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Audit of Antimanic Agents Monitoring in a High Secure Hospital
- Oluwaseun Oluwaranti, Nazurah Wahid, Henry Whitehouse-Lowe, Ian Yanson
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S175-S176
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- Article
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Aims
Antimanic agents are effective in the management of mood disorders and other neuropsychiatric conditions such as epilepsy and aggression. These medications may cause serious side-effects and affect vital organs; hence, specific checks are recommended before initiation and for continuous use of these medications. The aim of the audit was to check compliance with monitoring of antimanic agents (lithium, valproate, and carbamazepine) and to compare with the 2018 audit.
MethodsPreliminary data of all patients on the antimanic agents at Rampton Hospital from 01 December 2020 to 30 November 2021 were obtained from records.
Retrospective data were collected using a modified version of the 2018 audit tool. This includes patient hospital number, ward, medication initiation date, pre-initiation and monitoring tests. The tests were, depending on the medication; full blood count (FBC), thyroid function test (TFT), liver function test (LFT), electrolytes and urea (E&U), and electrocardiograph (ECG).
The audit criteria were based on the recommendation of the Maudsley Prescribing Guidelines (14th edition). A total of 16 standards were assessed overall.
ResultsA total of 98 patients were prescribed antimanic medications through the review period with valproate-59, lithium -32 and carbamazepine -7. Three patients on valproate and 3 on lithium had incomplete data and were excluded. Therefore, a total of 92 patients were included in the final audit (valproate-56, lithium-29 and carbamazepine-7).
Pre-initiation compliance for LFT and FBC for valproate were 35.8% and 41.5% respectively, while the monitoring compliance within 6 months were 85.7% and 87.5% respectively.
For lithium, pre -initiation compliance for ECG was 73.1%; TFT and U&E had 88.5% and 96.2% pre-initiation compliance respectively. There was 100% compliance with monitoring of lithium level at 3 months, and both U&E and TFT within 6 months.
For carbamazepine, the pre-initiation and monitoring compliance was 50% and 100% respectively for three tests (LFT, FBC and U&E).
There was improvement in all the standards when compared with the 2018 audit compliance except FBC monitoring for valproate within 6 months which dropped from 92% to 87.5%.
ConclusionOnly 6 standards had 100% compliance with the guidelines. Lithium monitoring was generally higher than for other mood stabilizers; pre-initiation monitoring was poor for both carbamazepine and valproate. There was general improvement in the standards compared with the 2018 audit.
The guidelines for monitoring mood stabilizers apart from lithium needs to be made popular especially pre-initiation monitoring for valproate and carbamazepine.
The Association of Black Psychiatrists (ABP-UK) and the RCPSYCH Introduction to Mentoring and Coaching: Impact of a Training Program
- Olamide Orimoloye, Oluwaseun Oluwaranti, Theresa Ugalahi, Uju Ugochukwu, Mosun Fapohunda
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S31
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- Article
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- You have access Access
- Open access
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Aims
The study aimed to check impact (active mentoring and willingness to mentor) following a mentoring and coaching training event facilitated by RCPSYCH and ABP-UK. The program involved watching two pre-recorded videos and a full-day practical session on mentoring and coaching skills.
MethodsThe training was targeted at psychiatrists of black heritage, working in the UK. They were recruited through social media adverts and emails sent to members of the organization. A predesigned questionnaire assessing feedback about the program and mentoring activities was sent to the emails of attendees immediately after the program and a year later.
ResultsForty-four participants attended the program; 32 completed the feedback immediately after the program, and 20 responded to the one-year follow-up.
From the initial survey, majority of respondents (78%) rated the program as excellent, and most (78%) found it relevant to their professional needs. Slightly more than half of the group (53.1%) were involved in mentoring, but only a few (6%) were involved in mentoring activities within a structured organization. Ninety-seven percent felt confident to mentor immediately after the program while 84.4% expressed interest in joining a college division for mentoring.
In the follow-up data with 20 respondents, 60% were involved in mentoring and 23% of respondents were new mentors. More respondents were engaged in college-related mentoring (41.7%) than in the previous year and majority (83.3%) expressed that the program had influenced their mentoring.
ConclusionResults from the follow-on survey shows that a good number of attendees at the training event had taken up mentoring roles at local, regional levels and at the College. We therefore recommend continued rollout of more targeted mentoring and coaching training programs, with consideration for cultural needs. This will boost the availability of diverse mentors within mentoring schemes available for doctors, ultimately improving quality of care to our diverse patients.