2 results
11 - Dementia: investigations
- from I - Disorders
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- By Amelia Orchard, Birmingham and Solihull Mental Health NHS Foundation Trust
- Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons
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- Book:
- 101 Recipes for Audit in Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2011, pp 41-42
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- Chapter
- Export citation
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Summary
Setting
This audit is particularly relevant to psychiatrists who investigate suspected dementia, such as specialists in old age psychiatry and intellectual disability, and neuropsychiatrists.
Background
Various guidelines have been published. The National Institute for Health and Clinical Excellence (NICE) and the American Academy of Neurology recommend neuroimaging and blood tests to investigate every patient with suspected dementia. The Canadian Consensus Conference on Dementia and the Royal College of Psychiatrists recommend neuroimaging only when clinical findings point to a possibility other than Alzheimer's disease. Reasons for imaging new referrals include detecting potentially reversible causes of dementia (although the prevalence of such cases is falling) and more accurate diagnosis of dementia subtype.
Standards
The standards were obtained from the NICE guideline Dementia: Supporting People with Dementia and Their Carers in Health and Social Care (National Institute for Health and Clinical Excellence, 2006). The guideline recommends that a basic blood test should be performed at the time of presentation and should include:
ᐅ routine haematology
ᐅ biochemistry tests (electrolytes, calcium, glucose, renal and liver function)
ᐅ thyroid function tests
ᐅ serum B12 and folate levels.
The guideline also states that structural imaging should be used in the assessment of people with suspected dementia to exclude other cerebral pathologies and to help establish the subtype diagnosis. Magnetic resonance imaging (MRI) is the preferred modality but computerised tomography (CT) could be used.
The expectation is that all new referrals should receive a dementia blood screen and neuroimaging.
Method
Data collection
Data were collected in a retrospective review of medical notes. All new referrals to mental health services involving suspected dementia or memory problems were identified. Data collected were:
ᐅ age and sex
ᐅ whether each of the required blood tests had been performed
ᐅ whether the patient had a CT or MRI scan and the result of the neuroimaging (recorded in categories as Alzheimer's disease, small-vessel disease, infarct, mixed pathology, normal, awaiting scan or other).
Data analysis
The percentage of patients who had had each investigation was calculated.
Resources required
People
It is suggested that this audit is undertaken by one or two people.
Time
For approximately 50 referrals it is estimated that data collection would take around 10 hours.
19 - Self-harm: assessment
- from I - Disorders
-
- By Amelia Orchard, Birmingham and Solihull Mental Health NHS Foundation Trust
- 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 57-58
-
- Chapter
- Export citation
-
Summary
Setting
This audit is relevant to all mental health professionals who assess patients who present with self-harm to accident and emergency (A&E) departments (e.g. liaison workers, home treatment teams and on-call psychiatrists).
Background
Self-harm is a common presentation to A&E departments. All patients presenting thus should receive a comprehensive assessment. This audit was part of a regional audit comparing self-harm assessments in different A&E departments.
Standards
The standards were obtained from a 2004 guideline on self-harm produced by the National Institute for Health and Clinical Excellence (NICE). It states that every person who self-harms and presents to the health service should receive a comprehensive assessment of psychosocial needs and risk by a healthcare professional. As defined in standards 8 and 9 from the guideline, this assessment should include all the following information:
ᐅ social situation (living arrangements, work, debt)
ᐅ personal relationships
ᐅ recent life events and current difficulties
ᐅ psychiatric history (previous self-harm, drug and alcohol use)
ᐅ mental state examination
ᐅ enduring psychological characteristics associated with self-harm
ᐅ motivation for the act
ᐅ characteristics of the act (intent, planning, violent methods)
ᐅ characteristics of the person (hopelessness, forensic history, future suicidal intent)
ᐅ circumstances of the person (social class, physical illness, social isolation, bereavement).
Any decision to refer for further management must be based upon the combined needs and risk assessment.
Method
Data collection
ᐅ All self-harm assessments completed by mental health professionals were identified for a certain time period. The records were retrieved from different locations (e.g. liaison notes, A&E notes, home treatment notes).
ᐅ The hospital used a specific self-harm assessment tool, which made data collection easier.
ᐅ A data-collection tool was used to determine whether all the relevant information required by NICE had been recorded at each assessment.
Data analysis
The percentage of assessments that had recorded each part of the needs and risk assessment was calculated.
Resources required
People
As this was part of a regional audit, several people were involved at different locations. Approximately two people per hospital are required.
Time
It is estimated that data collection for 50 cases will take 6 hours.