scholarly journals Implementation of physical examination pro forma – a complete audit cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S104-S104
Author(s):  
Deshwinder Singh Sidhu ◽  
Guy Molyneux
Keyword(s):  
Mental Health ◽  
Physical Examination ◽  
Physical Health ◽  
Medical Records ◽  
Psychiatric Ward ◽  
City Hospital ◽  
National Guidelines ◽  
Mandatory Requirement ◽  
Audit Cycle ◽  
Pro Forma

AimsAim of this audit is to achieve and maintain 100% compliance in physical examination on admission.BackgroundConducting physical examination on admission is a mandatory requirement and is monitored by the Mental Health Commission during yearly inspections. A report published by Inspectorate of the Mental Health Commission recently in 2019 identifies a gap in physical health monitoring. We conducted a complete audit cycle in an inner city hospital psychiatric ward to monitor compliance with physical examination on admission.MethodWe based the audit on Judgment Support Framework (JSF) version 5 standards. A retrospective review of all of the patient's medical records was carried out. 13 medical records were reviewed in the first cycle. The results of the first cycle were presented to the Multi Disciplinary Team (MDT) members, including the Non-Consultant Hospital Doctors (NCHD). Physical health policy was reviewed, in consultation with the committee and Clinical Director, a Physical Examination pro-forma (colour coded) was developed and implemented. It was based on the National Guidelines and the JSF ver.5. All members of the MDT and NCHDs were briefed on the pro forma introduced. A repeat audit cycle was conducted of all patients admitted after first audit cycle. Data were collected using a simple audit tool indicating if physical examination was conducted or refused.ResultA total of 22 medical records were audited. 13 medical records in the first cycle indicted only 3 patients had physical examination on admission. However, prior to admission a total of six patients had physical exam in the Emergency Department (ED). Upon implementation of the pro forma, 9 medical records of all patients admitted post-first cycle were audited. A total of 7 patients had physical examination on admission to the ward. Two patients refused physical examination and this was clearly documented. One patient had physical examination completed in ED. All newly admitted patients had physical examination completed or the reason why it wasn't completed documented clearly.ConclusionPhysical examination pro forma was successfully implemented, raising current compliance to a 100%, with a significant improvement from 23% compliance in the first cycle. Existing pro forma is helpful as a reminder to NCHDs. Colour coding of pro forma improves accessibility and distinguishability during the process of admission and auditing. Physical examination pro forma will be audited every 6 monthly.

scholarly journals Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S352-S352
Author(s):  
Andreea Steiu ◽  
Emma Diggins ◽  
Nagulan Thevarajan
Keyword(s):  
Mental Health ◽  
Young People ◽  
Physical Examination ◽  
Physical Health ◽  
Health Assessment ◽  
Health Problems ◽  
Inpatient Unit ◽  
Junior Doctors ◽  
Blood Tests ◽  
Service Specification

AimsThis audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.BackgroundMental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.MethodElectronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.Simple statistical analysis was carried out using excel.ResultOver 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.ConclusionTaken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.

The physical health of residents of long-stay wards in Carlow/Kilkenny

2011 ◽  
Vol 28 (4) ◽  
pp. 209-212
Author(s):  
Itoro Udo ◽  
Mary Mooney
Keyword(s):  
Mental Health ◽  
Physical Examination ◽  
Physical Health ◽  
Specific Antigen ◽  
Standards Of Care ◽  
Policy Document ◽  
Standard Of Practice ◽  
Quality Framework ◽  
High Standards

AbstractObjectives: This audit is supported by regulations within the Mental Health Act 2001. It is in response to the Mental Health Commission Strategic Priority Number One, Quality Framework, 2002-2008 which aims to promote high standards of physical examination in the care of long-stay residents of psychiatric facilities. It is based on improved awareness of adverse effects of mental illness or its treatment on physical health. This awareness informs better practice.Method: Physical examination proforma and case notes of all long-stay residents in wards in Carlow and Kilkenny were assessed over a six month period to examine the quality of physical examination. Following departmental meetings and literature review, standards of care as recommended by the Royal College of Psychiatrists in Occasional Paper 67 and Irish statutory documents were agreed to be the appropriate benchmark.Results: Areas of strength were the examination of ‘routine’ systems (> 92%), ie. cardiovascular, respiratory, alimentary, central nervous, genitourinary and the frequency of clinical review by treating psychiatric team. Areas needing improvement were eye (8%) and ear (3%) examinations, measurements of weight (58%), height (1.6%), body mass index (1.6%), waist circumference (0%), investigating for prostatic specific antigen (50%), discussion of results of physical examination and investigations with the residents (both 0%) and referral to BreastCheck (36%).Conclusion: A new physical examination form has been created for long-stay residents to correct these deficiencies and a new departmental policy document setting out a standard of practice consistent with recommended practice and general statutory requirements has been put into place.

scholarly journals Improving physical health form completion on a general inpatient adult ward

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S227-S228
Author(s):  
Brandon Wong ◽  
Anjna Vekaria
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Mental Health Problems ◽  
Electronic Record ◽  
Psychiatric Ward ◽  
Excel Spreadsheet ◽  
Record Keeping ◽  
Blood Tests ◽  
Cholesterol Levels ◽  
Adult Psychiatry

AimsThe government's Five Year Forward View Plan for Mental Health has set a target for 280,000 people with severe mental health problems to be offered screening and appropriate intervention based on physical health risk stratification, including obesity, diabetes and heart disease. As such, physical health review for patients on a general inpatient adult psychiatry ward includes routine blood tests for cholesterol levels and HbA1c. They are recorded together in a Physical Health (PH) Form in the patient's electronic record and used to stratify cardiovascular risk factors and risk of diabetes. If a patient declines these blood tests it should be recorded on the PH form.This study aims to improve the completion of Physical Health forms to ≥95% by within a 4-month period on a general adult inpatient psychiatric ward.MethodPH form completion was measured using Tableau Software for a 4-week period as a baseline then fortnightly during the study. PH form completion required HbA1c and cholesterol levels to be inputted, or to be marked as declined where the patient had declined these tests. Potential interventions were discussed by clinicians and implemented using PDSA cycles with iterative changes tested and analysed. PH form completion was re-audited monthly for a 6-month period.ResultBaseline data showed 61.54% of patients had physical health forms completed (n = 26; 61.54% with HbA1c, 76.92% with cholesterol completed). Iterative changes and improvements included; (i) paper list to track PH form completion, (ii) table on Microsoft Word, (iii) Excel spreadsheet, and (iv) a conditionally formatted Excel spreadsheet. The conditionally formatted Excel spreadsheet was colour-coded to show completed elements as green and incomplete elements as red.Paper lists increased PH completion to 84.85% (n = 33). Word table increased PH completion to 96.43% (n = 28). Excel spreadsheet had PH completion of 96.67% (n = 30). Colour coded excel spreadsheet increased PH completion to 100% (n = 28). This was used as standard practice with sustained 100% completion in November (n = 34) and December (n = 39). The improvement was sustained to January 2021, although there was a decrease to 97.7% (n = 30).ConclusionIt was hypothesised an intervention to track completion of PH forms would improve completion rate. The use of a colour-coded conditionally formatted Excel spreadsheet improved PH form completion to 100% within an 8-week period and a sustained increase of >95% 6 months after the study began. This study recommends the use of such an electronic record keeping system to assist with PH form completion.

scholarly journals Sammenhengen mellom depresjon, mental helse og fysisk funksjon i en alderspsykiatrisk avdeling, en pilotstudie

2015 ◽  
Vol 10 (2) ◽  
pp. 33
Author(s):  
Elfrid Margrete Aarseth ◽  
Maria Stylianou Korsnes ◽  
Ingun Dina Ulstein ◽  
Inger-Marie Tjernæs ◽  
Bodil A. Mcpherson
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Physical Health ◽  
Severe Depression ◽  
Good Effect ◽  
Psychiatric Ward ◽  
Physical Strength ◽  
General Mental Health ◽  
The Difference ◽  
Mental And Physical Health

<p>Patients with mental disorders are often less active than the general population and inactivity over time reduces mental and physical health. We know from previous studies that physical activity contributes to improved mental and physical health, but it is not clear whether any type of physical activity will give the same effect. The objective of this pilot study was to investigate whether the nature of the physical activity the patients participated in during their stay in a psychiatric ward would make a difference in outcome related to improved mental and physical health. Fifty patients (39 women) participated, mean age 80 years (SD 6.0), length of stat from 3 to 28 weeks (mean 8.8, SD 4.4). Patients were offered different types of physical activity and physical therapy in addition to cognitive psychotherapy and supporting conversations. They were subsequently divided into three groups (self-training, joint exercise, regular walking). We examined the difference in treatment effect with regard to general mental health, depression, balance, physical strength and walking skills. Average values showed significant improvements on all tests except for the timed walking tests. Depression scores according to the MADRS was at least one category lower on discharge than on arrival for 31 of the 36 participants. We find that older patients with moderate to severe depression benefit greatly from the treatment they receive during their stay at the age psychiatric ward. The improvements are significant both for mental and physical health. Furthermore, the findings indicate that walking appears to be a type of activity that has especially good effect on mental health.</p>

scholarly journals An audit cycle of physical health monitoring and record keeping of long term in-patients at male and female psychiatric rehabilitation wards using QI approach

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S107-S108
Author(s):  
Hina Tahseen ◽  
Peter Bramall
Keyword(s):  
Mental Health ◽  
Health Policy ◽  
Physical Health ◽  
Health Monitoring ◽  
Health Improvement ◽  
High Dose ◽  
Health Examination ◽  
Health Clinics ◽  
Audit Cycle ◽  
Rehabilitation Ward

AimsTo complete an audit cycle to evaluate and improve physical health monitoring practice for in-patients by incorporating small QI based projects between baseline audit and re-audit.BackgroundPeople with mental health illness are at increased risk of physical illness, morbidity and mortality compared with general population, mainly due to adverse effects of psychotropic medications, polypharmacy, poor lifestyle choices and socio-economic difficulties. It is important to recognise the need for active health promotion, including formal health checks for psychiatric in-patients.MethodStandards were obtained from NICE Guidelines, RCPsych Report on Physical Health in Mental Health and Cygnet Health Care's Physical health policy.An Audit tool with simple checklist was generated from key areas of Cygnet's physical health policy. Physical Health Files of 24 patients from Female Rehabilitation Ward and 28 patients from Male Rehabilitation Ward were audited in the initial audit cycle.Checklist included physical health examination within 24 hours of admission, Annual Health Improvement Profile (HIP), Monthly physical health reviews (including observations and weights), High Dose Antipsychotics Monitoring, Bloods and ECG records. After the initial baseline audit in Apr., 2019, some of the Quality Improvement (QI) approaches (4 PDSA cycles, driver diagrams, model for improvement) were used before conducting the re-audit in Oct., 2019.ResultThe baseline audit in Apr., 2019 showed 98% compliance with physical assessment within 24 hours of admission, however, there was a significant gap in the monthly physical health reviews (62%), Annual HIP (30%), High-dose antipsychotic monitoring (10%) and ECG/Bloods for antipsychotic monitoring (64%) as per guidelines. 10 Female and 12 male patients had regularly refused obs, weight checks and physical health monitoring.The re-audit showed an overall improvement of 92% in compliance, with increased High-dose antipsychotic monitoring (100%), Monthly physical health clinics (88%), Annual HIP (75%), Annual antipsychotic monitoring/bloods/ECG(95%).ConclusionInterventions, using QI approaches, between baseline and re-audit, included MDT discussion around strategies to improve patients’ engagement with monthly physical health clinics with Specialty doctor, adding to care plan points, timescales and reminders in doctors’ diaries for next bloods and ECGs due, MDT and patients’ health education and a designated support staff for physical obs and maintaining physical health files. This helped in providing a framework to test recommended changes and evolve design based on repeated date collection between cycles.The QI Interventions helped in implementation of a more holistic approach towards assessments due to which, the re-audit demonstrated a sustained improvement in compliance with all aspects of physical health monitoring.

scholarly journals Audit of the use of the physical health improvement (PHIT) to document physical health examination on an electronic health record at a mental health trust in Manchester

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S6-S7
Author(s):  
Anthony Baynham
Keyword(s):  
Mental Health ◽  
Physical Examination ◽  
Physical Health ◽  
Health Problems ◽  
Inpatient Unit ◽  
Health Improvement ◽  
Health Examination ◽  
Practical Consideration ◽  
Exclusion Criteria ◽  
Health Trust

AimsThe audit aimed to identify: The percentage of patients with Initial Physical Examination (IPE), ECG and bloods on admission being completed; If IPE, bloods and ECG result are documented on PHIT; To identify reasons for these interventions not being completed and review if refusal is being appropriately documented.Background“The Five Year Forward View for Mental Health NHS” report highlighted the poor physical health of those with mental health problems when compared to those without. In order to improve the identification and treatment of physical health problems within mental health inpatients, blood test results, physical examination and ECG results should be recorded and reviewed regularly. Within Greater Manchester Mental Health trust, the electronic records system PARIS contains a specific care document to record physical health interventions, known as the PHIT tool. The inpatient unit Park House, had recently changed to the PARIS system prior to this audit and the use of PHIT tool to monitor physical health parameters was considered a priority by the management team.MethodAll admissions to Park House inpatient unit, Manchester in April 2019 were audited. Patients were identified using a report prepared by Business Intelligence. Electronic notes were reviewed for evidence of physical interventions on admission and input of these data to the PHIT tool. Using a retrospective review of electronic notes, relevant information was anonymised and collected to a spreadsheet for further analysis. Inclusion/exclusion criteria was based on local conditions and practical consideration.ResultAn initial sample of 140 was reduced to 89 patients following application of inclusion/exclusion criteria. Of the 89 patients included, 73% had an IPE, 84% of patients had admission blood tests and 74% had an admission ECG. Recording of parameters on the PHIT tool was lower than expected with information recorded in 33–42% of patients. Where patients had refused IPE, ECG or bloods, a valid reason for refusal was documented between 63–91% of patients.ConclusionThe initial audit identified that most patients had IPE, ECG and bloods but this was documented appropriately in less than 42% had this appropriately documented.Interventions to improve this rate were developed, focussing on increasing completion of IPE, ECG and bloods as well as improving documentation. The completion of PHIT document is now monitored regularly. The re-audit to identify the magnitude of improvements from these interventions is currently underway.

The impact of economic crisis on mental and physical health in Italy

2017 ◽  
Vol 14 (02) ◽  
pp. 103-110
Author(s):  
S. Tomassi ◽  
M. Ruggeri
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Economic Crisis ◽  
Social Determinants ◽  
Great Recession ◽  
Economic Recession ◽  
Behavioural Disorders ◽  
Economic Activities ◽  
The Impact ◽  
Mental And Physical Health

Summary Background: The global crisis that began in 2007 has been the most prolonged economic recession since 1929. It has caused worldwide tangible costs in terms of cuts in employment and income, which have been widely recognised also as major social determinants of mental health (1, 2). The so-called “Great Recession” has disproportionately affected the most vulnerable part of society of the whole Eurozone (3). Across Europe, an increase in suicides and deaths rates due to mental and behavioural disorders was reported among those who lost their jobs, houses and economic activities as a consequence of the crisis.

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