16 results
Induction Folder for New Doctors in Psychiatry in North Wales- a Quality Improvement Project to Make Life Easy for Junior Doctors
- Sathyan Soundararajan, Asha Dhandapani, Catherine Baker
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S111
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Aims
The purpose of induction is to welcome our new employees and also ensure that they have the information and support to carry out their roles effectively. A robust induction not only benefits the doctor but also helps employers to ensure the delivery of high-quality patient care, increases retention, reduces absenteeism, and will promote the organization as a good employer. Doctors need to be supported in the workplace to provide safe, high-quality patient care. Induction as a minimum should introduce doctors to employer procedures and rules, arrangements for clinical governance (patient safety, clinical errors, clinical risk management, complaints, and litigation), orientation, and support. We have developed a new Induction folder containing all the necessary information for a beginner in Psychiatry in North Wales
MethodsWe initially arranged for a preintervention questionnaire for the Junior doctors in Psychiatry in North Wales. That included Core trainees, Foundation year doctors, Senior house officers (LAS CT- SHO, JCF- non-training post), and GP trainees.
The QIP started in 2019 August with Audits followed by PDSA cycles. Over a period of 2 years, various doctors both from the present and from the last 3 years were contacted via email and google forms. We completed 3 PDSA cycles.
During these 2 years, we included certain topics that were missed, such as medication during an emergency, contact details from the deanery, etc. We have been following up on the Induction folder with the new doctors as and when there is new recruitment.
ResultsThe first PDSA showed promising results. Following the first PDSA, we amended a few changes in order to improve the response which resulted in an overwhelmingly positive response from the new doctors/ old doctors in Psychiatry. Following the third PDSA, we included details from the deanery contact and updated the contact details from our own trust.
Conclusion2 years of work on this project has yielded good results. However, the sustainability of changes is questionable. This indicates continuity in changes. We are hoping that the new trainee doctors, either junior or senior trainees can consider working on this project and continue to amend changes on yearly basis.
The amended version of the folder can be completed at least 4 weeks prior to the major induction that happens every August.
We will consider sharing the Induction folder as handbooks/ pdf versions to all the trainees and non-trainees in our trust. Apart from this, we will continue to keep the information at a high quality and standards. We will achieve this by ensuring feedback from the new doctors.
An Audit on Venous Thromboembolism Risk Assessment in Older Persons Mental Health Inpatient Unit in North Wales With the Aim of a Quality Improvement Project
- Sathyan Soundararajan, Asha Dhandapani, Finlay Wallis, Manjiri Bhalerao
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S11
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Aims
The aim is to undertake a baseline audit of VTE risk assessment in older persons mental health unit in all 3 sites in North Wales. Following the implementation of recommendations, we aim to repeat the audit with an aim to complete a Quality improvement project.
MethodsA retrospective audit was conducted in older persons mental health unit in all 3 sites of North Wales in Betsi Cadwaladr University Health Board.
A prospective opportunistic sample of all the inpatients in the old age psychiatric unit was audited. Standards were based on the NICE and Department of Health guidelines.
We collected the data by reviewing the patients notes. The data collection happened in December 2022 to January 2023. We made a simple protocol to collect the data from all 3 sites.
The target was for 100 % compliance in all standards.
ResultsFrom the audit data collection, the results are as follows:
Overall, we gathered details of 29 patients in East, 21 patients in Central and 11 patients in the West (A total of 61 patients)
In the East, out of 29 patients, there was a form for VTE risk assessment in clerking proforma. However only 6/9 forms were filled by the junior doctors. In Central, out of 21 patients, only 2 patients had a form in their file but they were not filled. In Bryn Hesketh unit, there were no VTE risk assessment forms at all. In West, out of 11 patients, 3 of them had a VTE risk assessment form that were filled. Overall, we noticed that in some of the patient's medication chart, there was a mention about they receive prophylaxis for VTE or not. However, that was not consistent.
There is no standard proforma noted in any of the wards in Central and West. In East, there is a clerking proforma noted and in some patients hence as part of the proforma as the VTE risk assessment is already included the junior doctors do fill the VTE risk assessment form.
ConclusionI hope this audit will help in improving the patient care by identifying the risks factors of VTE earlier and preventing it. This would be in accordance with the guidelines.
It was evident that VTE risk assessment and prophylaxis was not something that was being considered for patients admitted to the old age psychiatric inpatient unit. However due to the risk factors this group of patients possess it is something vitally important. As a consequence of presenting the audit across the trust, a service change was recommended with a VTE risk assessment proforma planned to be introduced across the trust will be adapted to support use in psychiatric inpatients which can be used by mental health trusts.
Postgraduate Teaching Programme in Psychiatry in North Wales- a Regional Quality Improvement Project 2022-2023
- Asha Dhandapani, Sathyan Soundararajan, Catherine Baker, Rajvinder Sambhi
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S86-S87
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We aimed to arrange the local Postgraduate teaching in psychiatry as per the Deanery requirement/ HEIW requirement. We aim to achieve a better target with regard to local teaching as noted from the previous year's GMC trainee survey
MethodsThe project started in 2019. 3 sets of audits and PDSA's were done- one each year, before the final PDSA. During these 3 audits, only non-consultants were participants.
During the 4th PDSA, in 2022-2023, a purposive sample was selected to provide the best information possible for the audit. It included Consultant Psychiatrists from all three sites in North Wales, Trainees( Junior/ Senior), SHO, speciality doctors, FY2, GP trainees and Clinical fellows. The criteria for participation were that the doctors should be working in Psychiatry and should have attended the local postgraduate programme. Access to the internet and appropriate device was mandatory as an add-on availability.
An online questionnaire was emailed to the participants. There were only 3 questions for the Consultants and 5 for the non Consultants’ group. 2 weeks window was offered to fill out the forms.
ResultsThe 3 audits done initially revealed that consistent formal teaching was not provided. The candidates also found the current programme not fulfilling the criteria laid by the deanery and that their educational needs were neglected. The summary of the old audits suggested that the teaching had worsened eventually.
The final PDSA was done in 2022-2023. The overall time to fill out the form was 1.43 minutes. An equal number of Consultants and Non-consultants filled out the form. 31 Consultants rated the new programme as 4.23 for 5. The 31 non-consultants rated the programme 3.68 out of 4 and 95% identified that the new postgraduate programme covered the core trainees' requirements as per the MRCPsych Handbook from the Deanery.
ConclusionPrioritisation of the most important facilitators and identification of ‘easy wins’ are important steps in this process.
The purpose of this study was to develop a national expert group consensus amongst a range of relevant stakeholders; senior doctors, residents, patients, allied healthcare professionals and healthcare managers allowing us to;
1. identify important barriers and facilitators of learning in clinical environments and
2. indicate priority areas for improvement. Our overarching objective was to provide information to guide policymakers and those tasked with the delivery of graduate medical education in tackling the provision of high-quality clinical learning environments in challenging time
Admission Clerking- Inpatient Adult Psychiatric Unit - a Quality Improvement Project
- Asha Dhandapani, Sathyan Soundara Rajan, Alberto Salmoiraghi, Rajvinder Sambhi, Catherine Baker, Joanne Kendrick, Sherrie Stewart
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S91
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Aims
To improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.
MethodsWe started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.
With the findings obtained, we went ahead to create a proforma encompassing all the details.
The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming results
ResultsThe baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.
Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 year
ConclusionThis QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.
The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best
Web Pages on Mindfulness-Based Interventions: A Review on the Different Training of Third-Wave Psychotherapies Available in the United Kingdom
- Jiann Lin Loo, Jashan Selvakumar, May Honey Ohn, Asha Dhandapani, Sathyan Soundararajan, Sahar Ali, Nikhil Gaurishankar
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- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S71
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With extensive evidence and track record on efficiency, third-wave psychotherapies, i.e. mindfulness-based interventions (MBIs), have gained popularity in the United Kingdom (UK) as the mainstream tool for mental health and well-being. During the COVID-19 pandemic, a lot of MBI training has shifted from physical meetings to online to improve access nationally. To date, there is limited data on the differences of online MBIs available in the UK. This web pages review is aimed to elucidate the available resources for online training on MBIs in the UK.
MethodsGoogle Search engine was used to identify web pages providing MBI training in the UK from February 2021 to March 2021. The search words used were “mindfulness”, “acceptance commitment therapy”, “dialectical behaviour therapy”, “DBT”, “Compassion focused therapy”, “CFT”, “England”, “Northern Ireland”, “Scotland”, “Wales”, and “United Kingdom”. The search word “ACT” was omitted due to a high number of irrelevant search results. Inclusion criteria were any web page providing mindfulness training in the English language, based in the UK. Exclusion criteria were web pages that were not from the UK with limited information and the web page was not about the provision of mindfulness training. Given the high number of web pages appearing in the Google Search for each of the localities, further search was stopped when all ten web pages that appeared on a Google search page were all excluded.
ResultsThe total number of web pages returned from searches was 23,030,000 of which were 13.1 million for England, 2.89 million for Scotland, 3.09 million for Wales, 2.18 million for Northern Ireland, and 1,770,000 were unspecified. Only 165 web pages offering MBI training were included. Among those, 57% were for the general public while 30% had information for both professionals and the public. The majority of them, i.e. 65% offered online training courses when only 25% of them offered both online and face-to-face training. There were 25% of web pages offering free basic courses for the public. There was a similar split between the group, individual and mixed training.
ConclusionThere is a significant amount of MBI training resources available online for both public and professionals. One interesting finding is that a significant portion of them provide free basic training which is very encouraging and certainly has a positive impact on the accessibility of mindfulness education during the pandemic disruption.
Assessing the Impact of Pre-Existing Mental Health and Neurocognitive Disorders on the Mortality and Severity of COVID-19 in Those Aged Over 18 Years: A Systematic Review and Meta-Analysis
- Catrin Thomas, Laura Williams, Asha Dhandapani, Sarmishtha Bhattacharyya
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- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S75-S76
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Since the coronavirus disease 2019 (COVID-19) pandemic began, evidence suggests that people with underlying mental health disorders have worse outcomes from COVID-19 infection. Our aim was to assess the impact of COVID-19 infection on people with pre-existing mental health or neurocognitive disorder including COVID-19 related mortality and severity.
MethodsWe conducted systematic searches of PubMed, EMBASE, and Cochrane library for articles published between 1 December 2019 and 15 March 2021. The language was restricted to English. We included all case control, cohort and cross sectional studies that reported raw data on COVID-19 associated mortality and severity in participants aged 18 years or older with a pre-existing mental health or neurocognitive disorder compared to those without. Three independent reviewers extracted data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Methodological quality and risk of bias were assessed using the 9-star Newcastle-Ottawa Scale. We calculated the odds ratio as the summary measure along with the corresponding 95% confidence intervals. The random effects model was used to calculate the overall pooled risk estimates. COVID-19 related mortality was the primary outcome measure. The secondary outcome measure was COVID-19 related severity, defined as intensive care unit admission or use of mechanical ventilation.
ResultsFifteen studies were included in the meta-analysis comprising of 8,021,164 participants. There was a statistically significant increased risk of mortality for participants with a pre-existing mental health or neurocognitive disorder compared to those without (OR = 2.18, 95% CI = 1.63–2.90, P < .00001). Increased mortality risk was found on subgroup analysis for participants with pre-existing schizophrenia (OR = 2.55, 95% CI = 1.38–4.71, P = .003) and dementia (OR = 3.83, 95% CI = 2.42–6.06, P < .00001). There was no statistically significant difference in the severity of illness when comparing the two groups. There was a statistically significant increase in the number of participants with comorbid diabetes and chronic lung disease in those with a pre-existing mental health or neurocognitive disorder compared to those without.
ConclusionThe results show that people over 18 years with a pre-existing mental health or neurocognitive disorder have an increased risk of mortality from COVID-19 and are more likely to have comorbid diabetes and chronic lung disease. These results highlight the need for better physical health monitoring and management for this group of people and better integration of mental and physical health services, as well as adding to the evidence that they should be prioritised in the ongoing COVID-19 vaccination schedules worldwide.
Audit on use of PRN (pro re nata) psychotropic medication for behavioural disturbance in individuals with intellectual disability in the community
- Asha Dhandapani, Sathyan Soundararajan, Claire Jones
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S75-S76
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Aims
Psychotropic medication is commonly used in people with Intellectual disabilities (ID). This may be attributed in part to an increased prevalence of mental illness in this population and the presence of challenging behaviour which has been shown to increase rates of prescribing. Whilst there are a number of studies looking at regularly prescribed medication there are few studies on “as and when” required (PRN) medication.
Psychotropic medication continues to be used to manage behavioural disturbances in people with ID. Where there is no clear cut psychiatric illness, the role of psychotropic medication is an adjunct to a comprehensive multimodal treatment plan.
The aim is to find out if prn psychotropic medication for behavioural disturbance is being used appropriately and safely in these individuals.
MethodFiles and PRN protocols of individuals known to be using prn psychotropic medications for the management of acute episodes of agitation and behavioural problems and supported by professional staff teams was studied.
We collected the data by contacting the residential homes, carers, Collecting details from case notes, from the Staff nurse who made the protocol for their patients
A questionnaire based on the standards mentioned above was developed and files and prn protocols were marked against these standards.
ResultThe standards from the medical file were 100 % achieved. Thus indicating the importance of the psychotropic prn medication and documentation of the same.
However, the protocol that needs to be with the patient/carers had some lacuna/deficits. Overall only in 53% of the case, standards were achieved. This needs to be highlighted to the team.
The Audit gave an insight into what needs to be improved.
THE FOLLOWING AREAS NEEDED IMPROVEMENT
1. There should be a prn protocol/ similar instruction to the staff about the use of prn medication(written by appropriately trained professional)
2. Prn protocol should be accessible to direct care staff
3. There should be a description of when to use the prn medication
4. There should be a description of what non-pharmacological de-escalation methods ought to be tried before using prn/ is there a detailed behaviour support plan available
5. Protocol should describe what the medication is expected to do
6. Protocol should describe the minimum time between doses if the first dose has not worked
7. Protocol should state the maximum dose in 24 hour period
8. Use of prn should be recorded
ConclusionI hope this audit will help in improving the patient care with the right psychotropic prn medication, with correct doses and further details as mentioned in the standards of the protocol.
We also hope to ensure that in our area, prn psychotropic medication used for agitation and behavioural disturbance is used safely, appropriately and consistently by staff teams. This would be in accordance with the guidelines.
Audit of the quality and content of discharge summaries from mental health inpatient units across Betsi Cadwaladr University Health Board
- Asha Dhandapani, Sathyan Soundararajan, Laura Williams, Ediriverere Endurance Aghahowa, John Clifford
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S76
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Our aim was to carry out an audit of summaries sent from inpatient psychiatric units across North Wales (namely Heddfan in Wrexham, Ablett in Rhyl, and Hergest in Bangor), against recommendations from ‘Standards for Inpatient Mental Health Services’ (RCPsych 2014) and PRSB Mental Health Discharge guidelines (2018).
MethodAblett summaries are typed onto and electronically sent through the Welsh Clinical Portal (WCP) directly to the GP. Hergest and Heddfan both have their own templates which are then sent to the GP and filed in the case notes. Data were collected from both sources. The first audit cycle used 25 discharges selected at random from the male and female open wards in each site (n = 75 summaries). Data were collected over 3 months time using the audit proforma.
ResultAll mandatory headings are automatically inputted into the WCP summary used in Ablett therefore documentation was 100% for information such as patient name, DOB, and GP Details. Documentation of allergies was poor across 3 sites, particularly in Hergest, in which there was no mention of allergy status in 96% of summaries. Only 13% of Ablett summaries and 0% of Hergest summaries reach the GP on the day of discharge, however, 100% of summaries from Heddfan do, possibly due to their method of ‘discharge notification’. The date and location of discharge were documented in 84% of Heddfan summaries, 100% of Hergest summaries, and 100% of Ablett summaries. This implies that this heading is already incorporated into the templates for the 2 sites which scored 100%. In the Ablett, medication was documented in 88%, but we found that in 49% of discharge summaries, the medication was the only field filled in! In these cases, the GP may not even know why the patient had been admitted. This is clearly unacceptable. Risk history is poorly documented across the sites, with 0% in Hergest and Heddfan, and 12% in Ablett. 0% of summaries across the Health Board mentioned crisis contacts. 0% of summaries in Heddfan and Ablett contained details of the patient's care coordinator.
ConclusionOur audit has identified a lack of psychiatry-relevant headings in the discharge summaries, particularly for those working in Ablett.
Are the staff in Heddfan Psychiatric Unit, Wrexham Maelor Hospital, are adhering to the personal protective equipment (PPE) guidance as per Public Health Education, England? a QIP
- Asha Dhandapani, Sathyan Soundararajan, Rajvinder Sambhi, Catherine Baker
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S184
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The aim of this audit is to assess whether healthcare staff are correctly donning and doffing PPE when entering and leaving the wards (changed to donning and doffing PPE when within 2 metres vicinity of a patient).
MethodConsultants/ Junior doctors/ Ward managers/ Staff nurses/ student nurses/ Health care support workers/ Occupational therapist/ Psychologists/ Student nurses/ Housekeeping staff, were all included in this Audit. None of the staff was aware of this Audit and this was an entirely random observation. We used a standard proforma in order to audit. Followed by the Audit, we trained the staff in the unit and then re-audited.
Result98% of them wore mask whilst in the ward and 94% of them washed their hands after doffing. 36% did not wear them appropriately and about 10-14% did not wear PPE at all. A mere 7 out of 50 alone used hand gel. Overall the donning and doffing of PPE was not being followed and adhered to according to the standards from PHE as per the first Audit. In particular, during donning only 1/3rd of them donned the PPE as per guidance. Likewise, the doffing technique was also poor, with only half of them removing the apron and mask correctly. Unfortunately, only 7 of the 50 people were observed to have used hand gel in between the doffing. This could be potentially increasing the risk of the spread of the coronavirus.
We had trained almost 150 staff members in the Heddfan unit with regard to PPE/ donning and doffing.
Handwashing prior to donning was achieved by all the staff. All the staff, that is 100 % of them adhered to the donning technique in line with the guidance in comparison to just 64% during the first Audit. Whilst hardly just 1/2 to 2/3rd of the staff followed the doffing technique adequately, the second audit showed that only 2 of the 50 staff did not follow the guidance. A meagre/ handful of them followed the utilisation of hand gel in between the tasks of doffing during the first Audit. Almost 90% of them followed the technique properly during the second Audit. Thus showing that the PPE training was successful.
ConclusionFollowing the PPE training that was provided to them there was a good response from the staff and this went on to show how effectively we have managed the prevention/ contamination of virus in our unit.
Adherence to Public Health England (PHE) guidance for the use of personal protective equipment (PPE) in north Wales mental health unit- a regional audit
- Asha Dhandapani, Sathyan Soundararajan, Alberto Salmoiraghi, Shona Ginty, Tajnin Mitu, Justina Akinlua, Catrin Thomas, Rahul Malhotra, Zeenish Azhar, Haseeb Bhutta, Hanani Taib, Nikhil Gauri Shankar, Vikram Bhangu, Gathoni Kamau, Elizabeth Chamberlain, Anna Mackenzie, Henrik PAHLEN, Hannah Lock, Aniis Rymansaib, Pauline Mclean, Rodrigo Trujillo, Manjula Simiyon, Adam Chappell, Agnieszka Gross, Gaynor Gaskell
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S318
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Aims
To ensure that the PPE guidance is strictly adhered to.
To ensure that patient care is not compromised.
To help us in areas of need in order to educate the staff regarding the techniques of PPE and thus ensure patient and staff safety and care during the pandemic.
MethodNovel coronavirus 2019 was first described in December 2019 in Wuhan in China. Since those initial few cases, it has rapidly proliferated to a global pandemic, putting an inordinate amount of strain on healthcare systems around the world. We believe that the technique of donning and doffing if followed as per PHE guidelines would be of help in both preventing the infection and improve the care and safety of both patients and staff.
This Audit includes both In-patient and Out-patient units in Psychiatric services across North Wales. Data were collected from 19 units out of 39. We observed covertly 325 staff members belonging to various cadres. Apart from the Donning and Doffing techniques, we also observed the availability of designated areas for this purpose and the availability of PPE as well.
Data collection was by junior and senior doctors from various sites of the mental health unit in North Wales. A proforma was provided, the standards were based on PHE guidelines.
ResultIt was noted that just about 50% of the staff followed donning as per guidance. Amongst all three sites, the Central team showed a better adherence with 85% of them donning PPE correctly. whereas only 22% adhered to donning in the West team.
Only 21% of them managed to doff PPE as per guidance amongst all 3 centres in North Wales.
It was also noted that there are no designated areas to Don and Doff in outpatient units. Staff, in general, seem to not adhere to the guidance of utilising a mask, especially when within 2 meters distance of other staff.
ConclusionWe will be presenting the Audit at the regional meeting. After discussion with the infection prevention control team and Health and safety lead, we intend to improvise the wards with designated areas for donning and doffing. Teaching sessions for the staff in all three sites, reminders in various areas of the community mental health units and inpatient units.
We are hoping that these recommendations will help us in achieving our aim of health and safety during this pandemic.
Audit on monitoring physical health of patients on mood stabilisers following NICE guidelines
- Sathyan Soundararajan, Asha Dhandapani, Claire Jones
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S104-S105
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Aims
The aim is to find out if the physical health monitoring is adhered to in accordance with NICE guidelines in individuals with Intellectual disability who are on mood stabilisers and known to LD services.
MethodWe sought to explore if the physical health monitoring for prescribing mood stabilisers in a sample of people with ID was consistent with good practice guidelines.
We collected the data by reviewing the clinical records of individuals with LD who were under the care of mental health services in the CLDT- Wrexham and prescribed a mood stabiliser drug. We also contacted the patient's carers who came to outpatients and by calling the GP surgery and enquiring about the details. We also assessed the Welsh clinical portal in order to assess the blood tests.
Data were collected by trainee doctors in Psychiatry. This was a retrospective audit, looking at data from Learning Disability psychiatry caseload. We identified about 16 patients on mood stabilisers.
ResultPhysical health monitoring for prescribing mood stabilisers was almost consistent with good practice guidelines. This has shown that the majority of the monitoring has complied. There are few lacunae, such as Thyroid function not being monitored every 6 months for patients on Lithium, Serum Carbamazepine levels not being monitored as per guidelines with 1 patient not having blood done at all whilst on Carbamazepine. Moreover, the details are not readily available for the Consultant/ team when needed, thus making it very tedious for them to search/ contact the GP, etc.
ConclusionMedications such as mood stabilisers can increase the risk further if the patient's physical health is not monitored regularly. This can lead to compromised quality of life for the patient and in some cases increased morbidity. Hence we have come up with a proforma that can be attached to patient case notes. This will serve as a record for us and prompt for physical monitoring. We will keep a database online with reminders set. This is to ensure a continuity of care for the patients.
Are the rapid tranquilisation nice guidelines adhered to, in patients with agitated/aggressive behavior? a QIP
- Asha Dhandapani, Sathyan Soundararajan, Rajvinder Sambhi
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S184-S185
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Aims
To explore whether the NICE guidelines for rapid tranquilisation are adhered to in the Psychiatric intensive care unit (PICU/ Tryweryn).
MethodData were collected by core trainees. Standards were taken from NICE guidelines NG10. All patients who had received rapid tranquilisation, that were in PICU from August 2019 to February 2020 were considered in this a.
ResultDuring the first PDSA, we discussed with the staff in the ward regarding the protocol. Prior to actually starting the second audit, the adherence was noted to be low. However following persistence and having created a protocol jointly with the ward manager, we could see the difference. The staff were appreciated for their efforts in maintaining 100% adherence. The same was intended to be continued with some positive reinforcement from the auditing team. Over the first 2 months, 12 patients received Rapid Tranquilisation. Out of these 12, we randomly selected 4 patients to find the adherence of the NICE guidelines to be 100 per cent. The predictions regarding the adherence to protocol showed that the PDSA was successful.
During the second PDSA, the adherence was 100% again. The adherence to the protocol has been followed for not just the sample that was selected, but for the entire set of patients who received the Rapid Tranquilisation. Following this QIP, we formatted the proforma which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and response to medication.
ConclusionThe utilisation of de-escalation techniques and behavioural support plans that was person-centred in turn brought down the rate of Rapid Tranquilisation successfully. Thus placing our PICU as having the least restraints in the UK in 2019 (Second least 3/ month). Our PICU was awarded the prestigious Nursing Times Team of the Year Award for their pioneering work.
Following this QIP, we then formatted the proforma for Rapid Tranquilisation which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and patients response to medication. The PICU will continue to maintain this 100% standard and we would then consider extending the Audit to both Open wards and PICU in entire North Wales.
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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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
Service evaluation for services for younger people with dementia in east locality of north Wales
- Asha Dhandapani, Sathyan Soundararajan, Sharmi Bhattacharyya
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S20
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Aims
To evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.
MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.
ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.
ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.
What can be found in the spam folder? a self-study from junior researchers in psychiatry
- Nikhil Gauri Shankar, Jashan Selvakumar, Jiann Lin Loo, May Honey Ohn, Sze Hung Chua, Asha Dhandapani, Manjula Simiyon, Jawad Raja
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S250-S251
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Aims
Thriving on the pressure of “publish or perish” experienced by academicians, the industry of predatory publishers with dubious quality has mushroomed and gained their notoriety. The battle of uncovering predatory publishers, including Beall's list, has proven to be tough given the huge monetary gain generated by the predatory publishers. It may be difficult for an inexperienced junior researcher to identify those predatory publishers’ soliciting emails, which may disguise as a reputable journal's article-commissioning process. To date, there is a limited systematic approach to identify such emails. Hence, this research is aimed to describe the common features of soliciting emails from publishers which appeared to be predatory.
MethodThis self-study involved reviewing the content of emails in the spam folder of authors, a team of junior researchers in psychiatry, for a month. Emails included in this study were soliciting emails relevant to publications and the following were reviewed: types of solicitation, sentences used, strategies used, and information available in the public domain of their webpages. Informative types of emails were excluded.
ResultThe solicitation could include: 1) request for a manuscript to be published a journal article, 2) request for a thesis to be published as a book, 3) request to write for a book chapter, 4) invitation to be an editorial member or a reviewer with the offer of free publishing, 5) invitation to be a speaker for a conference, and 6) proofreading services. The publisher may cite a published article of the author from another journal, which was the source where they identified the author's email. Common strategies used for solicitation included: 1) promising a fast-tracked and guaranteed publication, 2) using compliments that appeared to be inappropriate, 3) repetitive emails, and 4) using argumentum ad passiones to induce guilt. The common features of the webpages of those publishers included: 1) open access publishing as the only option, 2) extensive list of indexing services excluding well-established indexing agencies, and 3) the publisher has a huge collection of journals in different disciplines.
ConclusionIt is hoped that these findings will help junior researchers in psychiatry to stay vigilant to avoid falling into the trap of predatory publishers, which may result in financial loss and loss of work to plagiarism. Total eradication of those predatory soliciting emails is unlikely despite the advancement of spam filtering technology, which necessitates a more united effort from different stakeholders to come out with a probable solution.
Junior doctor daytime bleep audit
- Asha Dhandapani, Sathyan Soundararajan, 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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Aims
There had been ongoing concerns with regard to covering daytime duty bleeps across the three sites in the Mental health Department, BCUHB, North Wales.
Frequent empty on-call slots meant some doctors being asked to hold the bleep between 9-5 in-order to cover the vacancy.
Some felt this added to the existing workload and that it was unfair and unsafe.
This issue was raised during a supervision session with the Educational supervisor, North Wales and an initial data collection was suggested.
MethodData were collected over 2 week period to look at the Daytime bleep duties between 9 am to 5 pm
We hoped the data would demonstrate certain patterns of the task being asked to perform.
ResultThe total number of bleeps were noted to be 249
Discharge notification and prescription writing was noted to be the commonest reason for bleep in East and Central while Routine review and Discharge notification was the reason to be bleeped major number of times in the West
Nearly 70% and 90% of the bleeps were found to be appropriate by the East and West respectively, while only a mere 15% were reported so in Central.
While 30% of these bleeps in the West were considered to be deferred, 70% bleeps were deferrable in the East and almost 95% in Central.
The general trend in all 3 centres was as follows:
All three centres have high numbers of bleeps for discharge, prescribing tasks and routine patient reviews
Most think planned discharge paperwork could be done in advance and jobs can be deferred if there is a ward/team doctor available
ConclusionA simple solution could be some jobs being planned ahead (e.g TTO/Discharge Summaries, Re-write charts) and done by the team/ward doctor. ECG could be arranged to be done by nurses/ECG technicians. Some nurses/HCAs are trained in phlebotomy, however, they have not been utilising the skills. That needed to be reinforced in safety huddles meeting.
Apart from these suggestions, we were also wondering about the impact of the service models and how the juniors placed in the community mental health unit could stay involved in their team inpatients