5 results
Experience and Reflection From Inpatient Staff at an Intellectual Disability Hospital During COVID-19
- Rahul Malhotra, Zeenish Azhar
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S43
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Aims
The COVID-19 pandemic and the associated impact on the NHS led to particular challenges for Intellectual Disability (ID) inpatient hospitals across the country. The aim of this Research Project is to gather the experience of Inpatient staff in our local ID Hospital following the first wave of COVID-19 pandemic in July 2020.
MethodsWe gathered data by means of survey from inpatient staff including ‘staff nurses’ and ‘health care support workers’ from 2 cute assessment and treatment units and 1 rehabilitation unit over the preceding 3 months. We obtained 15 responses. We gathered quantitative data via a questionnaire on the views of staff regarding the service provision for patients and staff during COVID-19. We also gathered qualitative data on learning points and how things would have been done differently in hindsight.
ResultsThe responses were anonymised, directly transcribed, coded and grouped into themes. 67% of staff stated appropriate type and quantity of Personal Protective Equipment was available. 60% of staff stated it was ‘easy’ to access a General Practitioner for patient reviews. 60% of staff stated, there was a change in arrangements for Do Not Resuscitate/Escalation plans during COVID-19. 47% of staff stated there was availability of virtual or face-to-face clinical training support. 67% of staff did not take sickness leave due to symptoms or contact with a COVID-19 patient. 67% of staff did not receive or found it difficult to access a COVID-19 test. 47% of staff reported a negative impact of the pandemic on their physical and mental health well being. 13% of staff found the Counselling/emotional Support helpful.
Some of the key themes that emerged in the qualitative data analysis included the importance of being grateful for personal health and well being, move lives could be saved if earlier and more frequent testing was available during the first wave, delays in the arrival of PPE in the hospital and ideas to mitigate risk by designating members of staff to a fixed work area to reduce mixing.
ConclusionA wide range of reflections, suggestions and feedback were obtained during the research project which will be helpful to plan and organise services moving forward should future waves of COVID-19 emerge.
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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- Journal:
- 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.
Clozapine clinics in north Wales - service evaluation audit
- Jawad Raja, Zeenish Azhar, Masood Malik
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S343
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Aims
1. Quality of clozapine clinic appointment
2. Effectiveness of clozapine clinic servive
3. Compliance with BCUHB guidelines for physical health monitoring in clozapine clinics
4. We retrospectively audited 40 case notes 10 each from 4 differtent CMHT clozapine clinics
1. I was the audit and overall lead for this project
2. I formulated the audit tool and registered my project with Audit Registration Team
3. I lead data collection and compilation of results
Background1. This audit followed up from a Coroner's investigation for a clozapine clinic patient
2. Clozapine is used for Treatment Resistant Schizophrenia but needs close monitoring due to potentially fatal side effects
3. NICE recommends annual monitoring of weight, blood pressure, waist measurement, blood glucose and plasma lipid levels
Method1. Has the patient been seen in the past year by clinician to monitor response to clozapine treatment?
2. Has the clozapine plasma level been measured during the last year of treatment?
3. Is brief MSE & Risk assessment documented during review?
4. Has Life style modification advice been provided?
5. Has annual physical health been completed?
6. Has Annual CTP/CPA been completed and documented?
7. Has the patient been allocated a named care coordinator?
8. Has clozapine side effects monitoring been documented?
Conclusion1. Clozapine is a superior medication for the treatment of refractory schizophrenia and is also be effective for other conditions
2. Clozapine is underused due to a variety of barriers related to the drug and its properties, the health care system & regulatory requirements
3. This service evaluation/quality improvement project provides the framework for clozapine clinics evaluation and recommends strategies for improvement
Service evaluation of primary care mental health support services in north Wales
- Jawad Raja, Alberto Salmoiraghi, Zeenish Azhar
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S343-S344
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Aims
Bringing specialist psychiatrist into PCMHT
Undertaking initial assessments for people Referred by G.P's
Working According to the principle of “Prescribing Interventions”
Decrease number of assessments carried out within secondary Care
MethodCounty of Wrexham is situated between the lower Dee Valley and the Welsh mountains. It is the largest town in North Wales (140,000)
Since 2013, the total new patient referrals to be seen by Wrexham county consultant psychiatrists has consistently risen
This issue has been dealt with in different ways across North Wales and indeed the whole of Wales
Following a review of services in Wrexham during 2017, it was identified that there was an opportunity to pilot a new model which would allocate a designated Consultant to the local Primary Care Mental Health Team (PCMHT)
The Consultant would work entirely within Part 1 of the Mental Health Measure and would offer specialist opinions to Tier 1 Services
ResultPCMHT team members are maintaining open cases for a significant amount of time rather than the 8–10 sessions that was originally predicted during the implementation of the Mental Health Measures
In order to sustain the service, the minimum number of direct clinical patient contact sessions to be offered by the psychiatrist was up to 4 a week.
During the review period, total number of clinics offered were 51 and a total of 139 patients were offered appointments
Consultants in secondary care covering the same area received exactly 100 less referrals in the first 6 months of the pilot
Main source of referrals to the Tier 1 Consultant came from G.P.'s and the local PCMHT itself
ConclusionPilot demonstrated that bringing specialist consultant psychiatrist dedicated to the PCMHT improved the care offered to patients referred by G.P's
Scope of PCMHT needs to extend in order to absorb mild to moderate mental illness and thus avoid patients going into secondary care
This model should be supported, and further resources should be inputted into PCMHT
We should move from a categorical diagnostic referral system to a needs-based intervention where only the most complex cases requiring lengthy interventions shall progress to secondary care
Risk should not be classed as criteria to move patients into secondary care and PCMHT should be able to absorb moderately risky cases
Adult ADHD clinics in north Wales - case load prevalance & compliance with nice guidelines (quality evaluation project)
- Jawad Raja, Zeenish Azhar, Alberto Salmoiraghi
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S342-S343
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- Article
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- You have access Access
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Aims
Measure compliance with National Institute for Health and Care Excellence (NICE) recommendations in four Adult CMHT's
Guide further service development.
We audited the case notes of 20 patients each currently under care of 9 General Adult Consultants across 6 CMHT's in East side of North Wales against NICE standards using an adapted version of the ADHD audit support tool.
My role in the Project & How does this represent my practice?
I was the audit and overall lead for this project
I formulated the audit tool and registered my project with Audit Registration Team.
I lead data collection and compilation of results.
MethodOverall, this is the first audit of Adult ADHD Services in East side of North Wales.
It established good compliance with NICE guidance for assessment and treatment.
NICE has expressed the need for full mental health and social assessment including full history and physical examination prior to the drug treatment.
Good compliance was observed in using & documenting Diagnostic Criteria (DSM-IV and/or ICD-10).
There were deficiencies in conducting or arranging recommended physical examination & side effect monitoring.
Drug treatment was the first line of treatment in the majority of cases.
Antipsychotics were used in some patients referred for ADHD assessment, despite the fact that NICE has ruled out the use of antipsychotic drugs in treatment of core symptoms of ADHD.
ResultPrevalence of Adult ADHD clinician case load in Wrexham and Fintshire Counties.
Diagnosis of Adult ADHD according to ICD 10 & DSM IV Guidelines.
Pre treatment screening of physical health for ADHD patients.
Side effects monitoring of patients on stimulant medications.
ConclusionThe finding highlights the need for more effort in educating clinicians about safety and effectiveness of antipsychotics in ADHD.
Comprehensive treatment programmes that address psychological, behavioural, educational and occupational needs should be established.
Development of local ADHD Clinics, support groups and in partnership with the voluntary sector should be encouraged.
It is important that mental health professionals receive appropriate training in assessment, management & monitoring of ADHD patients with co morbid substance use disorder and other mental illnesses.
BETSI Health Board to participate in national Prescribing Observatory for Mental Health (POMH-UK) Quality Improvement Programme (QIP) focusing on prescribing for ADHD in children, adolescents & adults.