4 results
Re-Audit of Prescribing Responsibility for Antipsychotic Depots for Shared Care Patients(PRAD-SCP)
- Ayebakari Ziriki, Cara Webb, Oluwabunmi Olowoyo, Kenn Lee
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S189
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Aims
To re-audit whether community teams are requesting GPs to take over the prescribing of antipsychotic depots for patients who have been stabilised on treatment, in line with Shared Care Pathway protocols by Greater Manchester Medicines Management Group (GMMMG).
MethodsThe sample size was 199 patients open to Rochdale, Heywood and Middleton community mental health team antipsychotic depot clinics. Information was gathered from depot cards, care records and clinical entries on Paris and imputed on an Excel spreadsheet. This was a prospective audit and data collection took place between 01/11/22 and 30/12/22 by the auditors. Microsoft Excel was used to carry out simple percentage analysis by the authors and presented using charts.
ResultsTransfer of prescribing responsibility for first generation antipsychotic had the highest compliance rate with 98% prescribed by GP on shared care protocol for stable patients followed by Paliperidone and Risperidone at 94%. Aripiprazole was the least compliant with 91% prescribed by GP for stable patients as against 100% target.
Overall compliance rate for all depot antipsychotics was 96% compared with 83% from original audit in 2020. In comparing the different community teams, one team was compliant by 99% overall in transferring prescribing responsibility to the GP for stable patients and 100% compliant with 1st generation antipsychotics, paliperidone and risperidone.
The data showed that CMHT prescribed higher proportion of 2nd generation antipsychotics when compared to original audit.
ConclusionThis re-audit has demonstrated that overall, there was significant improvement in compliance with GMMMG shared care guidelines by Rochdale community teams from 83% in 2020 to 96% in 2022. However, this does not meet the standard of 100% target for depot antipsychotics as per GMMMG guidelines. In other to ensure that target standards are met a 100%, secondary care prescribers should ensure appropriate transfer of prescribing responsibilities via the shared care protocol to the GP for stable patients are done and also shared with the new team particularly during the transition phase for patients transferred from one team to another who are stable on their current medication.
Psychiatric Consultation Skills Toolkit - a Pilot
- Cara Webb
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S39
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Aims
The aim is to understand whether the online video based psychiatric consultation skills toolkit, which was developed to attempt to address some of the differential attainment seen amongst International Medical Graduates (IMGs) within psychiatry, is feasible, effective and acceptable by running a pilot amongst core psychiatric trainees in the North West prior to a full roll out.
Methods19 trainees sitting the 2022 North West formative skills test were invited to take part by email. 7 trainees accessed the toolkit. Performance from the skills test was analysed in excel looking at averages of individual domains across all stations. Results from those who used the toolkit prior to the skills test were compared with those who did not access the toolkit. Toolkit completion rates were obtained and feedback was accessed from an online survey. Data were analysed in excel, rigour was ensured by the supervisor reviewing data and results.
ResultsThere were 7 trainees who accessed the toolkit, 3 IMGs and 4 UK graduates. 12 trainees sat the skills test but did not access the toolkit, 9 IMGs and 3 UK graduates.
Regarding acceptability of the toolkit, IMGs completed 92.7% of the toolkit on average and UK graduates completed 87.8%. 86% of trainees strongly agreed that the toolkit was easy to use and 14% agreed. 57% of trainees strongly agreed that the toolkit had helped develop their communication skills and 43% agreed. 86% of participants strongly agreed and 14% agreed that they would recommend the toolkit to a colleague suggesting they found it helpful and acceptable to use.
The highest percentage improvement in scores with toolkit use was in clinical skills amongst IMGs of 29.4%, followed by communication skills amongst international medical graduates with a 25.5% improvement to their counterparts who did not use the toolkit.
On average, across all domains, IMGs improved by 25.3% and UK graduates by 20% in their average score.
ConclusionThe results above suggest that the toolkit has been well completed and deemed acceptable by those who accessed it during the pilot period.
Although the results statistical significance cannot be determined at present due to small sample size, it is hoped when the project is fully rolled out this will be demonstrated and the initial findings showing some improvement in both IMGs and UK graduates are encouraging.
It appears that this toolkit could go come way to addressing the differential attainment seen between IMGs and UK graduates.
Medical Assessment and Management of Self-Inflicted Head Injury in an Inpatient Child and Adolescent Mental Health Services (CAMHS) Setting
- Georgie Patrick, John Smallwood, Cara Webb
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S169-S170
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Aims
To ascertain whether current medical assessment and management of self-inflicted head injuries in an inpatient CAMHS setting conforms with current NICE guidance.
MethodsIncidents of self-inflicted head injury were identified on the incident logging system Ulysses. Incidents were matched to entries on Paris, the online clinical notes system. Data were collected from Paris on whether the incident was reviewed by a doctor, time until doctor review and which components of the NICE guidance were completed during the review. The data were collated into an Excel spreadsheet and analysed.
Inclusion criteria were CAMHS inpatients at 1 Greater Manchester hospital during November 2021 who had an incident of ‘head banging’ recorded on Ulysses. Exclusion criteria were patients on ward A as the ward was found to have its own care plans for managing head banging rather than escalating to doctors.
ResultsThere were 52 incidents of head banging logged. 56% (n = 29) of incidents received a doctor review and 32% (n = 17) did not. For 10% (n = 5) of incidents a doctor review was declined and for 2% (n = 1) a review was conducted for another indication. The mean time taken until review was 4.3 hours with a range of 1 to 16 hours.
NICE guidance lists 9 components of the history that should be covered. 1 component met the 100% target and 1 component was documented in > 50% of incidents. The remaining 7 components were documented in < 50% of incidents.
NICE guidance lists 16 components of physical examination that should be completed. No components of the physical examination met the 100% target. 5 components were documented in > 50% of incidents. The remaining 11 components were documented in <50% of incidents.
NICE guidance recommends verbal and written safety netting advice is given. Advice was given in 16% (n = 5) of incidents. NICE recommends a responsible adult remains with the patient for 24 hours, this was documented in 77% (n = 22) of incidents. NICE recommends ongoing doctor concerns necessitate patient transfer to A&E. Concerns/lack of concerns were documented in 6.6% (n = 2) of incidents.
ConclusionThis audit has demonstrated inconsistencies between doctor's documentation of self-inflicted head injuries in an inpatient CAMHS setting. The reviews do not meet the standards outlined by NICE. There is a good emphasis on gross neurology but less awareness of the need to document more subtle pathology and ongoing monitoring requirements.
Research into psychiatry trainees views around the impact COVID-19 has had on the provision of electroconvulsive therapy training
- Cara Webb
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S161
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Aims
The current COVID-19 outbreak has changed the way electroconvulsive therapy (ECT) is provided. In many areas it has been moved from the more traditional ECT suites to general surgical theatres for a number of reasons, most notably being the need to ensure adequate ventilation. The introduction of the need for PPE to be worn throughout ECT and for general hospital operating procedures to be adhered to has also been a big change. The change in the required infection control procedures has had an impact on treatment capacity and has led many areas to reduce, relocate or centralise their ECT provisions which has had a knock on effect on training.
This study assesses the perceived impact COVID-19 has had on the provision of training and learning in ECT for core and higher psychiatry trainees in the North West as well as their perceived competence levels.
MethodViews were sought through surveys and focus groups from September to December 2020, participants were core and higher psychiatry trainees in the North West. Participants were recruited via email, the total population size was 87, 21 Core trainees responded and 14 higher trainees. From the survey respondents, 5 participants agreed to attend a focus group.
ResultResults show that the provision of ECT training has been poor during the COVID-19 outbreak. Almost 81% of core trainees surveyed and 92.86% of higher trainees had participated in no ECT sessions from the start of the COVID-19 outbreak to the time of data collection eight to ten months later.
81% of core trainees and 85.71% of higher trainees had received no teaching in any form about ECT over the period studied.
When considering the competencies required in ECT for a core trainee, one (4.76%) felt they were fully competent, 3 (14.29%) nearly competent, 7(33.33%) needs some improvement, 10 (47.62%) not yet competent. Only one higher trainee felt they met the RCPsych competencies, 5 (35.71%) were nearly competent, 6 (42.86%) need some improvement and 2 (14.29%) were not yet competent.
ConclusionThis study indicates a clear lack of provision of training which is very concerning ,and possibly pre dates the COVID outbreak, particularly in the case of specialty trainees who may well be consultants in a number of months and will not have the time to make up for the lost training. In order for ECT provision to continue it is crucial that we are able to adequately train the future workforce.