3 results
Reinforcing Recovery and Relapse Prevention: Creation of a Junior Doctor Led Psychoeducation Course for Adolescent Inpatients With Psychosis
- Vatsala Mishra, Reshma Azim, Saam Idelji-Tehrani, Sophia Ulhaq, Ravi Patel
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S102-S103
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Aims
The aim was to provide psychoeducation sessions to inpatients at a London adolescent mental health unit, admitted with first episode psychosis, at the recovery stage of admission. The COVID-19 pandemic-associated rise in admissions and clinical demand meant psychologists within the unit struggled to provide psychoeducation sessions; a deficit in care was identified and junior doctors established a psychoeducation group to meet this clinical need.
MethodsCourse participants were three adolescent inpatients from black and ethnic minority backgrounds who were informal/voluntary patients approaching discharge. This ensured adequate insight into their mental health disorder and its impact on functioning, to effectively benefit from psychoeducation, and capacity to consent to this pilot programme.
Doctors liaised with psychologists, occupational therapists and nursing colleagues to create this holistic, patient-centred course, suited to patients’ current psychosocial abilities with appropriate accommodations for age, developmental level and stage in recovery.
The team provided effectual, engaging content to deliver key messages while ensuring sessions were enjoyable for teenagers. Use of repetition accounted for residual effects of psychosis such as impaired concentration and memory. Patients actively participated with use of colourful visual aids, created interactively to consolidate learning. Peer discussion and personal reflection was supported, balanced with the need for patient confidentiality.
ResultsThrough post-course feedback, patients agreed sessions provided better understanding of their diagnosis and difficulties, and felt more empowered in managing their recovery. They reported highly enjoying the group and actively looking forward to sessions. Patients were able to recall key points and take home messages several weeks after content delivery, suggesting effective learning had taken place.
Doctors involved in creation and delivery of the course experienced greater rapport and empathy with patients, greater understanding of psychosis as a condition and its wider impact on the individual and their family. Deeper understanding of relapse prevention interventions allowed juniors doctors to take a more active role in discharge planning, with greater appreciation for patients’ biopsychosocial needs.
ConclusionPsychoeducation sessions were highly impactful for patients and doctors involved, and are anticipated to have a positive effect on prognosis, likely reduced relapse rate and increased engagement with community care. The earlier deficit in care was successfully filled through this doctor-led psychoeducation course.
Next steps involve standardising content and training colleagues to deliver a more extensive course to larger numbers of inpatients. The project has been heavily patient-centred with involvement of young people throughout, and aims to consult more closely with patients during further development.
Improving safety-planning in patients admitted with self-harm
- Vatsala Mishra, Kathryn Hughes, Alexander Sunderland, Marilia Calcia, Martin Parsons
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S208-S209
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Aims
Self-harm is a common presentation to acute hospitals, associated with increased risk of completed suicide. Safety plans are increasingly recommended to help patients recognise and prevent escalation of self-harm behaviours.
This project aimed to improve quality and documentation of safety planning for patients admitted at an acute general hospital due to self-harm, who were assessed by Liaison Psychiatry. We aimed to increase the number of patients given written safety plans on discharge by 50%.
MethodThe PDSA cycle model of quality improvement was used. A retrospective audit of clinical records was conducted over 3 months to establish baseline documentation of safety planning (n = 51). A template for a self-harm crisis plan, used in other areas of the Trust, was adopted, to be adapted to each patient. A leaflet for sources of crisis support and patient feedback form were developed and distributed to clinicians in the team. Data collection was repeated one month later (n = 48). The second set of interventions involved a training session for clinicians on developing safety plans in collaboration with patients, and a poster highlighting the process to be undertaken when discharging a patient admitted with self-harm.
ResultFollowing initial interventions, 20% of patients had completed safety plans and 50% received advice, an increase of 20% and 40% respectively. The second PDSA cycle showed increase in numbers to 38% and 67% respectively.
ConclusionCreating a crisis plan with a hospital-specific leaflet for the Liaison Psychiatry team increased the number of patients discharged with safety plans in place. 86% of patients who participated in safety-planning found the process helpful and felt likely to use the plan in future crises. This is an area of ongoing quality improvement which can be implemented in other hospitals to better equip patients with skills and support to reduce self-harm/suicide attempts.
Improving facilitation of ECT treatment for patients in an acute medical hospital
- Vatsala Mishra, Chun Chiang Sin Fai Lam, Marilia Calcia, Isabel McMullen
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S42
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Aims
A Quality Improvement Project aiming to streamline facilitation of electroconvulsive therapy (ECT) treatment for psychiatric patients at a general acute hospital and reduce cancellation rates via the use of a checklist.
ECT treatment is an essential aspect of psychiatric care for patients with severe depression or treatment-resistant psychosis. Facilitation of ECT treatment is an uncommon task for liaison psychiatry and the medical and nursing teams responsible for patients’ medical care. Between August-October 2019, this liaison psychiatry team had 3 patients undergoing ECT treatment a total of 13 times, with treatment being cancelled on 4 occasions. After engagement with stakeholders from the acute medical teams, the liaison team and the ECT suite team, key areas requiring intervention were identified to help reduce the rates of cancellation. Areas identified included a lack of ownership on the logistic and operational aspects of ECT amongst staff, a lack of knowledge of what the process involved and a lack of confidence in managing said patients. Difficulties in communication between teams and accurate documentation may contribute to errors and cancellation of ECT sessions, which in turn would delay treatment and impact on patient safety and clinical outcomes.
MethodThe first author, a Foundation Year 1 doctor, developed a 10-point checklist to be referred to when arranging ECT for patients, to ensure errors were not made which could lead to missed treatment and delayed recovery. The tasks and responsibilities of each key member of the team were clearly identified. This checklist was included in all ECT patients’ files and teaching was provided to staff involved. Feedback was obtained from staff involved regarding the clarity of information and their confidence in managing such cases.
ResultIn the month following initial intervention the liaison psychiatry team organised 12 ECT sessions. The checklist was pasted into notes the day before each ECT session and 0 sessions were missed for avoidable reasons. Feedback from staff showed all teams felt more confident co-ordinating ECT treatment as a result of the checklist.
ConclusionCreating a 10-point checklist for the facilitation of ECT treatment in patients at a medical hospital was beneficial in reducing avoidable errors from 16% to 0%. The liaison psychiatrists, medical doctors, and nurses involved reported greater confidence in managing patients undergoing ECT and described the checklist as enhancing the feeling of teamwork and communication within the multi-disciplinary team, and felt it had improved patient safety and clinical outcomes.