Systematic risk assessment in a mother-baby unit (MBU)–Importance for maternal and infant safety

2017 ◽  
Vol 41 (S1) ◽  
pp. S363-S363
Author(s):  
G. Saraf ◽  
P. Chandra ◽  
G. Desai ◽  
H. Thippeswamy
Keyword(s):  
Risk Assessment ◽  
Infant Health ◽  
Assessment Tool ◽  
Systematic Risk ◽  
Risk Assessments ◽  
Systematic Assessment ◽  
Adequate Care ◽  
Self Harm ◽  
Competing Interest ◽  
Infant Neglect

IntroductionSystematic assessment of risks is an essential component of care in psychiatric mother baby units. Self-harm, infant neglect and harm or the vulnerable physical health of both mother and infant may all pose risks.AimDevelopment of a risk assessment tool and risk assessment among mother-infant dyads at a MBU in Bangalore, India.MethodsBased on data from 200 admissions, doctors and nurses of the unit developed a 15-item tool for risk assessment. Risk was assessed by both nurses and doctors among 58 consecutive mothers admitted to the unit. Risk domains included risks to self, to infant, related to infant health and feeding and violence faced by mother. Frequencies of various risks were calculated. Nurses’ risk assessments were compared to the residents’ risk assessments.ResultsThe mean age of the mothers was 25 (±4) years, age of infant 4 (±4) months and duration of episode was 4 (±14) months. Diagnoses included acute polymorphic psychosis (30%), BPAD (27%) and depression (21%). 47% had high suicidal risk and 28% had made an attempt in the current episode. 22% had expressed ideas of infant harm and 24% had physically harmed the infant. 48% of mothers had been physically violent. Multiple risks were seen in 47%. Doctors were able to identify risks more often than nurses.ConclusionRisks for self-harm, infant harm and related to infant health were high. Systematic risk assessment by both nurses and doctors is important in an MBU to ensure adequate care for the mother infant dyad.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Urban Security and Counterterrorism: An Approach to Proportionality

2021 ◽  
Vol 14 (3) ◽  
pp. 70-85
Author(s):  
Tegg Westbrook ◽  
Thomas Schive
Keyword(s):  
Risk Assessment ◽  
Urban Design ◽  
Assessment Tool ◽  
Dead Reckoning ◽  
Assessment Tools ◽  
Risk Assessments ◽  
Design Strategies ◽  
Risk Assessment Tools ◽  
Urban Security ◽  
Security Returns

As cities and crowded areas increasingly become targets of terrorist plots and attacks, there is ample demand for risk assessment tools that consider proportional measures that reduce the threat, vulnerability, and possible impacts, whilst providing ‘security returns’ for those investments. There is a risk in this process of over- or under-fortifying places based on practitioners’ subjective biases, experiences, dead reckoning and conflicting agendas. Currently, risk assessments rely on qualitative tools that do not consider proportionality that removes these inherent biases. Critiquing well-known urban design strategies and national risk assessments, this article therefore seeks to develop a supplementary assessment tool – an equation for proportionality – that is more objective and is created to help practitioners make good choices, in particular on: (1) reducing the threat, (2) vulnerability, (3) impact, (4) accepting risk, and (5) measuring a security measure’s ability to deter, delay or stop an attack. It concludes that while no assessment is truly objective, the equation works to remove as much subjectivity as possible when assessing proportional urban security.

Assessing the risk of venous thromboembolism in psychiatric in-patients

2017 ◽  
Vol 41 (S1) ◽  
pp. S686-S686
Author(s):  
N. Ellis ◽  
M. Quraishy ◽  
C.M. Grubb ◽  
S. Fitch ◽  
J. Harrison
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
Psychiatric Patients ◽  
Health Board ◽  
Compression Stockings ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Competing Interest ◽  
The Uk

IntroductionVenous thromboembolism (VTE) is a potentially fatal condition. Hospital-associated VTE leads to more than 25,000 deaths per year in the UK. Therefore identification of at-risk patients is crucial. Psychiatric in-patients have unique factors which may affect their risk of VTE (antipsychotic prescription, restraint) however there are currently no UK guidelines which specifically address VTE risk in this population.ObjectivesWe assessed VTE risk among psychiatric inpatients in Cardiff and Vale university health board, Wales, UK, and whether proformas currently provided for VTE risk assessment were being completed.MethodsAll acute adult in-patient and old age psychiatric wards were assessed by a team of medical students and a junior doctor over three days. We used the UK department of health VTE risk assessment tool which was adapted to include factors specific for psychiatric patients. We also assessed if there were concerns about prescribing VTE prophylaxis (compression stockings or anticoagulants), because of a history of self-harm or ligature use.ResultsOf the 145 patients included, 0% had a completed VTE risk assessment form. We found 38.6% to be at an increased risk of VTE and there were concerns about prescribing VTE prophylaxis in 31% of patients.ConclusionsOur findings suggest that VTE risk assessment is not being carried out on psychiatric wards. Staff education is needed to improve awareness of VTE. Specific guidance for this population is needed due to the presence of unique risk factors in psychiatric in-patients and concerns regarding VTE prophylaxis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Risk assessment and management in obsessive–compulsive disorder

2009 ◽  
Vol 15 (5) ◽  
pp. 332-343 ◽  
Author(s):  
David Veale ◽  
Mark Freeston ◽  
Georgina Krebs ◽  
Isobel Heyman ◽  
Paul Salkovskis
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Obsessive Compulsive Disorder ◽  
Careful Consideration ◽  
Risk Assessments ◽  
Obsessive Compulsive ◽  
Children And Young People ◽  
Compulsive Disorder ◽  
Self Harm ◽  
Risk Assessment And Management

SummarySome people with obsessive–compulsive disorder (OCD) experience recurrent intrusive sexual, aggressive or death-related thoughts and as a result may be subjected to lengthy or inappropriate risk assessments. These apparent ‘primary’ risks can be dealt with relatively easily through a careful understanding of the disorder's phenomenology. However, there are other, less obvious ‘secondary’ risks, which require more careful consideration. This article discusses the differentiation of intrusive thoughts and urges in people with OCD from those experienced by sexual or violent offenders; assessing the risk of self-harm and suicide; discussing the nature of repugnant obsessions with a patient; assessing risk of harm and violence to the dependents and family living with someone with the disorder; and assessing the lack of insight and the use of the Mental Health Act. Issues specifically related to children and young people with OCD are also highlighted.

scholarly journals EP.FRI.495 A retrospective audit of electronic venous thromboembolism risk assessment compliance across three surgical wards in a district general hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Tavlene Banwaith ◽  
Mohammed Kaif Qayum ◽  
Chokkalingam Arun ◽  
Ghulam Nawaz
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Tool ◽  
District General Hospital ◽  
Risk Assessments ◽  
Cross Sectional ◽  
Vte Prophylaxis ◽  
Retrospective Audit ◽  
The Mean ◽  
Audit Cycle

Abstract Aims Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths; with hospital-acquired VTEs accounting for 50% to 60% of all VTEs seen. This project aims to review and improve the number of VTE risk assessments completed for surgical in-patients. Methods This retrospective, cross-sectional study involved data collection from surgical in-patients (n = 648) over three consecutive months, using an electronic VTE risk assessment tool. Data was categorised into ‘First VTE prophylaxis risk assessment completed within 24 hours of admission’ and ‘Second VTE prophylaxis risk assessment completed within 48 hours of admission’. This was further sub-categorised into surgical specialties. Results were presented in departmental meetings and educational posters were displayed. The study was re-audited using the same method over one month (n = 216). Results Results demonstrated improvement from the initial audit cycle, particularly in relation to the mean number of VTE risk assessments completed for patients undergoing breast surgery (100% from 95.3%), colorectal surgery (93.3% from 90%) and general surgery (88.0% from 86.6%). The mean number of first VTE risk assessments completed in 24 hours across all surgical wards remained above 65%, whilst the mean number of second VTE risk assessments completed in 48 hours improved from 36.1% to 47.6%. Conclusions Variation in compliance is still evident across the surgical in-patient wards. Going forward, responsibility to complete outstanding VTE risk assessments will be handed to the FY1 on the late shift. Following this intervention, a further audit cycle will be performed, with the aim of 100% compliance in VTE risk assessment completion.

scholarly journals Assessing the quality of risk assessment conducted for new psychiatry inpatients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S80-S80
Author(s):  
Nikhita Handa
Keyword(s):  
Risk Assessment ◽  
Junior Doctor ◽  
Risk Assessments ◽  
Junior Doctors ◽  
Illicit Substance Use ◽  
Negative Findings ◽  
Acute Psychiatric Wards ◽  
Quantitative Results ◽  
Self Harm

AimsAn audit was conducted to assess if thorough risk assessments had been documented in electronic clinical record notes (ECR) clerking for new patients in two acute mental health wards. Risk assessment is a vital part of admission clerking and when done well it can prevent early incidents and aid the ward nursing team greatly. During induction, junior doctors are advised to document assessed risks when clerking a new patient. A screening of the risks on admission could help determine the levels of observations required to minimise the identified risks whilst the patient awaits their first ward review.MethodThe NHS numbers for the 30 current inpatients across male and female acute psychiatric wards were gathered at the time of the audit (February – March 2020). Admission clerking was analysed for a clear statement of patient risk to self, others or property. Within these categories quantitative results were obtained on how often the risk of self-harm, self-neglect, absconding, vulnerability or aggression was documented. The term ‘risk’ was used for each patient on their ECR notes to search for risk assessments in all entries other than admission clerking.Result12 out of the 30 patients had a junior doctor risk assessment documented in their clerking (40%). 14 patients had no mention of risk assessment on admission (47%) and their first formal risk assessment was documented only in their senior ward review. Of the 12 assessments completed in clerking; all assessed self harm/suicide risk and violent risk to others, 1 mentioned risk of absconding, 8 mentioned risk of illicit substance use and 8 mentioned vulnerability. It was unclear if the risks documented were based on current or historic presentation. Junior doctors were anonymously surveyed following this audit and reported they did not feel confident in how to document a risk assessment or whether to document negative findings.ConclusionClear documentation of risk assessment being performed was lacking in over half of junior doctor admission clerkings. When risks were assessed it was mainly violence/self harm risk documented not vulnerability and physical health risks. Based on these findings we have designed more comprehensive teaching on risk assessments and a template for how to complete a risk assessment. We feel the use of a template will ensure all elements of risk are clearly considered even if they are not present currently. This is being reaudited to assess if the changes have impacted the quality of risk assessment conducted.

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