2 results
Secondary Service Communications to GPs-a Regional Audit
- Tajnin Mitu, Vinila Zachariah, Jason Ray, Alberto Salmoiraghi, Ramandeep Singh, Laura Williams, Vikram Bhangu, Asmaa Elsayed, Opeyemi Ikuewumi, Wamiqur Rehman Gejdhar, Amin Rezk, Mohammad Khan, Christopher Rowley, Lopez Okhiai
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S170-S171
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
The purpose of the audit was to assess the standard of communication to GPs from secondary mental health services and to ascertain whether the information included in letters to GPs was in accordance with the recommendations of RCPsych and PRSB. The audit cycle was completed by re auditing to identify how the recommendations from the first audit has improved the quality of communication to GPs.
MethodsThe audit was conducted on three psychiatric units, in three sites across Betsi Cadwaladr University Health Board and clinic letters were studied to identify whether the information was as per recommendations from: RCPsych and PRSB.
The first audit used 121 letters in total from 3 sites, with the data being collected using audit proforma over a 2 week period from 04/04/22.
The re audit looked at 69 letters with data collection using audit proforma over one week period from 19/12/22.
ResultsMajority of letters sent to GP were lacking key information like details of Care coordinators ,medical comorbidities ,non psychiatric diagnosis, and actions for GP with this data missing in 91.7%, 61.22 %,79.59% and 71.43% respectively. Fill rates for other information like patients' details was 100% , psychiatric diagnosis was 83.47%, psychiatric medications , follow-up plan were 80.17%.
The results of the re-audit most letters contained Psychiatric Diagnosis (97.1%, previous 83.5%), Psychiatric Medication (91.4%)previous 80.17%), and Follow Up Plan(98.6%, previous 80.2%). Many letters did not include information regarding Medical Comorbidity (28.6% vs 31.4% ), Non-Psychiatric Medication (65.7% vs 34.7%), Details of Care Co-ordinator (54.3% vs 8.3% ) and Action for GP (27.1%, vs 44.6%).
ConclusionThe recommendations from first audit were to create local guidelines and templates with recommended headings for clinical letters, provide formal teaching for junior doctors and to re audit to see if the implemented changes has led to an improvement.
The re-audit showed improvement since the introduction of the template in majority of headings in GP letters with decline in fill rate for 2 headings and these changes varied among three sites.
Barriers identified affecting the overall outcome of the re audit were :template not being used, lack of training to juniors, and psychiatrist workload.
In conclusion , we aim to re-distribute the template and increase awareness with informal teaching sessions, provide information on template during induction for doctors and organize training sessions on three sites.
Improving Clinical Care in Tobacco and Smoking-Related Problems: A Report of Clinical Audit and Quality Improvement Project
- Jiann Lin Loo, Jawad Raja, Ugochukwu Anyanwu, Nikhil Gauri Shankar, Asmaa Elsayed, Zeenish Azahr, John Clifford, Faye Graver
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S148-S149
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Around 40% of people with serious mental health problems smoke, which is significantly higher compared to the general population of the United Kingdom. The Welsh Government has set the target to reduce the overall prevalence of smoking in Wales to 16% from 19. In order to reduce the impact of smoking on the population, the first step is to identify the problem. Hence, a comprehensive history of smoking will help to identify the addiction-related problems. Hence, this combined clinical audit and quality improvement project (QIP) is aimed at the evaluation of the admission clerking around the assessment and management of smoking-related problems in an inpatient mental health unit.
MethodsThis clinical audit was carried out at the local inpatient general adult mental health units in Wrexham. It was based on NICE smoking guidelines “Smoking: acute, maternity and mental health services”. Clinically relevant information without personal identification information was collected based on a proforma. The first re-audit was repeated without a specific intervention to see any change in pattern and the need for intervention. This was followed by the first intervention, i.e., the sharing of a PowerPointTM presentation discussing commonly utilised measurement tools in the assessment of smoking-related behaviours and the second re-audit.
ResultsThe first round of clinical audit involves 32 admissions, the first re-audit was 19 admissions, and the second re-audit was 37 admissions. The baseline showed 71.88% of inpatient admissions were asked about their smoking history, but only less than 10% of them were assessed in detail around the types and quantity of tobacco products, features of dependence and withdrawal, the motivation of the clients to quit smoking, and any help offered to the patients. The number of inpatient admissions which was assessed for their smoking-related behaviour dropped to 36.84% during the first re-audit, and less than 16% of them were assessed in detail. The number improved slightly to 57.14% after the first intervention, although less than 40% of the inpatient admissions were assessed in detail.
ConclusionThere is an inconsistent pattern of change in the percentage, and it seems that the intervention leads to minimal improvement of the assessment of smoking-related problems during admission clerking. The minimal change may be attributable to the change in posting around the intervention period. The future plan includes a more regular intervention arranged around the beginning of new postings for doctors to ensure they have adequate exposure to the assessment of smoking-related addiction problems.