Understanding Barriers and Facilitators to Nonpharmacological Pain Management on Adult Inpatient Units

AimsTo evaluate the use of antipsychotics, and high dose antipsychotic treatment (HDAT) in psychiatric inpatient unitsBackgroundThe Royal College of Psychiatrists published a consensus statement on high dose antipsychotic medication in October 1993. Such treatment carries an increased risk of adverse effects including towards ventricular tachycardia and sudden death.MethodA retrospective case note review of all male patients on acute adult inpatient units in a psychiatric hospital in South Birmingham on a date in June 2018 (n = 45) including review of electronic patient records and prescriptions. This was compared with the results of an earlier study, with identical methods, undertaken in June 2015.Result•In both 2015 and 2018, only a minority of patients (20% and 11% respectively) were informal.•In both 2015 and 2018, the majority of inpatients had a diagnosis of schizophrenia (54% and 67%)•In both 2015 and 2018, 93% inpatients were prescribed antipsychotic medication.•In 2015, 56% patients were prescribed HDAT. This reduced in 2018 to 16%.•This reduction in use of HDAT was almost entirely due to a reduction in the prescription of PRN antipsychotic medication.•In terms of regularly prescribed antipsychotic medication, in both years, the most commonly prescribed drug was flupentixol, with a range of other second generation oral and long acting medications being prescribed, usually at doses within BNF limits.Between the two years, there was a substantial change in the prescribing of PRN antipsychotics. In 2015, 59% individuals were prescribed at least one PRN antipsychotic (27% were prescribed two). In 2018, this reduced to 40% prescribed at least one, and only 2% being prescribed 2 PRN antipsychotics. In both years, oral quetiapine was a common choice (39% patients in 2015 prescribed oral quetiapine, and 34% in 2018). In 2015, 39% patients were prescribed oral or intramuscular aripiprazole, while this reduced to 7% in 2018.ConclusionThe vast majority of psychiatric inpatients were being prescribed antipsychotic medication. Prescription of high dose antipsychotic medication was common in 2015, and this was largely attributable to high levels of prescribing of PRN antipsychotics. Following an educational programme for junior doctors and ward nurses, and the introduction of electronic prescribing, we achieved a significant change in practice, particularly in the prescribing of PRN antipsychotics, which has reduced our patients’ risk of receiving high dose antipsychotic medication.

Download Full-text

Preliminary investigation into the identification and management of catatonia in patients admitted to adult inpatient units

BJPsych Open ◽

10.1192/bjo.2021.881 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S336-S336

Author(s):

Joanna Moore ◽

Amy Kunicki ◽

Georgina Latcham ◽

Eleanor Perkins ◽

Emma Vaccari

Keyword(s):

Neuroleptic Malignant Syndrome ◽

Mental State ◽

Rating Scale ◽

Statistical Significance ◽

Preliminary Investigation ◽

Psychiatric Inpatients ◽

Service Evaluation ◽

Improvement Project ◽

Adult Inpatient ◽

Inpatient Units

AimsThe prevalence of catatonia is considered to be approximately 10% in psychiatric inpatients. Clinical experience suggests a lower documented prevalence. This could cause longer admissions and complications, such as Neuroleptic Malignant Syndrome (NMS). We carried out a service evaluation to investigate the recognition and management of catatonia on inpatient units in Southern Health Foundation Trust (SHFT). We reviewed the local documented prevalence of catatonia, treatment offered and prevalence of complications.MethodWe retrospectively reviewed the electronic records of 95 consecutive admissions to four adult inpatient units in SHFT, starting on 1st August 2020. We reviewed notes for the admission to establish whether catatonia was suspected and identified. We applied the screening questions from the Bush-Francis Catatonia Rating Scale (BFCRS) to the documented mental state examinations (MSE) prior to, and shortly after, admission. We also recorded the prescriptions issued during the first 72 hours of admission, and whether patients developed neuroleptic malignant syndrome (NMS), serotonin syndrome or required admission to a general hospital during admission.ResultCatatonia was documented as a possibility for 2 patients (2.1%). One showed possible posturing and stupor, while there were no documented symptoms for the other. In both cases the possibility was discounted by the clinical team. Twelve patients (12.6%) showed one or more possible or confirmed signs of catatonia. Eleven of these were prescribed regular antipsychotic medication on admission, but only 3 were prescribed regular benzodiazepines. NMS was more likely to be suspected in patients with a BFCRS of 1 or more compared with those with a score of 0, with an odds ratio of 8.1 (95% CI [1.03-64.0], Fisher's exact test = 7.79, p = .076).ConclusionCatatonia is likely under-recognised and under-treated locally among psychiatric inpatients. Although only approaching statistical significance, the higher rate of suspected NMS in patients showing possible catatonia is noteworthy and needs further investigation. Regular benzodiazepines were not frequently prescribed in this group, while antipsychotics, prescribed in all of these patients, can precipitate NMS. Alternatively, this finding could reflect the overlap in clinical presentation between NMS and catatonia. Data collection was limited by the frequent use of “remote clerking”, in the context of the COVID-19 pandemic. Additionally, the quality of mental state examinations was often not sufficient to draw any conclusions on the possible presence or absence of catatonic symptoms. This project has highlighted practice in need of improvement, which will be further prospectively investigated and improved via a Quality Improvement Project.

Download Full-text

A Contextual Analysis to Explore Barriers and Facilitators of Pain Management in Swiss Nursing Homes

Journal of Nursing Scholarship ◽

10.1111/jnu.12508 ◽

2020 ◽

Vol 52 (1) ◽

pp. 14-22

Author(s):

Thekla Brunkert ◽

Michael Simon ◽

Wilhelm Ruppen ◽

Franziska Zúñiga

Keyword(s):

Pain Management ◽

Nursing Homes ◽

Contextual Analysis ◽

Barriers And Facilitators

Download Full-text

The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units

Australasian Psychiatry ◽

10.1177/1039856219859280 ◽

2019 ◽

Vol 27 (5) ◽

pp. 465-468

Author(s):

Conor Daly ◽

Karen Phillips ◽

Richard Kanaan

Keyword(s):

Length Of Stay ◽

Clinical Outcomes ◽

Limited English Proficiency ◽

Service Use ◽

English Proficiency ◽

Psychiatric Inpatient ◽

Psychiatric Units ◽

Adult Inpatient ◽

Interpreter Service ◽

Inpatient Units

Objective: The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay. Methods: Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared. Results: An increased length of stay for those with LEP was not statistically significant ( p=0.155). The LEP group did undergo more consultant reviews ( p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made ( p=0.018). Conclusions: This study provides evidence of significant effects of limited English on both service burden and outcome.

Download Full-text

Increasing Nursesʼ Knowledge and Behavior Changes in Nonpharmacological Pain Management for Children in China

Journal of Nursing Care Quality ◽

10.1097/01.ncq.0000313767.09891.0a ◽

2008 ◽

Vol 23 (2) ◽

pp. 170-176 ◽

Cited By ~ 11

Author(s):

Hong-Gu He ◽

Katri Vehviläinen-Julkunen ◽

Anna-Maija Pietilä ◽

Tarja Pölkki

Keyword(s):

Pain Management ◽

Behavior Changes ◽

Nonpharmacological Pain Management ◽

And Behavior

Download Full-text

Pain Education and Management in the Rehabilitation from Sports Injury

The Sport Psychologist ◽

10.1123/tsp.12.1.68 ◽

1998 ◽

Vol 12 (1) ◽

pp. 68-88 ◽

Cited By ~ 13

Author(s):

Jim Taylor ◽

Shel Taylor

Keyword(s):

Pain Management ◽

Management Strategies ◽

Return To Sport ◽

Sports Injury ◽

Current Status ◽

Pain Education ◽

Rehabilitation Process ◽

Pain Medications ◽

Nonpharmacological Pain Management ◽

Injured Athletes

This article addresses the essential role that pain plays in the rehabilitation of sports injury. It will describe important information and approaches that applied sport psychologists can use to more effectively manage pain in injured athletes. The article includes a brief discussion of the most accepted theories of pain. Types of pain that injured athletes may experience and how they can learn to discriminate between them will be discussed. The article will also consider how pain can be a useful tool as information about injured athletes’ current status in recovery and the need to modify their rehabilitation regimens. The value of measuring pain will be examined with emphasis on determining a simple and easy means of assessing pain. Next, the article will examine why nonpharmacological pain management may be a useful adjunct to pharmacological pain control. Then, a brief description of the most commonly used pain medications and a detailed description of common nonpharmacological pain-management strategies will be furnished. A discussion of how nonpharmacological pain management can be incorporated into the traditional rehabilitation process will be offered. Finally, the article will describe the role that sport psychologists can play in the management of sport injury-related pain. The objective of this article is to provide applied practitioners with the knowledge and tools necessary to assist injured athletes in mitigating the pain they will experience during recovery as a means of facilitating their rehabilitation and return to sport.

Download Full-text

Nurses' perception about the application and purpose of clinical reasoning in the care of hospitalized adults with chronic diseases

Research Society and Development ◽

10.33448/rsd-v9i11.9907 ◽

2020 ◽

Vol 9 (11) ◽

pp. e3769119907

Author(s):

Adrieli dos Santos Quaresma ◽

Daiani Modernel Xavier ◽

Clarice Alves Bonow ◽

Marta Regina Cezar-Vaz

Keyword(s):

Chronic Diseases ◽

Clinical Reasoning ◽

Deductive Reasoning ◽

Care Patient ◽

University Hospital ◽

Patient Comfort ◽

Structured Interviews ◽

Adult Inpatient ◽

Care Practices ◽

Inpatient Units

Objective: to know the perception of nurses about the application and purpose of clinical reasoning in the care of hospitalized adults with chronic diseases. Methodology: exploratory-descriptive study, with a qualitative approach. It was carried out with nurses working in adult inpatient units of a University Hospital in southern Brazil. Data collection took place from july to december 2018, through semi-structured interviews. The data were analyzed using the Thematic Content Analysis. Results: it was found that the nurses' perception of clinical reasoning was applied (in)consciously in care and management activities. Its purpose was self-reported in the qualification of care, patient comfort and prevention of complications. Conclusion: these findings are believed to be guiding instruments for questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application and creativity for nurses' decision-making in care practices for adult hospitalized patients with chronic diseases.

Download Full-text

An analysis of the views of different members of the inpatient team on the role of the physician associate on the general adult psychiatric wards

BJPsych Open ◽

10.1192/bjo.2021.399 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S140-S141

Author(s):

Declan Hyland ◽

Mohammed Uddin

Keyword(s):

Mental Health ◽

Strong Argument ◽

Staff Members ◽

X Band ◽

Negative Comments ◽

Mental Health Settings ◽

Adult Inpatient ◽

Inpatient Units ◽

Assistant Practitioner

AimsPhysician Associates (PAs) are healthcare professionals who have a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.

Download Full-text