scholarly journals Implementation of treatment escalation plans in an old age psychiatry inpatient hospital

2021 ◽  
Vol 10 (4) ◽  
pp. e001640
Author(s):  
Anne Y T Chua ◽  
Adnaan Ghanchi ◽  
Sangeeta K Makh ◽  
Jessica Grayston ◽  
Stephen J Woolford ◽  
...  
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Tertiary Hospital ◽  
Improvement Project ◽  
Inpatient Hospital ◽  
Psychiatric Setting ◽  
Uptake Length ◽  
Old Age Psychiatry ◽  
Effective Decision Making ◽  
Treatment Escalation

A treatment escalation plan (TEP) enables timely and appropriate decision making in the management of deteriorating patients. The COVID-19 pandemic precipitated the widespread use of TEPs in acute care settings throughout the National Health Service (NHS) to facilitate safe and effective decision making. TEP proformas have not been developed for the inpatient psychiatric setting. This is particularly concerning in old age psychiatry inpatient wards where patients often have multiple compounding comorbidities and complex decisions regarding capacity are often made. Our aim for this quality improvement project was to pilot a novel TEP proforma within a UK old age psychiatry inpatient hospital. We first adapted a TEP proforma used in our partner acute tertiary hospital and implemented it on our old age psychiatry wards. We then further refined the form and gathered data about uptake, length of time to complete a TEP and the ceiling of care documented in the TEP. We also explored staff, patient and family views on the usefulness of TEP proformas using questionaries. TEP decisions were documented in 54% of patient records at baseline. Following revision and implementation of a TEP proforma this increased to 100% on our two wards. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. Feedback from staff showed improvements in understanding about TEP and improved knowledge of where these decisions were documented. We advocate the use of TEP proformas on all old age psychiatry inpatient wards to offer clear guidance to relatives and treating clinicians about the ceilings of care for patients. There are potentially wider benefits to healthcare systems by reducing inappropriate transfers between psychiatry and acute NHS hospitals.

Ethics, capacity, and decision-making in the practice of old age psychiatry: an emerging dialogue

2009 ◽  
Vol 22 (6) ◽  
pp. 519-521 ◽  
Author(s):  
Carmelle Peisah ◽  
Orestes Forlenza ◽  
Edmond Chiu
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Old Age Psychiatry

Oxford Textbook of Old Age Psychiatry

2013 ◽  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Old Age ◽  
Mental Capacity ◽  
Global Approach ◽  
Additional Information ◽  
Memory Clinics ◽  
Old Age Psychiatry ◽  
The Common ◽  
Ethics Of Caring

Taking a global approach by highlighting both the common burdens and the differences in management from country to country, The Oxford Textbook of Old Age Psychiatry, Second Edition includes information on all the latest improvements and changes in the field. New chapters are included to reflect the development of old age care; covering palliative care, the ethics of caring, and living and dying with dementia. Existing chapters have also been revised and updated throughout and additional information is included on brain stimulation therapies, memory clinics and services, and capacity, which now includes all mental capacity and decision making.

The early experience of Old Age Psychiatrists in the application of the Mental Capacity Act 2005: a pilot study

2009 ◽  
Vol 22 (1) ◽  
pp. 147-157 ◽  
Author(s):  
Ajit Shah ◽  
Natalie Banner ◽  
Chris Heginbotham ◽  
Bill Fulford
Keyword(s):  
Decision Making ◽  
Old Age ◽  
Social Care ◽  
Mental Capacity ◽  
Best Interests ◽  
Decision Making Capacity ◽  
Mental Capacity Act 2005 ◽  
Old Age Psychiatry ◽  
Mental Capacity Act

ABSTRACTBackground: The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales.Methods: A pilot questionnaire study examined the experience of consultants in Old Age Psychiatry in the early implementation of the MCA pertaining to local policy and training in the application of the MCA, the assessment of decision-making capacity, the determination of best interests, and the use of the least restrictive option and restraint.Results: Fifty-two (27%) of the 196 consultants in Old Age Psychiatry returned useable questionnaires. Seventy-five percent of them reported that local training on the application of the MCA was available, but less than 50% reported that training was mandatory. The vast majority of assessments of decision-making capacity were conducted by consultants in Old Age Psychiatry. Almost all of them reported using the four-fold specific test of decision-making capacity (DMC) described in the MCA. Restraint was reported to be rarely used.Conclusions: Consultants in Old Age Psychiatry generally reported using the criteria for the assessment of DMC, the determination of best interests and restraint described in the MCA. The findings highlight concern about the workload of clinicians in implementing the MCA and this requires careful monitoring. Consideration should be given to statutory provision of training in the application of the MCA by all healthcare and social care providers for all their healthcare and social care staff.

scholarly journals Using quality improvement to standardise and enhance the use of the national early warning score (NEWS) in an old age psychiatry inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S38-S39
Author(s):  
Fraser MacNicoll ◽  
Mong Sun Tung ◽  
Brion McGowan
Keyword(s):  
Quality Improvement ◽  
Old Age ◽  
Quality Improvement Project ◽  
Assessment Process ◽  
Early Warning Score ◽  
Post Intervention ◽  
Improvement Project ◽  
Physical Deterioration ◽  
Increased Risk ◽  
Old Age Psychiatry

AimsWithin an inpatient old-age psychiatry setting, there is an increased risk of acute physical deterioration secondary to age, comorbidities and reduced physiological reserve. Numerous recent clinical incidents highlighted late recognition of physical deterioration within this population. We assessed the use of the NEWS, a system for scoring physiological measurements, in an old-age psychiatry ward and subsequently attempted to improve performance of obtaining physical health observations in this cohort of patients.MethodRetrospective pre- and post- quality improvement study in a twenty bed Old Age Psychiatry Ward in East Lothian Community Hospital, Haddington, Scotland. Data were collected from 12th October – 16th November, 2020 (pre- period) and from 16th November 2020 to 15th February, 2021 (post- period). The primary process measure was ensuring all patients had at least one full set of physical observations at least once a week, or more frequent as deemed clinically appropriate. Secondary measures included ensuring NEWS scores were accurately calculated and improved documentation. This was tracked using a run chart. Improvement activities focused on increased awareness, effective training, key stakeholder buy-in and reviewing trust policy.ResultThe percentage of NEWS documented for all patients at least once a week improved from a mean of 28.7% (31/108) in the 6 weeks prior to intervention, to a mean of 71.4% (125/175) in the following 13 weeks. The minimum required physical observations required to accurately calculate a NEWS improved from 51.6% (16/31) pre-intervention to 95.2% (119/125) post-intervention and NEWS being calculated correctly increased from 80.6% (25/31) to 96% (120/125). Documentation of a reason why physical observations were not taken increased from 2.5% (2/77) to 62% (31/50) pre- and post- intervention respectively.ConclusionThis quality improvement project highlighted that recording of physical observations and use of NEWS was inadequate in this setting, increasing the risk of a delay in identification of acute physical deterioration and thus increase morbidity and mortality. Introducing simple measures and standardising the NEWS assessment process, along with senior nursing and medical oversight, greatly enhanced acquiring and recording of physical observations and NEWS scores. This quality improvement project has shown that practical solutions and staff education can increase efficacy and are hoping further input can consolidate the gains achieved and lead to continued improvements.

scholarly journals Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S176-S177
Author(s):  
Sarah Brennan ◽  
Rajdeep Routh
Keyword(s):  
Old Age ◽  
Good Practice ◽  
Health Board ◽  
List Type ◽  
Care Planning ◽  
Care Plans ◽  
Information Leaflets ◽  
Medical Emergencies ◽  
Old Age Psychiatry ◽  
Treatment Escalation

AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.

Old age psychiatry home treatment team--preliminary audit of a service improvement project

2009 ◽  
Vol 24 (6) ◽  
pp. 648-649 ◽  
Author(s):  
Kathryn Fraser ◽  
Michael Clark ◽  
Susan M. Benbow ◽  
Gloria Williams ◽  
Ivan Burchess
Keyword(s):  
Old Age ◽  
Home Treatment ◽  
Service Improvement ◽  
Treatment Team ◽  
Improvement Project ◽  
Old Age Psychiatry

scholarly journals Improving physical health assessment of old age inpatients on the Oaks Acute Admission Ward

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S200-S200
Author(s):  
Dr Karen Aus ◽  
Marilia Gougoulaki ◽  
Maja Elia ◽  
Emily Wall
Keyword(s):  
Vitamin D ◽  
Physical Health ◽  
Old Age ◽  
Thyroid Function ◽  
Health Assessment ◽  
Glycated Haemoglobin ◽  
Cognitive Testing ◽  
Full Blood Count ◽  
Improvement Project ◽  
Old Age Psychiatry

AimsOld age psychiatry patients are subject to increased frailty, comorbid load and medication adverse events than equivalent older age populations without psychiatric illness. Timely physical health assessment and monitoring is therefore an essential part of treatment provision. The Oaks is a 20-bed old age acute admissions ward in Barnet, Enfield and Haringey Mental Health Trust. With this quality improvement project, we aimed to deliver high-quality assessment and treatment of physical health for our patients.MethodUsing NICE guidelines as a blueprint, we devised a list of parameters essential to the management of old age inpatients. This included blood tests (full blood count, urea and electrolytes, liver function, thyroid function, cholesterol, lipids, iron studies, vitamin D, glycated haemoglobin, prolactin), investigations (imaging, ECG, physical examination, cognitive testing) and assessments (body mass index [BMI], functional review, mobility, Rockwood Frailty Score). The implementation goal was to ensure all parameters were acted on within 24 hours of admission (or 48 hours for patients admitted on weekends).We initially audited these parameters in patients admitted to the Oaks in October and November 2020 (n = 24). We subsequently collated all parameters into an online spreadsheet, which was distributed to ward medical staff. For each new admission, parameters could be marked as pending or complete. The spreadsheet was reviewed in daily ward handover. Following implementation, we collected data on the parameters for patients admitted in December 2020 and January 2021 (n = 16).ResultPrior to implementation of the spreadsheet, 42.0% of all parameters had been actioned within 24 hours of admission. Following the implementation of the spreadsheet, 86.2% of parameters had been actioned within 24 hours (mean difference 44.2%, 95% CI 13.5% to 64%, p = 0.006).In detail, there were significant increases in timely actioning of magnesium (increased by 61.7%, p < 0.001), cholesterol (61.7%, p < 0.001), glycated haemoglobin (65.8%, p < 0.001), vitamin D (65.8%. p < 0.001), prolactin (61.7% p < 0.001), lipids (61.7%, p < 0.001), thyroid function (51.7%, p < 0.01), iron studies (80.9%, p < 0.001), imaging (42.5%, p = 0.01), frailty scores (60.0%, p < 0.01), BMI measurement (55.9%, p < 0.001), and functional review (42.5%, p = 0.01).ConclusionImplementation of a monitoring spreadsheet with relevant parameters linked to daily ward handover resulted in widespread and significant improvement in the assessment of physical health among old age psychiatry inpatients.

Developing simulated training in old age psychiatry to recognise and assess medical problems in a psychiatric setting (RAMPPS)

2016 ◽  
Vol 33 (S1) ◽  
pp. S168-S169
Author(s):  
U. Narayana ◽  
O.J. Corrado ◽  
P. Rowlands ◽  
S. Kaur
Keyword(s):  
Old Age ◽  
Simulation Training ◽  
The Elderly ◽  
Biliary Cirrhosis ◽  
Physical And Mental Health ◽  
Medical Problems ◽  
Psychiatric Setting ◽  
Old Age Psychiatry ◽  
Competing Interest

IntroductionOlder people with mental ill health are more likely to receive lower quality of health care, inappropriate prescriptions and reduced access to services, leading to increased rates of mortality [1–3]. There is increase focus on supporting people with multiple long-term physical and mental health conditions, particularly by embracing opportunities created by technology [4] (references are not available for this abstract).ObjectivesTo identify the common medical comorbidities on the Old Age Psychiatry Wards.AimsTo develop simulation training from the medical scenarios.MethodWe audited all patients referred to the Liaison Geriatrician from 2008 to October 2015 from the Mount Hospital Leeds, which consists of 4 Old Age Psychiatry wards. Data was collected in October 2015 and included referral date, patients’ age and sex, number of referrals, reason for referral and the outcome.ResultsWe assessed 339 (142 F, 197 M) patients with a mean age of 77 (range: 56-94). The cardiovascular problems constituted the majority (34%) of the referrals, central nervous system (11%), respiratory (8%), gastrointestinal (8%), infection (8%), musculoskeletal (7%), renal (3%), others (19%) and the reasons were unknown in (2%) of the 440 referrals. Some unusual problems were diagnosed including a spontaneous pneumothorax, primary biliary cirrhosis.ConclusionThe audit highlights the essence for more training in recognising and assessing medical problems in psychiatric settings - the simulation programme (RAMPPS) in Old Age Psychiatry. As a result of the service model, we are developing a simulation-training course tailored to the mental and physical health needs of the elderly.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Old age psychiatry in Ireland: The way forward

1996 ◽  
Author(s):  
Colm Cooney ◽  
Margaret Kelleher
Keyword(s):  
Old Age ◽  
Old Age Psychiatry ◽  
The Way
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