VTE and physical health assessment upon admission to acute functional and organic psychiatric in-patient wards: An audit

2017 ◽  
Vol 41 (S1) ◽  
pp. S479-S479
Author(s):  
N. Mistry ◽  
G. Sikka
Keyword(s):  
Physical Health ◽  
Blood Clot ◽  
Venous Blood ◽  
Health Assessment ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Health And Wellbeing ◽  
Competing Interest ◽  
To Receive ◽  
Calf Pain

IntroductionVenous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.ObjectivesThere has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.MethodsVTE and physical health assessment data was collected by checking electronic admission summaries from three acute psychiatric in-patient wards on a random date in 2016. The local pathway for the management of physical health and wellbeing states that the VTE assessment and Physical Health Assessment should be completed within 6 hours of admission. NICE guidelines also state that all patients should be assessed on admission, with a standard of 100%.Results60% of patients had a VTE assessment and 54% of patients had a physical health assessment done within 6 hours of admission.ConclusionsThis audit shows that the necessary standards are not met. Importance of these assessments has been communicated during induction programmes for all staff.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Documenting the decision-making process for initiation of pharmacological VTE prophylaxis in patients admitted to an adult psychiatry ward background

2017 ◽  
Vol 41 (S1) ◽  
pp. S615-S615
Author(s):  
G. Sikka ◽  
N. Mistry
Keyword(s):  
Blood Clot ◽  
Venous Blood ◽  
Assessment Data ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Adult Psychiatry ◽  
Competing Interest ◽  
To Receive ◽  
Calf Pain ◽  
Learning Points

BackgroundVenous thromboembolism (VTE) is a condition that causes a blood clot to form within the venous blood system. If this blood clot forms in the peripheral venous system, it can cause symptoms such as calf pain and swelling. If this clot becomes dislodged, it may travel through the vessels into the pulmonary artery which can have much more severe consequences.ObjectivesThere has been a great deal of effort in recent years to increase the percentage of in-patients receiving a VTE assessment; and for those patients to receive appropriate VTE prophylaxis. VTE is a significant cause of inpatient deaths. This audit aims to compare current working practice to local standards and identify learning points.MethodVTE assessment data were collected from two acute psychiatric in-patient wards within a specified, random date range in 2016. Data was collected by checking paper admission documentation. NICE guidelines also state that all patients should be assessed for VTE on admission, with a standard of 100%.ResultsOverall, 6.25% of general adult psychiatry patients had a VTE assessment done within 24 hours of admission.ConclusionThis audit shows that the necessary standards are not met. Importance of these assessments will be communicated during induction programmes for all staff and the results of this audit communicated to current staff on all in-patient psychiatry wards.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Are we meeting local and national guidelines for physical health assessment following admission to the meadows?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S304-S305
Author(s):  
Yasmin Abbasi ◽  
Ruairidh Morgan ◽  
Alice O'Docherty
Keyword(s):  
Physical Examination ◽  
Physical Health ◽  
Psychotropic Medication ◽  
Health Assessment ◽  
Health Examination ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Healthcare Needs ◽  
Common Diagnosis ◽  
Level Of Consciousness

AimsWe audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.BackgroundSABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.MethodAll admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.The sample included 35 patients.Result55% of patients had a diagnosis of dementia.63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.ConclusionWe found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.

EP.FRI.771 National audit on VTE prophylaxis for lower limb injuries treated in a plaster cast

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Georgios Karagiannidis ◽  
Omar Toma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Lower Limb ◽  
Plaster Cast ◽  
Junior Doctors ◽  
National Audit ◽  
Lower Limb Injuries ◽  
Nice Guidelines ◽  
Vte Prophylaxis ◽  
Limb Injuries

Abstract Aims Audit to assess Orthopaedic departments’ compliance with NICE guidelines on Venous thromboembolism (VTE) prophylaxis published in 2010, specifically looking at VTE practices for patients with lower limb injuries treated in a plaster cast. Methods A telephonic survey was carried out on junior doctors within orthopaedic departments of 66 hospitals across all regions of England. A questionnaire was completed regarding VTE risk assessment, prophylaxis and hospital guidelines etc. Data collected from August 2016 till February 2017. Results 83% (n = 55) of trusts routinely give VTE prophylaxis to these patients. 96% (n = 64) give Chemoprophylaxis of some sort. Formal VTE assessments are performed in 81% (n = 54) and 77% (n = 51) have a local VTE prophylaxis policy. Conclusions We conclude that Orthopaedic departments across England have increased compliance with NICE guidelines for VTE prophylaxis. However there is considerable variation in practice, especially in duration and chemoprophylaxis agent. We attribute this to the lack of specific NICE guidelines for this cohort of patients. We aim that this study can influence NICE to introduce added guidance that will standardise practice.

Duloxetine augmentation in resistant obsessive compulsive disorder: Surveying a new medication for challenges in treatment of OCD

2017 ◽  
Vol 41 (S1) ◽  
pp. S415-S415
Author(s):  
A. Mowla
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Primary Outcome Measure ◽  
Controlled Clinical Trial ◽  
Double Blind Study ◽  
Obsessive Compulsive ◽  
Double Blind ◽  
Compulsive Disorder ◽  
Significant Difference ◽  
Competing Interest ◽  
To Receive

IntroductionUp to 50% of patients with OCD have failed to respond in SSRI trials, so looking for pharmacological alternatives in treatment of obsessive compulsive disorder (OCD) seems necessary.ObjectivesSurveying duloxetine augmentation in treatment of resistant OCD.AimsStudy the effects of serotonin-norepinephrine enhancers for treatment of OCD.MethodsThis augmentation trial was designed as an 8-week randomized controlled, double blind study. Forty-six patients suffering from OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor (fluoxetine, citalopram or fluvoxamine) were randomly allocated to receive duloxetine or sertraline plus their current anti OCD treatment. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure.ResultsForty-six patients (24 of 30 in duloxetine group and 22 of 27 in sertraline group) completed the trial. Both groups showed improvement over the 8-week study period (mean Y-BOCS total score at week 8 as compared with baseline: P < 0.001 and P < 0.001) without significant difference (P = 0.861). Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0% in Y-BOCS score and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5% in Y-BOCS.ConclusionsOur double blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in resistant OCD patients. However, it needs to be noted that our study is preliminary and larger double blind placebo controlled studies are necessary to confirm the results.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Perceived mental health, wellbeing and associated factors among Nepali migrant and non-migrant workers: A qualitative study

2020 ◽  
Author(s):  
Hridaya Raj Devkota ◽  
Bishnu Bhandari ◽  
Pratik Adhikary
Keyword(s):  
Mental Health ◽  
Qualitative Study ◽  
Physical Health ◽  
Working Conditions ◽  
Migrant Workers ◽  
Health Condition ◽  
Poor Mental Health ◽  
Physical Work ◽  
Health And Wellbeing ◽  
Mental And Physical Health

AbstractBackgroundPoor mental health and illness among the working population have serious socio-economic and public health consequences for both the individual and society/country. With a dramatic increase in work migration over the past decades, there is recent concern about the health and wellbeing of migrant workers and their accessibility to healthcare services in destination countries. This study aimed to explore the mental health and wellbeing experiences of Nepali returnee-migrants and non-migrant workers, and identify their perception on the risk factors for poor health and health service accessibility for them.MethodsThis qualitative study was conducted among Nepali migrant and non-migrant workers in February 2020. Four focus group discussions (n=25) and 15 in-depth interviews were conducted with male non-migrant and returnee migrant workers from Gulf countries and Malaysia. The discussions and interviews were audio-recorded, transcribed, translated into English and analysed thematically.ResultMigrant workers reported a higher risk of developing adverse mental health conditions than non-migrant workers. In addition, fever, upper respiratory infection, abdominal pain, ulcer, and occupational injuries were common health problems among both migrant and non-migrant workers. Other major illnesses reported by the migrant workers were heat burns and rashes, snake-bites, dengue, malaria, gallstone, kidney failure, and sexually transmitted diseases, while non-migrants reported hypertension, diabetes, and heart diseases. Adverse living and working conditions including exploitation and abuse by employers, lack of privacy and congested accommodation, language barriers, long hours’ hard physical work without breaks, and unhealthy lifestyles were the contributing factors to migrant workers’ poor mental and physical health. Both migrant and non-migrants reported poor compliance of job conditions and labor protection by their employers such as application of safety measures at work, provision of insurance and healthcare facilities that affected for their wellbeing negatively. Family problems compounded by constant financial burdens and unmet expectations were the most important factors linked with migrant workers’ poor mental health condition.ConclusionBoth migrant and non-migrant workers experienced poor mental and physical health condition largely affected by their adverse living and working conditions, unmet familial and financial needs and adherence to unhealthy life styles. It is needed to ensure the compliance of work agreement by employers and promotion of labor rights in relation to worker’s health and safety. In addition, policy interventions on raising awareness on occupational health risk and effective safety training to all migrant and non-migrant workers are recommended.

Psychological and Physical Problems in Elderly People with Problems of Falls

2017 ◽  
Vol 41 (S1) ◽  
pp. S659-S660
Author(s):  
M. Mentis ◽  
M. Gouva ◽  
E. Antoniadou ◽  
K. Mpourdoulis ◽  
I. Kesoudidou ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Elderly People ◽  
The Elderly ◽  
Poor Mental Health ◽  
University Hospital ◽  
Psychological State ◽  
Physical Damage ◽  
The Difference ◽  
Competing Interest

IntroductionFalls of the elderly to a degree been associated with poor mental health, poor social support and poor physical health.ObjectivesTo investigate the falls of elderly people in relation to their mental and physical healthy.AimsTo compare the effects of falls in the elderly in the areas of mental and physical health.MethodsThe current study used purposive sampling compromised from 48 people that visited the emergency department at the Patras University Hospital in 2016. The inclusion criterion for participation was age (> 65 years). Data was collected using WHO's questionnaire, the WHOQUOL-BREF. Finally, data was analyzed using the test t test for independent samples.ResultsThe sample constituted by 39.6% of male and 61.4% of female. The average age of the sample was M = 75.89 years. In relation to mental health, the average of the elderly with a history of falls found M = 57.26 (SD = ± 22.87), while the other was found M = 74.45 (SD = ± 15.81). The difference between the two groups was statistically significant (P < 0.05), while physical health although again the first group found to have a smaller average (M = 56.65, SD = ± 22.13) relative to the second group (M = 63.78, SD = ± 12.59) no statistical difference was observed.DiscussionsThese results demonstrates that falls beyond the physical damage that are immediately visible can as well create significant issues in the psychological state of the elderly exacerbating anxiety, fear and social isolation, which has been associated with depression event.Disclosure of interestThe authors have not supplied their declaration of competing interest.

A Population Service Evaluation of the ADHD Pathway of Children and Young People's Services, Malta

2017 ◽  
Vol 41 (S1) ◽  
pp. S222-S223
Author(s):  
A. Saliba ◽  
D. Agius ◽  
E. Sciberras ◽  
N. Camilleri
Keyword(s):  
Neurodevelopmental Disorder ◽  
Reliability And Validity ◽  
Service Evaluation ◽  
Assessment Process ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
Nice Guidelines ◽  
Case File ◽  
Mean Waiting Time ◽  
Competing Interest

IntroductionADHD is the commonest neurodevelopmental disorder in young people (YP) aged 5–18 years. YP with untreated ADHD are 5 times more likely to develop co-morbid psychiatric disorders.ObjectivesTo carry out a population service evaluation of the assessment process and management of YP with ADHD at Child and Young People's Service (CYPS), Malta age 0–16 years for 2014.AimsTo describe the service input, assessment and treatment of YP attending CYPS and compare to ADHD NICE guidelines 2008.MethodsAll patients diagnosed with ADHD at CYPS throughout 2014 were included. The incidence of YP with ADHD on treatment age 3–16 years in Malta was calculated. Information was collected from; (i) retrospective case file review and (ii) methylphenidate and atomoxetine registry and compared with NICE guidelines.ResultsOne hundred and thirty-six YP were diagnosed with ADHD. The minimum 12-month incidence of ADHD on treatment (3–16 years) in Malta was 553 per 100,000. Pre-diagnosis assessments were more frequently performed by other YP services (n = 97, 71.3%, P ≤ 0.01). A psychiatrist or paediatrician confirmed the diagnosis in 113 (83.1%). Sixty-two (45.3%) of YP were prescribed medication, 50 (36.8%) were referred for parental skills course and 55 (40.4%) psychotherapy. Mean waiting time for first appointment was 187.6 days (CI ± 26.9, 0–720), and first specialist review was 301.0 days (CI ± 34.4, 0–800) (1–3).ConclusionsThe incidence for YP (3–16 years) with ADHD on treatment was lower than the US. Since most pre-diagnostic assessments were carried out by other services, this raised the question about the reliability and validity. We recommend a diagnostic MDT meeting following the multimodal assessment to diagnose ADHD. Medication prescribing followed NICE overall, standardising non-pharmacological management is required.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Audit of patients with intellectual disabilities accessing a specialist neuropsychiatry service for epilepsy management

2017 ◽  
Vol 41 (S1) ◽  
pp. S352-S352
Author(s):  
A. Adetoki
Keyword(s):  
Intellectual Disability ◽  
Intellectual Disabilities ◽  
Total Sample ◽  
Best Interest ◽  
Nice Guidelines ◽  
Specialist Services ◽  
Co Morbidity ◽  
Planning Processes ◽  
Competing Interest ◽  
Equity Of Access

IntroductionEpilepsy is a frequent co-morbidity in patients with intellectual disabilities, some of whom require specialist services. The National institute for health and care excellence (NICE) has recommended that there should be equity of access to high quality of care regardless of the existence of a diagnosis of intellectual disability.ObjectivesTo observe current practice with regards to NICE guidelines for epilepsy care in patients with intellectual disability.AimsTo identify the level of compliance with NICE guidelines and provide evidence which may inform care planning processes.MethodsA retrospective review of the electronic and paper-based records of a total sample of intellectually disabled patients who accessed a specialist neuropsychiatry service for the management of epilepsy during a six-month period was carried out.ResultsThe records of 21 patients whose ages ranged from 20 to 58 years were audited. The waiting period ranged from 4 weeks to 46 weeks. There was evidence of Carer involvement in the management of 100% of the patients and seizure improvement since referral was documented in 66%. Non- medication treatment was offered in 67% of cases. Evidence of special considerations in view of patient's intellectual disability was recorded in 24%, best interest considerations in 24% and capacity assessment in 19%.ConclusionsThere is a significant improvement in the symptoms of 66% of patients in this audit. However there is room for improvement and a more specific plan for patients with intellectual disabilities should facilitate this.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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