Cardiovascular risk assessment in psychiatric inpatient setting

2016 ◽  
Vol 33 (S1) ◽  
pp. s281-s281
Author(s):  
E. Dahmer ◽  
N.C. Lokunarangoda ◽  
K. Romain ◽  
M. Kumar
Keyword(s):  
Cardiovascular Risk ◽  
Psychiatric Inpatient ◽  
Cardiac Risk ◽  
Inpatient Setting ◽  
Qtc Interval ◽  
Cardiac Health ◽  
Psychiatric Units ◽  
Acute Psychiatric Wards ◽  
Competing Interest ◽  
Clinically Significant

ObjectivesTo assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.AimsOverall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.MethodsTen percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.ResultsA score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.ConclusionsOne in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Violent incidents within psychiatric settings

2017 ◽  
Vol 41 (S1) ◽  
pp. S589-S589
Author(s):  
B. Motamedi ◽  
A. Mahmoudi ◽  
M. Motamedi
Keyword(s):  
Relative Risk ◽  
Nursing Staff ◽  
Violent Behavior ◽  
Psychiatric Inpatient ◽  
Low Grade ◽  
Psychiatric Units ◽  
Inpatient Settings ◽  
Competing Interest ◽  
Complex Relationships ◽  
Patient Mix

ObjectiveTo determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviours were explored.MethodsData on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. The classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix. Regression analysis was used to calculate relative rates.ResultsA total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.ConclusionsViolent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals HOUT-15. IDENTIFICATION AND CHARACTERIZATION OF CARDIAC EVENT ABNORMALITIES IN PATIENTS WITH CRANIOPHARYNGIOMA

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi115-vi115
Author(s):  
Christa Seligman ◽  
Rebecca Harrison ◽  
Saamir Hassan ◽  
Jimin Wu ◽  
John DeGroot ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Cancer Center ◽  
Qtc Interval ◽  
Cardiac Health ◽  
Cardiac Risk Factors ◽  
Related Information ◽  
Abnormal Rate ◽  
Md Anderson

Abstract BACKGROUND Craniopharyngiomas (CP) are frequently associated with a malignant clinical trajectory despite their benign histology. This population frequently has endocrinopathies and autonomic dysfunction due to tumour location, which may influence cardiac function and long term health outcome. In this study, we evaluated for clinical and paraclinical cardiac abnormalities in adult and pediatric patients with craniopharyngioma. METHODS We retrospectively identified patients in our neurosurgery database with a diagnosis of craniopharyngioma that received neurosurgery at MD Anderson Cancer Center. We queried the medical record for demographic and disease-related information, as well as clinical information regarding cardiac risk factors. Perioperative electrocardiograms (EKGs) were analyzed where available. RESULTS We identified 56 patients with craniopharyngioma, 27 (48.2%) of which were female. Average age was 39 years, and all patients had undergone subtotal (49.1%), gross total (32.7%), or near gross total (18.2%) resection. Over half (53.6%) had undergone radiation, none had received systemic therapy, and 1 (1.8%) intra-cystic chemotherapy. The majority had adamantanomatous-type histology (83%) and the remainder papillary (17%). At diagnosis, average BMI was elevated at 30.98. Hypertension (30.4%), diabetes mellitus (32.1%), and thyroid dysfunction (80%), were found in this cohort. Nearly a quarter (23.2%) were on statin therapy for dyslipidemia. Stimulant (14.3%) and neuropleptic (3.6%) use were also identified. Of patients with perioperative EKG performed (N= 39), 30 were available for review. Of these, patients were identified with abnormal rate (N=9, 30.0%), PR interval (N=2, 6.7%), QRS interval (N=4, 13.3%), and QTc interval (N=1, 3.3%). Some patients presented with a history of heart palpitations (1.8%) and syncopal episodes (3.6%), but not chest pain. CONCLUSION This analysis demonstrates frequent vascular and cardiac risk factors in patients with craniopharyngioma. We advocate for increased awareness of cardiac health in this young population. Further prospective evaluation is warranted to better understand cardiac health in this patient group.

A review of ECG and QT interval measurement use in a public psychiatric inpatient setting

2017 ◽  
Vol 26 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Ingrid Berling ◽  
Rahul Gupta ◽  
Cecilia Bjorksten ◽  
Felicity Prior ◽  
Ian M Whyte ◽  
...  
Keyword(s):  
Mental Health ◽  
Qt Interval ◽  
Psychiatric Inpatient ◽  
Torsades De Pointes ◽  
Qt Prolongation ◽  
Inpatient Unit ◽  
Inpatient Setting ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Clinically Significant

Objectives: There is an increased rate of sudden cardiac death (SCD) in mental health patients. Some antipsychotic medications are known to prolong the QT interval, thus increasing a patient’s risk of SCD via the arrhythmia, torsades de pointes (TdP). Our aim was to evaluate assessment for QT prolongation within a public inpatient mental health facility by auditing electrocardiograph (ECG) use. Methods: We reviewed records of all mental health inpatient admissions to a public emergency mental health inpatient unit between 1 January 2016 and 11 February 2016. ECG availability was noted and QT interval was manually measured and assessed for risk of TdP using the QT nomogram when present. Demographic information and medication use was collected. Results: Of 263 mental health inpatient admissions, 50 (19%) presentations had an ECG. A total of four (8%) had a prolonged QT interval. Of the 50 patients with an ECG, 12 (24%) were taking medication known to prolong the QT interval. Conclusions: There was very limited risk assessment for QT prolongation in a public hospital psychiatric inpatient unit, with less than 20% of patients having an ECG performed. Our study supports an association between QT-prolonging drugs and a clinically significant prolonged QT interval; however, a larger study with routine ECG screening is required.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting

2017 ◽  
Vol 23 (6) ◽  
pp. 422-430 ◽  
Author(s):  
Patrick Triplett ◽  
Sandra Dearholt ◽  
Mary Cooper ◽  
John Herzke ◽  
Erin Johnson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Psychiatric Inpatient ◽  
Cost Effective ◽  
Cost Of Care ◽  
Inpatient Setting ◽  
Patient Acuity ◽  
Psychiatric Units ◽  
Nursing Cost

BACKGROUND: Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. OBJECTIVES: Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. DESIGN: Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a “milieu manager” to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. RESULTS: The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. CONCLUSIONS: The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

scholarly journals Psychiatric staff training in managing medical emergencies: re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S63-S63
Author(s):  
Sarah Abd El Sayed ◽  
Sudhir Salujha
Keyword(s):  
Physical Health ◽  
Nursing Staff ◽  
Life Support ◽  
Psychiatric Inpatient ◽  
Inpatient Setting ◽  
Local Hospital ◽  
Staff Members ◽  
Psychiatric Units ◽  
Psychiatric Staff ◽  
Level Of Training

AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.

Cardiac Issues Raised by an Examination of the Antipsychotic Prescribing Practices in the Elderly of St. James's Hospital (SJH), Dublin

2017 ◽  
Vol 41 (S1) ◽  
pp. S659-S659
Author(s):  
B. McCarthy ◽  
C. Power ◽  
B. Lawlor ◽  
E. Greene
Keyword(s):  
Elderly Population ◽  
The Elderly ◽  
Cardiac Risk ◽  
Antipsychotic Treatment ◽  
Qtc Interval ◽  
Prescribing Practices ◽  
Antipsychotic Medications ◽  
Average Change ◽  
Competing Interest ◽  
Current Monitoring

BackgroundAntipsychotic medication use may be associated with prolongation of the QTc interval, increasing the risk of potentially fatal arrhythmias [1]. This is particularly pertinent in the elderly due to comorbid cardiovascular disease and polypharmacy. Attention to the ECG and co-prescribed medications is essential to minimise cardiac risk when prescribing antipsychotics.MethodsOn 23rd February 2016 all inpatients aged over 65 who were prescribed antipsychotic medications were identified as part of a hospital-wide survey. Data was collected from medical and electronic patient notes and medication kardexes.ResultsComplete data was obtained for 36 patients aged over 65 who were newly-prescribed an antipsychotic or had their antipsychotic changed. Of these, 39%(n = 13) had a cardiac history. One quarter did not have an ECG in the 12 months preceding antipsychotic initiation. Of the 28 patients with an ECG, 57% (n = 16) had a QTc > 450ms before starting antipsychotic treatment. Only 11% (n = 4) had an ECG within 24 hours of starting the antipsychotic. The average change of the QTc interval in those with a repeat ECG was 30msecs. 42% (n = 15) were co-prescribed another QTc-prolonging medication.ConclusionCurrent monitoring of QTc interval in an elderly population newly prescribed antipsychotic medications is inadequate and a cause for significant safety concerns. Education and clear guidance is warranted to improve safety and minimise risk in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Patterns of Long Acting Injectable Antipsychotic Prescription During Criminal Acts in a Portuguese Psychiatric Hospital

2016 ◽  
Vol 33 (S1) ◽  
pp. S458-S458
Author(s):  
M.A. Duarte ◽  
F. Vieira ◽  
A. Ponte
Keyword(s):  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
The United States ◽  
Security Measures ◽  
Court Records ◽  
Psychiatric Units ◽  
Icd 10 ◽  
History Of ◽  
Competing Interest ◽  
Long Acting

IntroductionUnder the Portuguese law, criminal offenders that are designated as non-criminal responsible – “inimputáveis”, similar those in the United States of America found “not guilty by reason of insanity”, are forced to be committed to inpatient forensic units either in psychiatric hospitals or prison hospitals for mandatory security measures.Objectives/aimsTo evaluate if patients committed in a regional forensic inpatient unit (RFIU) who had a psychiatric history preceding the crime, were under long acting injectable antipsychotic (LAIA) in during the period of the crime.MethodsDuring September/October 2015, patients committed to the RFIU in Centro Hospitalar Psiquiátrico de Lisboa were characterized using medical and court records regarding clinical and demographic variables. The type of crime and previous number of criminal acts were also accounted for.ResultsWe included 33 patients in the study. During time of the crime, 25 patients (75.8%) had history of previous psychiatric appointments, with an average of 3 commitments to the psychiatric inpatient units. The majority (n = 17; 68%) had a diagnose of “schizophrenia, schizotypal and delusional disorders” (F20–29; ICD 10) and committed “crimes against life” (n = 13; 52%). They had an average of 0.8 previous criminal acts. During the crime, 7 patients (28%) were taking LAIA. Those, 16% (n = 4) were doing an unknown antipsychotic and 12% (n = 3) were doing Haloperidol.ConclusionsDespite several studies showing the clinical and rehabilitative benefit of using LAIA early in the disease course, most of the patients in our study, who were already being followed in outpatient psychiatric units, did not benefit from them.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

2015 ◽  
Vol 18 (4) ◽  
pp. 140 ◽  
Author(s):  
Mehmet Taşar ◽  
Mehmet Kalender ◽  
Okay Güven Karaca ◽  
Ata Niyazi Ecevit ◽  
Salih Salihi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Carotid Artery Disease ◽  
Risk Groups ◽  
Cardiac Risk ◽  
Cervical Plexus ◽  
Cardiac Risk Factors ◽  
Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. <br />Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared.<br />Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P &gt; .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection.<br />Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed. <br /><br />

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