
Whilst the MUST score within the first 72 hours following admission had been completed in most inpatients, referrals to the dietician had not been done consistently in line with Trust policy. This is an area that requires addressing. Some training may need to be delivered to underline the importance of adhering to Trust policies.
An action plan to circulate the audit findings to all general adult inpatient wards across the Trust and re-auditing with a larger sample size across the Trust has been recommended.
Improving Equity of Access for Women Admitted to a Psychiatric Mother & Baby Unit in Kent
- Tasneem Saumtally, Bosky Nair, Chidi Nwosu, Serena Merchant, Stephanie Archer
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- Journal:
- BJPsych Open / Volume 10 / Issue S1 / June 2024
- Published online by Cambridge University Press:
- 01 August 2024, pp. S154-S155
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Rosewood Mother and Baby Unit (MBU) aims to provide inpatient psychiatric care to women with severe mental illness in Kent, Surrey & Sussex (KSS) in UK. Data from admissions during 2022 demonstrated discernible inequalities in admissions. A quality improvement project was undertaken to improve equity of access for admission of women with severe mental illness to Rosewood MBU, specifically, those under 18 years old, black and minority ethnicities, and across counties in KSS. The aim was to improve quality of care and patient experience for vulnerable groups across all ethnicities, not limited to their location or age.
MethodsBaseline data of MBU admissions in 2022 was collated, including demographics, age, origin of referrals, diagnosis, ethnicity, length of stay, parity, previous MBU admissions, safeguarding concerns.
The project group, inclusive of an expert by lived experience, presented the data at various network meetings and stakeholder events that helped to share information and gather experiences on barriers to referrals to Rosewood MBU, barriers for women of black and ethnic minority background accessing MBU, differences in service provisions for under-18-year-old women with perinatal mental illness in various counties.
Data for women discharged from Rosewood MBU in 2023 was collated and compared against the findings from the previous year.
ResultsIn the first half of 2022, there were 20% more women admitted from Kent than Surrey and Sussex combined. This improved following interventions with a better spread of patients across counties in July–December 2023 and a 11% rise in admissions of women from Surrey and Sussex compared with Kent.
There was a greater number of ethnicities and a greater number of women from different ethnicities admitted to Rosewood MBU when comparing 2022 with 2023, and specifically across each of the 6-monthly periods. In January–June 2022, 3 women of non-White British ethnicity were admitted, compared with a 400% increase in July–December 2023 with 12 women. Overall there was 260% increase in admissions of women of Black, Asian, Mixed, White-Other ethnicity in 2023 compared with 2022. Also, in 2023, there were 2 referrals and 1 admission of a women under the age of 18, compared with no referrals in 2022.
ConclusionOverall, the project demonstrates the positive impact of streamlining referral pathway, fostering collaborative working and integrating expertise from diverse professionals including experts by experience that can reduce service inequalities and improve patient outcomes.