3 results
Using SBAR in psychiatry: findings from two london hospitals
- Benjamin Janaway, Ruslan Zinchenko, Lubna Anwar, Clare Wadlow, Edwin Soda, Karen Cove
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S197
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Aims
We aimed to evaluate the use of the Situation, Background, Assessment and Recommendation communication tool (SBAR) at two large psychiatric hospitals, in order to design new approaches to teach and reinforce its sustained use. In doing so we hope to improve communication, staff experience and outcomes for patients.
We hypothesised that use prior to intervention would be low and attitudes inconsistent between teams and objective data.
BackgroundSBAR is a communication tool developed to accurately refer information with improved outcomes within the NHS. Within psychiatry there is evidence of relatively poor care of medical problems leading to adverse outcomes in a group more susceptible to multiple physical illnesses. The reasons for this include a cultural ethos of learned helplessness in staff and lack of medical knowledge.
The use of SBAR is likely to overcome these issues.
MethodSurveys were presented to doctors and nurses staff at two Psychiatric Hospitals, Chase Farm and Edgeware. Inclusion in the survey was voluntary and anonymous. Questions elucidated topics ranging from awareness of SBAR through to its use and benefits.
Objective data were also collected, looking at handover gathered during the survey period. This was collected via phone from the duty physician over a five-day period, twice-daily. Qualitative data on handover content was collected at CFH.
Audit standards around knowledge, use and outcomes were set. Data were collected and analysed in house.
ResultThe data (n23) showed that most nurses reported awareness (86.96%) ease of use (86.96%) actual use (60.87%) efficacy in communication (78.26%) value in understanding patients (78.26%) and agreement with mandatory use (78.26%.)
Doctor reports (n14) showed that although 100% were aware of SBAR, no respondents thought nurse-led communication was adequate, or that SBAR was used. The majority thought that mandatory SBAR use would improve communication (92.86%) and patient care (100%)
Objective data (pooled) of referrals showed that on 6.52% used SBAR. Qualitative data showed that handover was often inaccurate, lacking in information and unsafe. Suggestions for teaching included written or video media, or taught classes.
All audit standards were failed.
ConclusionSBAR is an effective tool for improving communication and patient outcomes, and is well perceived by the MDT. However, it is poorly used with psychiatry leading to adverse outcomes. Reported use is undermined by objective data. Its mandatory use is well supported and new teaching initiatives are thus being designed to remedy this and improve client experience.
Hyperprolactinaemia: audit of practice and new guidance
- Benjamin Janaway, Lubna Anwar
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S196-S197
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Aims
Hyperprolactinaemia is a problem secondary to antipsychotic use. Current management guidelines are heterogeneous and impractical. We aimed to assess coherence to common themes monitoring and intervention, reasons for failure, and to design new guidance for both general use Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and beyond.
We hypothesised that performance would be poor and new guidance warranted.
BackgroundHyperprolactinaemia is defined as blood prolactin of >530 miu/L in females and >424 miu/L in males, with 49.9% is due to medication. Several agents are deemed higher risk Symptom profiles and risk are idiosyncratic and there are adverse long-term outcomes. Treatment is based on symptom profile and severity and cause. Current guidance is trust specific or advised through The Maudlsey Prescribing Guidelines.
Comprehensive and practical guidance reflecting front-line limitations is lacking. There is no clear delineation of a risk stratified pathway.
MethodWe wished to ascertain data on surveillance, aetiology and signpost opportunities for service improvement. We also designed ‘risk strata’ to guide intervention.
A random sample (n30) was selected from Enfield South Locality Team and data captured using local records. No ethical considerations were raised.
A number of audit standards (95%) were developed based on previous guidance and agreed within the team and included frequency of monitoring, time to review and need for further referral.
New guidance was developed based on results, MDT agreement and consultation with medical specialities.
ResultData (n 30) showed predominant male bias to sample (66%) and average age of 48.87 yrs. Predominant diagnoses were Paranoid Schizophrenia (53.33%) and Schizoaffective disorder (33.33%.) Only 7/30 (23.33%) had undergone testing within the last year.
Of those sampled, 2 (6.667%) had a new diagnoses of Hyperprolactinaemia, one on routine monitoring, one incidentally on admission to hospital. Both were on high risk agents. Both were reviewed and treated within one month. No audit standards were met, but no further referrals were required.
Reasons for failure varied, but included loss to follow-up, no test requested or appointments missed.
ConclusionBased on these data it was noted that monitoring was poor and reasons for failure varied. New Guidance was developed in response. The scope and validity of this guidance was agreed by MDT and awaits formal ratification.
Re-audit will occur in 2020, and if successful the guidance submitted to other Trusts and RCPSYCH for national use.
No financial interests to declare.
Persistent psychotic symptoms following COVID-19 infection
- Soon Tjin Lim, Benjamin Janaway, Harry Costello, Anand Trip, Gary Price
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- Journal:
- BJPsych Open / Volume 6 / Issue 5 / September 2020
- Published online by Cambridge University Press:
- 22 July 2020, e105
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To date, there have been no detailed reports of patients developing persistent psychotic symptoms following Coronavirus disease 2019 (COVID-19) infection. There have been reports of patients developing transient delirium (with and without hypoxia) after COVID-19 infection as well as other neurological manifestations. We report on a female patient who, post-COVID-19 infection, developed an initial delirium followed by persistent and florid psychotic symptoms consisting of persecutory delusion, complex visual and auditory hallucinations and Capgras phenomenon in the absence of hypoxia but elevated tumour necrosis factor (TNF)-α. The psychotic symptoms persisted for about 40 days. Her magnetic resonance imaging brain scan, electroencephalogram, cerebrospinal fluid examination and extensive autoimmune panel did not show any abnormalities. The cause of the psychotic symptoms in this patient were not ascertained but we propose either an inflammatory state, characterised by the patient's elevated TNF-alpha levels as a possible contributing mechanism for her psychosis in line with the proinflammatory changes observed in some cases of psychosis. Or, an alternative, but unproven, hypothesis is one of an antibody-mediated encephalitic event induced by viral infection.