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Compliance With Nice Policy on Ecg in Patients on Psychotropic Medications: Frays Ward August 2020 to January 2021
- Olajide Adegbite, Saal Seneviratne, Ruchit Patel
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S75-S76
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- Article
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Aims
1. The need to ensure ECG is done before commencing Psychotropic medications. 2. The need to ensure both medical and non-medical staff cooperate in ensuring ECG monitoring is done according to guidelines. 3. The need to help Nurses acquire competence in performing ECG
MethodsA total of 101 patients were reviewed, all with various diagnoses, cardiovascular risks, and on different medications. Of these, 61 were included while 40 were excluded.
The exclusion criteria include:
1. Transfer from another trust to Frays ward
2. Transfer or step down from ICU to Frays ward
3. Transfer from frays ward on the day of admission
4. Patients who are already on treatment and recently had physical health assessments.
5. Admitted before August and after January
Some of the patients were already known to mental health services and had been on medications. While others were having contact with mental health services for the first time.
After the exclusion, only about 61 patients were included in the study over the 5-month period.
Data were collected on the following:
1. Date of admission
2. Date ECG was done.
3. Date medication was commenced.
4. QTc readings
5. Type of medication commenced.
6. Days between admission and completion of ECG were extrapolated.
7. Days between admission and commencement of medication were also extrapolated.
All the above data were analysed and presented in charts, tables, and graphs.
Some Limitations identified:
Lack of standard admission register
Lack of discharge register
Missing ECG reports
Recruitment and participation of team members due to multiple training activities on Frays
Results1. A total number of 48 patients had ECG while 13 of them did not. Some refused to give consent or were not mentally/clinically stable.
2. A total of patients that had Baseline ECG before the commencement of medications on admission was 22(36%), while 39(64%) had ECG after the commencement of medications. The vast majority of the non-compliant patients were due to failure to consent at the time of admission.
3. Timeline for Baseline ECG vs commencement of medications: 16 patients had within 24 hours, 10 patients had after 24 hours, 16 patients had within one week and 4 patients had after one week.
4. Concerning QTc pattern; A total of 37 patients had normal, 10 patients had borderline and 1 had prolonged
5. Patients with other ECG abnormalities: Out of the 48 patients that had ECG at one point during the admission, about 44 of them had a Normal sinus rhythm while 4 were abnormal. However, all the abnormal ECGs were asymptomatic
ConclusionAlthough the vast majority of service users in this study had normal ECG readings and overall low cardiovascular risk, the compliance rate with Trust/NICE guidelines are significantly low. Apart from falling short of Trust and NICE policies, this increases the chances of missed diagnosis, especially in people with pre-existing cardiac conditions.
Efforts must be intensified to ensure the vast majority of service users get thorough physical health assessments including ECG before psychotropic medications are commenced.
Service evaluation of a sole-session psychoeducational intervention to improve caregivers’ key illness beliefs after first episode psychosis (FEP)
- Cassie M. Hazell, Natasha Lyons, Juliana Onwumere, Joerg Schulz, Naomi Glover, Sarah Whittaker, Lai Chu Man, Caroline Floyd, Lucy Brown, Gareth James, Roya Afshardazegan, Saal Seneviratne, Shireen Rahim, Jonathan Souray, David Raune
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- Journal:
- The Cognitive Behaviour Therapist / Volume 13 / 2020
- Published online by Cambridge University Press:
- 28 July 2020, e28
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Carers of people experiencing a first episode of psychosis are at an increased risk of developing their own physical and mental health problems. Psychoeducation has been found to improve carer wellbeing and reduce distress. However, few psychoeducation interventions have considered the resource constraints on mental health services and the impact that these can have on the implementation of any such interventions. The present service evaluation aimed to evaluate an abbreviated version (sole session) of a previously tested psychoeducation intervention (three sessions) that targets less adaptive illness beliefs (n = 17). Pre–post effect sizes reveal that all of the carers’ illness beliefs changed in the desired direction, with four out of the 10 illness beliefs associated with large to moderate improvements. When compared with the outcomes obtained in our evaluation of the more intensive, three-session version of the intervention, the between-group effects largely favoured the three-session version but were mostly small. Moderate to large effects in favour of the three-session version were found for two of the 10 illness beliefs. These findings support the further investigation of the sole session psychoeducation intervention as part of a randomised controlled trial.
Key learning aims(1) To evaluate the impact of a sole-session psychoeducation intervention on illness beliefs.
(2) To compare the outcomes of the sole-session psychoeducation intervention to the previous, more intensive (three-session) version of the same intervention.
(3) To consider the value of research approaches to evaluating psychoeducation interventions for carers of people with psychosis.