scholarly journals Audit of physical health monitoring in a forensic psychiatric community caseload

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S107-S107
Author(s):  
Neeti Sud ◽  
Michael Lacey
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Due Dates ◽  
Mental Health Team ◽  
New Process ◽  
Audit Period ◽  
Forensic Psychiatric ◽  
Temporary Closure ◽  
Acute Trust

AimsAdherence to Cumbria Northumberland Tyne and Wear NHS Foundation (CNTW) Trust physical health monitoring guidelines for a caseload of community forensic psychiatry patients residing at Westbridge supported accommodation was audited to identify areas for improvement in practice. It was also our aim to highlight the delay in obtaining non-urgent investigations due to the need to minimize COVID infection transmission risks.MethodData were collected from mental health and acute trust electronic records (Rio and ICE) of all patients taking antipsychotic medications currently care coordinated by the Westbridge Forensic Community Mental Health Team (FCMHT) between January 2020 and January 2021 (8 patients). Analysis of compliance with standards set by Trust guidelines was made.ResultIn the chosen audit period, compliance with physical health monitoring standards was below target of 100% (80% compliance for bloods, 50% for ECG). Reasons for non-compliance were unexpected restrictions in service availability (e.g. temporary closure of walk-in ECG clinic) and one omission of sending a prolactin levels request.ConclusionThe need for practice adaptation and advance planning by team in anticipation of potential delays was identified. Request for routine bloods and ECGs will now be made two months before the annual due dates to compensate for delays in the new process with plan to continue re-audit yearly.

scholarly journals Physical health monitoring of patients prescribed depot antipsychotic medication in north west Edinburgh community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S336-S337
Author(s):  
Douglas Murdie ◽  
Jakub Wojtowicz ◽  
Alexandra Thompson ◽  
Anne MacLeod ◽  
Adam Mallis ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
North West ◽  
Depot Antipsychotic ◽  
Major Mental Disorder

AimsTo monitor the quality of physical health monitoring of patients prescribed depot antipsychotic medication in the North West Edinburgh Community Mental Health Team (CMHT). We also evaluated the completeness of prescriptions and Mental Health Act (Scotland) (Act) 2003 paperwork where relevant.BackgroundAntipsychotic medications are medicines for treating conditions such as Schizophrenia, but some may be associated with an increased risk of Metabolic Syndrome. Moreover, evidence indicates that patients with major mental disorder have a reduced life expectancy in comparison to those without such diagnoses. These two factors illustrate the importance of the physical health of this patient cohort being monitored on a regular basis. This project will evaluate how a local CMHT is performing, with the possibility of enacting service improvements if required.MethodThe records of the 60 patients prescribed depot antipsychotic medication administered by this CMHT were reviewed. A check-list was created consisting of 14 categories analysing the quality of physical health monitoring, as well as compliance with prescription standards and, where relevant, Mental Health Act (Scotland) (Act) 2003 paperwork. We compared patient records against our checklist for the calendar year of 2019. The Scottish Intercollegiate Guidelines Network (SIGN) 131 (Management of Schizophrenia) section 5.2 was used as the gold standard for physical health monitoring against which the data we collected was compared.ResultWe identified a wide range of flaws with the current system and implementation of monitoring, and difficulty in locating the required information. There was no consistent monitoring of physical observations on electronic record, nor an accepted alternative way in which this was documented. Furthermore, blood tests were not consistently obtained either by the service or GP practices in a reproducible manner. This led to discussions within the CMHT regarding creation of a new pathway for the monitoring of this patient cohort using a Quality Improvement model, with the ultimate goal to establish a regular physical health clinic.ConclusionThere is significant evidence that patients with major mental disorder do not access healthcare as consistently as those without, leading to a disparity in life expectancy. In light of the fact that antipsychotic medications can be associated with Metabolic Syndrome, we have an even greater responsibility to tackle this marked health inequality by appropriately monitoring our patients. This was not done well in this particular CMHT, but this project will lead to improvements in the service and ultimately patient care.

Monitoring the physical health of individuals with serious mental illness

2008 ◽  
Vol 25 (3) ◽  
pp. 108-115
Author(s):  
Majella Cahill ◽  
Anne Jackson
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Health Service ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Monitoring ◽  
Service Providers ◽  
Psychiatric Service ◽  
Service Users ◽  
Effective Models

AbstractDeveloping effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring.

Improving physical health of patients with mental health problems

2011 ◽  
Vol 26 (S2) ◽  
pp. 1234-1234
Author(s):  
F. Cheema ◽  
J. Graham ◽  
D. Moffat ◽  
C. Gordon
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Health Problems ◽  
Community Mental Health Service ◽  
Individual Parameter ◽  
Mental Health Difficulties

It is well recognised that individuals with severe mental health difficulties have increased risks of significant physical health problems and that some of the treatments for mental health problems can cause physical health difficulties as side effects. It is also known that people with mental health difficulties do not present themselves regularly for physical health monitoring as suggested by national and international guidelines. We show how a secondary care community mental health service cooperated with primary care general medical services to increase the take up of physical health monitoring by patients with severe and enduring mental health problems.Staff in the community mental health team which served a rural/small urban population identified patients with severe and enduring mental health difficulties or those patients on medications linked to physical problems and contacted the primary care physicians responsible for the patients’ general care with patient details and encouraged patient attendance for physical health monitoring. Physical monitoring included blood pressure, ECG, glucose, thyroid, lipids, height and weight. Post-intervention attendance figures show an increase of 30% in patients attending physical health reviews compared with pre-intervention figures. The intervention has been now rolled out to a larger catchment area of 25000 persons.[Physical health monitoring by individual parameter]

scholarly journals Antipsychotic monitoring in dementia: quality of completion of antipsychotic monitoring forms in an older adult mental health service

2021 ◽  
pp. 1-7
Author(s):  
Helen Anderson ◽  
Anna Kolliakou ◽  
Daniel Harwood ◽  
Nicola Funnell ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Psychological Symptoms ◽  
Antipsychotic Treatment ◽  
Pharmacological Interventions ◽  
Health Records ◽  
People With Dementia ◽  
Adult Mental Health Service

Aims and method To support safe prescribing of antipsychotics in dementia, antipsychotic monitoring forms were embedded into our electronic health records. We present a review of the data collected on these forms to assess prescribing and identify areas for improvement in our practice and processes. Data were extracted from the structured fields of antipsychotic initiation and review forms completed between 1 January 2018 and 31 January 2020. Results We identified gaps in practice where improvements could be made, mainly with regard to physical health monitoring (and particularly electrocardiograms, performed in only 50% of patients) and the low (less than 50%) recorded use of non-pharmacological interventions for behavioural and psychological symptoms of dementia. In addition, antipsychotic treatment was continued despite lack of benefit in almost 10% of reviews. Clinical implications We advocate for recommendations on physical health monitoring of people with dementia taking antipsychotics to be added to the National Institute for Health and Care Excellence guidance on dementia and the Prescribing Observatory for Mental Health (POMH-UK) national audit.

scholarly journals Mind and body: physical health monitoring in clozapine treatment

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S168-S168
Author(s):  
Moataz Abdelreheem ◽  
Olivia Connell ◽  
Daniel McNally ◽  
Itunuayo Veronica Ayeni ◽  
Clare Smith
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Blood Count ◽  
Full Blood Count ◽  
Clozapine Treatment ◽  
Health Review

AimsTo evaluate physical health monitoring standards in patients on Clozapine in the community.StandardsNICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.BackgroundIn the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.MethodThis audit is a retrospective study of patients known to South Kensington & Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.ResultOf the 48 patients, one was transferred to a different service so was excluded (n = 47 total).All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).ConclusionFollowing review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.

Screening of metabolic side effects of antipsychotics in patients with mental disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 1274-1274 ◽  
Author(s):  
H.T. Reddy ◽  
R. Edwards
Keyword(s):  
Mental Health ◽  
Smoking Cessation ◽  
Side Effects ◽  
Mental Health Services ◽  
Health Services ◽  
Physical Health ◽  
Lipid Profile ◽  
Service Users ◽  
Due Dates ◽  
Metabolic Side Effects

This audit was undertaken to evaluate what screening is undertaken for metabolic side effects of antipsychotic drugs in patients under the care of Ceredigion Community Mental Health.Raise awareness with Local health Board regarding metabolic screening Raise awareness regarding four aspects of metabolic syndrome.Audit tool based on POMH (Prescribing Observatory for Mental Health) Topic 2B Audit Data was collected from medical notes, abstracted and inputted into Microsoft Excel. The sample consisted of 15 service users; 11(73%) male and 4(27%) female.Most individuals where of white British/Irish ethnicity, (14, 93%).Most (14, 93%) patients primary clinical psychiatric diagnosis based on the ICD10 category was F20–F29.Six (40%) individuals in the sample smoked, of which two (33%) were offered help with smoking cessation. There was evidence of diabetes in three case notes. In one (33%) case note it was Mental Health services that uncovered the diabetes. One service users file had evidence of a known diagnosis of Hypertension. This was not discovered by Mental Health services. Three service users had evidence of a disturbed lipid profile. In two (66%) of these notes it was Mental Health services that discovered the disturbed lipid profile.Lifestyle management pack: guidance and resources for staff and service users around diet, exercise, smoking cessation and other health lifestyle issues. Physical health check reminder cards: A patient-held card to record the results of physical health checks and due dates for new appointments.

scholarly journals The contagiousness of memes: containing the spread of COVID-19 conspiracy theories in a forensic psychiatric hospital

2020 ◽  
pp. 1-7
Author(s):  
Reena Panchal ◽  
Alexander Jack
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Physical Health ◽  
Service Provision ◽  
Healthcare Service ◽  
Conspiracy Theory ◽  
Tertiary Level ◽  
Conspiracy Theories ◽  
Forensic Psychiatric ◽  
Health Guidance

Summary COVID-19 has transformed healthcare service provision. In addition to the spread of a virus, there has been an equally concerning emergence and spread of conspiracy theories. Such theories can threaten societal cohesion and adherence to the necessary public health guidance. In a forensic in-patient setting, such difficulties can be amplified. In this paper, we outline the key theory in relation to the development and spread of conspiracy theory memes. We propose primary, secondary and tertiary level responses to tackle the possible generation and spread of harmful conspiracies in the forensic in-patient setting. We consider this to be important, as there is a risk that such beliefs could affect patients’ mental health and, in extremis, undermine physical health efforts to reduce the spread of COVID-19.

Can We Improve Physical Health Monitoring for Patients Taking Antipsychotics on a Mental Health Inpatient Unit?

2018 ◽  
Vol 38 (5) ◽  
pp. 447-453 ◽  
Author(s):  
Elyse Ross ◽  
Rebecca Barnett ◽  
Rebecca Tudhope ◽  
Kamini Vasudev
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Health Monitoring ◽  
Inpatient Unit
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