3 results
III - Physical health
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- By Marlene M. Kelbrick, St Andrew’s Healthcare, Northampton, Ayesha Muthu-Veloe, St Andrew’s Healthcare, Northampton
- Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons, { Author Role= exceeds the limit of 5 characters including spacing}
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- Book:
- 101 Recipes for Audit in Psychiatry
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 77-106
-
- Chapter
- Export citation
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Summary
Setting
This audit was conducted in a tertiary specialist secure hospital, and will be particularly relevant in forensic secure and rehabilitation services with long-stay psychiatric in-patients.
Background
People with severe mental illness are at an increased risk of physical health problems and often find it hard to access good-quality care. Patients with schizophrenia in particular have an increased prevalence of type II diabetes compared with the general population.
Standards
Audit standards were based on the 2008 guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of type II diabetes (see also NHS Diabetes, 2009). Key priorities within the guideline were identified and adapted to suit a psychiatric in-patient setting. Of particular relevance were:
▸ structured patient education at the time of diagnosis, with annual reinforcement and review
▸ individualised and ongoing dietary advice from a healthcare professional with specific expertise and competencies in nutrition
▸ setting a target HbA1c (generally 6.5%) –
⊲ involve the patient in the decision and give encouragement to maintain individual targets
⊲ offer therapy interventions (lifestyle and medication) to help achieve and maintain target
⊲ monitor every 2–6 months according to individual needs until stable on unchanging therapy, and every 6 months once the blood glucose level and blood glucose-lowering therapy are stable
▸ self-monitoring to be offered where possible
▸ management of acute changes in plasma glucose control.
The target was for these standards to be met for every patient with diabetes in the form of an individual care plan.
Method
Data collection
The hospital on-site general practice register or physical healthcare register or prescription charts were used to identify patients with type II diabetes. Data collection was from patient records, care plans, hospital-wide risk assessment and management documents, and ward documents, including nursing care plans, drug prescription charts and blood results. Other sources of information included informal interviews with nursing staff and information obtained from medical staff.
Data analysis
The proportion of patients with diabetes for whom the standards were met was calculated.
Resources required
People
Two people were required to conduct this audit in an in-patient service with 548 beds. Some additional assistance was required from nursing staff and other medical colleagues.
An audit of diabetes mellitus management within a specialist secure psychiatric hospital
- Marlene Kelbrick, Ayesha Muthu-Veloe, Marco Picchioni
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- Journal:
- Journal of Psychiatric Intensive Care / Volume 8 / Issue 2 / August 2012
- Published online by Cambridge University Press:
- 19 October 2011, pp. 88-95
- Print publication:
- August 2012
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- Article
- Export citation
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Background: People with severe mental illness are at an increased risk of physical health problems including diabetes.
Aims: To identify the proportion of patients with diabetes in specialist secure psychiatric care, establish current practice in diabetes care and management, and clarify the role of the psychiatric medical team versus the on-site general practitioner.
Method: Hospital-wide data collection from electronic and paper case notes of all identified diabetic patients. Audit standards were based on current National Institute for Clinical Excellence guidelines.
Results: 64 out of 548 patients (11.7%) were identified with a diagnosis of diabetes. 18 (28%) of these patients had an individual care plan to address their diabetic management and risk. The majority of patients had regular blood glucose and HbA1c monitoring.
Clinical implications: Patients should receive regular structured education sessions, regular feedback about their own management, and individual care plans that include the management of common and potentially life threatening complications. These are essential components of providing good quality diabetes care. Clinical audit may provide a means of identifying and rectifying problems in relation to diabetes care in long-stay psychiatric inpatients.
28 - Diabetes: management
- from III - Physical health
-
- By Marlene M. Kelbrick, St Andrew's Healthcare, Northampton, Ayesha Muthu-Veloe, St Andrew's Healthcare, Northampton
- Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons
-
- Book:
- 101 Recipes for Audit in Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2011, pp 79-80
-
- Chapter
- Export citation
-
Summary
Setting
This audit was conducted in a tertiary specialist secure hospital, and will be particularly relevant in forensic secure and rehabilitation services with long-stay psychiatric in-patients.
Background
People with severe mental illness are at an increased risk of physical health problems and often find it hard to access good-quality care. Patients with schizophrenia in particular have an increased prevalence of type II diabetes compared with the general population.
Standards
Audit standards were based on the 2008 guideline from the National Institute for Health and Clinical Excellence (NICE) for the management of type II diabetes (see also NHS Diabetes, 2009). Key priorities within the guideline were identified and adapted to suit a psychiatric in-patient setting. Of particular relevance were:
ᐅ structured patient education at the time of diagnosis, with annual reinforcement and review
ᐅ individualised and ongoing dietary advice from a healthcare professional with specific expertise and competencies in nutrition
ᐅ setting a target HbA1c (generally 6.5%) –
▹ involve the patient in the decision and give encouragement to maintain individual targets
▹ offer therapy interventions (lifestyle and medication) to help achieve and maintain target
▹ monitor every 2–6 months according to individual needs until stable on unchanging therapy, and every 6 months once the blood glucose level and blood glucose-lowering therapy are stable
ᐅ self-monitoring to be offered where possible
ᐅ management of acute changes in plasma glucose control.
The target was for these standards to be met for every patient with diabetes in the form of an individual care plan.
Method
Data collection
The hospital on-site general practice register or physical healthcare register or prescription charts were used to identify patients with type II diabetes. Data collection was from patient records, care plans, hospital-wide risk assessment and management documents, and ward documents, including nursing care plans, drug prescription charts and blood results. Other sources of information included informal interviews with nursing staff and information obtained from medical staff.
Data analysis
The proportion of patients with diabetes for whom the standards were met was calculated.
Resources required
People
Two people were required to conduct this audit in an in-patient service with 548 beds. Some additional assistance was required from nursing staff and other medical colleagues.