Metabolic screen and intervene: improving mental health inpatient metabolic monitoring

2020 ◽  
pp. 103985622093614
Author(s):  
Luke Viglione ◽  
Brooke L Short
Keyword(s):  
Mental Health ◽  
Plasma Lipids ◽  
Health Workers ◽  
Low Cost ◽  
Psychiatric Inpatient ◽  
Inpatient Setting ◽  
Inpatient Service ◽  
Metabolic Monitoring ◽  
Before And After ◽  
The Impact

Objective: To assess rates of metabolic monitoring in patients prescribed antipsychotic medications in the psychiatric inpatient setting and the impact education can have regarding monitoring compliance. Method: Two identical audits were undertaken at a NSW mental health inpatient service before and after a campaign designed to educate mental health workers about the importance of metabolic monitoring. Results from both audits were compared for statistically significant improvements in monitoring rates. Results: Rates of monitoring plasma lipids increased from 21.7% to 78.8% ( p < 0.01) and rates for plasma glucose increased from 20.8% to 73.7% ( p < 0.01). There were no statistically significant changes in rates of monitoring body mass index (83.0% and 77.1%, respectively), waist circumference (36.8% and 43.2%, respectively) and blood pressure (99.1% and 100%, respectively). Conclusion: This study has shown that rates of metabolic monitoring in the inpatient setting can be improved with a relatively low-cost education intervention. While absolute rates remain low, outcomes suggest that it may be worthwhile trialling further modes of education and repeating this education in cycles.

scholarly journals Unlocking an acute psychiatric ward: The impact on unauthorised absences, assaults and seclusions

2017 ◽  
Vol 41 (2) ◽  
pp. 92-96 ◽  
Author(s):  
Ben Beaglehole ◽  
John Beveridge ◽  
Warren Campbell-Trotter ◽  
Chris Frampton
Keyword(s):  
Psychiatric Inpatient ◽  
Psychiatric Ward ◽  
Inpatient Service ◽  
Positive Effects ◽  
Adverse Event Data ◽  
Before And After ◽  
Acute Psychiatric Ward ◽  
Restrictive Environment ◽  
Open Wards ◽  
The Impact

Aims and methodThe acute psychiatric inpatient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change.ResultsRates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant.Clinical implicationsAlthough unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.

Evaluation of the EssenCES in a neurodevelopmental inpatient service for adolescents

2017 ◽  
Vol 22 (3) ◽  
pp. 233-245 ◽  
Author(s):  
Ciara Glennon ◽  
Marilyn A Sher
Keyword(s):  
Mental Health ◽  
Learning Disability ◽  
Normative Data ◽  
Psychiatric Inpatient ◽  
The Body ◽  
Inpatient Setting ◽  
Inpatient Service ◽  
Service Users ◽  
Inpatient Settings ◽  
Ward Climate

Ward climate is a key element within psychiatric settings, associated with positive clinical outcomes. The Essen Climate Evaluation Schema (EssenCES) is a ward climate measure, which is validated for use within UK forensic settings. It has been studied within neurodevelopmental psychiatric inpatient settings with mixed findings on its appropriateness, and there is a dearth of EssenCES research which has been conducted within an adolescent psychiatric inpatient setting. The present study piloted the EssenCES within an inpatient psychiatric neurodevelopmental setting for adolescents in the East of England, in order to explore its usefulness within this setting and to provide preliminary normative data for a child and adolescent mental health services inpatient learning disability population. Staff and service users from a locked ward ( N = 28) and low secure ward ( N = 31) participated in the pilot. Results are discussed in relation to the body of the literature on ward climate, including consideration of discrepancies in the results between wards and discrepancies between staff and service.

scholarly journals Lively Social Space, Well-Being Activity, and Urban Design: Findings From a Low-Cost Community-Led Public Space Intervention

2016 ◽  
Vol 49 (6) ◽  
pp. 685-716 ◽  
Author(s):  
Jamie Anderson ◽  
Kai Ruggeri ◽  
Koen Steemers ◽  
Felicia Huppert
Keyword(s):  
Public Space ◽  
Urban Design ◽  
Design Research ◽  
Local Community ◽  
Social Space ◽  
Low Cost ◽  
Well Being ◽  
Observation Data ◽  
Before And After ◽  
The Impact

Empirical urban design research emphasizes the support in vitality of public space use. We examine the extent to which a public space intervention promoted liveliness and three key behaviors that enhance well-being (“connect,” “be active,” and “take notice”). The exploratory study combined directly observed behaviors with self-reported, before and after community-led physical improvements to a public space in central Manchester (the United Kingdom). Observation data ( n = 22,956) and surveys (subsample = 212) were collected over two 3-week periods. The intervention brought significant and substantial increases in liveliness of the space and well-being activities. None of these activities showed increases in a control space during the same periods. The findings demonstrate the feasibility of the research methods, and the impact of improved quality of outdoor neighborhood space on liveliness and well-being activities. The local community also played a key role in conceiving of and delivering an effective and affordable intervention. The findings have implications for researchers, policy makers, and communities alike.

What is the impact of staff wearing uniforms in psychiatric inpatient settings?

2021 ◽  
Author(s):  
Sophie Collingwood ◽  
Laura McKenzie-Smith
Keyword(s):  
Mental Health ◽  
Thematic Analysis ◽  
Negative Impact ◽  
Psychiatric Inpatient ◽  
Ideal Self ◽  
Search Terms ◽  
Mental Health Settings ◽  
Inpatient Settings ◽  
The Impact

Background: Uniform has traditionally been worn in psychiatric inpatient and other mental health settings, but there has been a move to non-uniform in recent years. Some services have made the change back to uniform, raising questionsabout the potential impact on patients and staff.Aim: To review the impact of uniform within a psychiatric inpatient or mental health setting.Method: Databases were searched for articles exploring the impact of uniform use using specified search terms. Articles were assessed for suitability with inclusion and exclusion criteria, critically appraised, then analysed for themes using thematic analysis.Results: 17 papers were included in the review. Thematic analysis identified five main themes and 29 subthemes. Main themes were Attitudes and interactions, A freer environment, Are you both nurses?, The ‘ideal self’ and There are more important things. A critical appraisal of the articles suggested issues with validityand reliability, which are discussed.Discussion: Studies identified that wearing non-uniform facilitated positive changes in both patients and staff. This raises the potential negative impact of uniform on both patients and staff, and the role of power imbalance in these settings is discussed. Further themes around identification of staff out of uniform were considered.Implications for practice: The use of uniform in mental health and psychiatric inpatient settings should be considered carefully, due to the potential negative impact, whilst also recognising the importance of staff identification and supporting professional identity.

scholarly journals The impact of a teacher-based positive education intervention on student wellbeing literacy

2021 ◽  
Vol 2 (1) ◽  
pp. 22-43
Author(s):  
Lea Waters ◽  
Matthew Charles Higgins
Keyword(s):  
Mental Health ◽  
Education Intervention ◽  
Positive Education ◽  
Post Intervention ◽  
Emotional Management ◽  
Strength Based ◽  
Before And After ◽  
Education Interventions ◽  
Written Descriptions ◽  
The Impact

Over the past decade, research has consistently found that positive education interventions have a beneficial effect on mental health outcomes for students, such as improvements in life satisfaction and reduction of anxiety. While it is encouraging to see these changes in student mental health, the research has not yet adequately explored whether positive education interventions change a student’s understanding of wellbeing itself. Wellbeing literacy is a new construct within the field of positive education and is defined as the ability to understand the concept and language of wellbeing. This study examines whether student language and understanding of wellbeing changes following an intervention that trains teachers in the core principles of positive education. Students across grades five, six and seven (ages 11–13; n = 231) from three Australian schools provided brief written descriptions of their understanding of wellbeing before and after their teachers undertook an eight-month positive education intervention. Thematic analysis was used as the methodological tool to analyze student language and understanding of wellbeing. Inferential frequency-based statistical analyses were used to compare the pre-intervention and post-intervention responses. The results revealed that student understanding of wellbeing evolved in four key ways to become more: (1) detailed; (2) strength based; (3) expanded/multidimensional; and (4) relational. Post-intervention understanding of wellbeing was significantly more likely to include aspects of emotional management, strengths, coping, mindfulness and self-kindness. Implications, limitations and future directions are discussed.

scholarly journals Psychiatric admission for homeless people: the impact of a specialist community mental health team

1997 ◽  
Vol 21 (5) ◽  
pp. 260-263 ◽  
Author(s):  
Martin Commander ◽  
Sue Odell ◽  
Sashi Sashidharan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Homeless People ◽  
Discharge Process ◽  
Community Mental Health Team ◽  
Psychiatric Admission ◽  
Mental Health Team ◽  
Health Team ◽  
Before And After ◽  
The Impact

The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

The frequency of references to decision-making capacity in reports to the NSW Mental Health Review Tribunal did not change after legislative reforms that promoted them

2020 ◽  
Vol 28 (2) ◽  
pp. 171-174
Author(s):  
Tim Foley ◽  
Christopher J Ryan
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Education Campaign ◽  
Mental Health Act ◽  
Decision Making Capacity ◽  
Before And After ◽  
Legislative Reforms ◽  
The Impact ◽  
Health Review

Objective: To assess the impact of a 2015 reform to the Mental Health Act 2007 (NSW) ( MHA) that was interpreted as requiring a reference to decision-making capacity (DMC) in reports to the NSW Mental Health Review Tribunal (MHRT). Method: A sample of reports to the MHRT were audited for references to the MHA’s treatment criteria and DMC in periods before and after the reforms, and the frequency of references between the two periods was compared. Results: The frequency of references to DMC did not change significantly after the reforms. (However, references to the ‘least restriction’ criterion increased markedly between the two periods). Conclusion: Despite legislative reforms and a supporting education campaign promoting the importance of consideration of DMC, references to DMC did not increase after the reforms.

scholarly journals What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e016107 ◽  
Author(s):  
Sherifat Oduola ◽  
Til Wykes ◽  
Dan Robotham ◽  
Tom K J Craig
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Intervention Group ◽  
Research Participation ◽  
Clinical Activity ◽  
Clinical Services ◽  
National Health Service Foundation ◽  
Apply Research ◽  
Before And After ◽  
The Impact

ObjectivesKey challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources. We examined the impact of employing dedicated staff to promote research in community mental health clinical settings.DesignQuasiexperiment before and after study.SettingSouth London and Maudsley National Health Service Foundation Trust.Participants4455 patients receiving care from 15 community mental health teams between 1 December 2013 and 31 December 2014.Outcome measuresThe proportion of patients approached for research participation in clinical services where research champions were present (intervention group), and where research champions were not present (comparison group).ResultsPatients in the intervention group were nearly six times more likely to be approached for research participation (Adj. OR=5.98; 95% CI 4.96 to 7.22).ConclusionsInvesting in staff that promote and drive research in clinical services increases opportunities for patients to hear about and engage in clinical research studies. However, investment needs to move beyond employing short-term staff.

Nature-based Group Therapy Reflections: A Grounded Theory Study

2020 ◽  
Vol 42 (12) ◽  
pp. 1129-1136
Author(s):  
Kelly Carlson ◽  
Jeanette Kingsley ◽  
Caroline Strimaitis ◽  
Shira Birnbaum ◽  
Theresa Quinn ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Grounded Theory ◽  
Mental Health Care ◽  
Therapy Group ◽  
Psychiatric Inpatient ◽  
Inpatient Setting ◽  
Grounded Theory Study ◽  
Beneficial Effects ◽  
Patient Responses

Nature-based therapies have a long history in mental health care. Beneficial effects have been documented for nature-based therapies in a variety of other health care settings. The aims of this grounded theory study were to understand the processes of maintaining nature-based therapeutic groups and the value of the activities to patients in a psychiatric inpatient setting. Over a nine-month period, semi-structured surveys of patient responses to nature-based activities were administered to patients in a pilot therapy group assessing the feasibility of a nature-based group program. Findings indicated that the group promoted use of the senses, social interaction, and care of self/others. Perceptions of benefits led to a nuanced understanding of the effects of being in contact with nature. Based on our findings we offer a preliminary theoretical model for patient engagement with nature-based programming in inpatient mental health care.

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