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
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S170-S171
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- Article
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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.
An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales
- Asha Dhandapani, Sathyan Soundararajan, Manjula Simiyon, Vinila Zachariah, Rajvinder Sambhi
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S75
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- Article
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Aims
To ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.
MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.
We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.
Our aim is to achieve 100 % compliance in clerking
ResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.
Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.
ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.
Apart from this, it also is needed for further continuity of care.
Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.
We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.
We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.
We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic