Wellbeing support for foundation doctors during COVID-19 in GHNHSFT

AimsThe COVID-19 pandemic highlighted the importance of wellbeing amongst healthcare professionals. Medical professionals, notably junior doctors, are at increased risk of developing poor mental health and burnout. The GMC Barometer Study in 2020 showed that 32% of doctors found the first wave of the COVID-19 pandemic detrimental to their wellbeing and mental health.The aim of this quality improvement project was to assess and improve hospital wellbeing support available to foundation doctors within Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) by learning and reflecting on the impact of COVID-19.MethodAfter identifying a lack of resources within GHNHSFT, wellbeing information boards were displayed in communal areas and distributed by email. These encompassed trust wide support, practical information including childcare and relaxation resources concentrating on mindfulness, exercise and culture. A survey of foundation doctors was completed to assess doctors’ focus and approach to wellbeing. Questions assessed influential factors in maintaining wellbeing, access to current hospital resources and future interventions.Result94% of respondents recognised that their focus on wellbeing increased during COVID-19. One third of foundation doctors found it challenging to maintain their wellbeing, with 40% reporting difficulty accessing hospital support and advice. The most important factors foundation doctors identified in maintaining wellbeing were exercise, cooking and baking, and social networks. Colleagues were a significant source of wellbeing support, followed by notice boards, email resources and social media.ConclusionCOVID-19 highlighted the importance and burden on wellbeing of foundation doctors, with a significant number struggling to access support. Future recommendations include the use of a ‘buddy system’, regular and accessible exercise classes and improved communication of wellbeing support and resources to staff members.Buddy systems have already shown success amongst teams however it is important these are accessible to all foundation doctors and universally offered within the trust. A weekly yoga class is being reintroduced to be available to all doctors.A particular focus has been the development of a health and wellbeing section to feature in the trusts weekly communications, with the aim to regularly signpost staff to ongoing wellbeing resources and support.Social networking and media were highlighted as important in both maintaining wellbeing and accessing resources. A future goal is to develop an official GHNHSFT Instagram or Twitter account focused on wellbeing. We hope to continue to learn from the impact of COVID-19, improving the availability of wellbeing support at GHNHSFT that will continue into the future.

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The Introduction of An Intravenous Fluid Bundle to Improve the Prescribing of Intravenous Fluids Within a District General Hospital (Preprint)

10.2196/preprints.36304 ◽

2022 ◽

Author(s):

Abdul-Rahman Gomaa ◽

Sharan Sambhwani ◽

Jonathan Wilkinson

Keyword(s):

Point Of Care ◽

Kidney Injury ◽

District General Hospital ◽

Good Clinical Practice ◽

Point Prevalence ◽

Grand Round ◽

Junior Doctors ◽

Improvement Project ◽

Increased Risk ◽

The Impact

BACKGROUND Intravenous (IV) fluids are some of the most commonly prescribed day-to-day drugs. Evidence suggests that such prescriptions are rarely ever done correctly despite the presence of clear guidelines (NICE CG174). This is believed to be due to lack of knowledge and experience, which often breeds confusion and places patients at increased risk of harm. It also incurs avoidable costs to hospitals. OBJECTIVE This quality improvement project (QIP) aims to ensure that IV fluid prescriptions are: safe, appropriate and adhere to evidence-based NICE guidance. The project’s aims will be achieved through implementing multiple interventions that are categorised under: educational, changing prescribing habits and raising awareness. METHODS Review and improve the prescribing process of “IV fluid prescribing” via three simultaneous approaches. Teaching sessions were delivered to all junior doctors in order to improve knowledge and awareness of appropriate IV fluid prescribing and promote familiarity with the current NICE IV fluid guidelines. This included a ‘feature session’ at our local hospital Grand Round. A point-of-care aide-memoire containing a summary of the information needed for correct prescription was designed and printed. This complimented the teaching sessions and supported good clinical practice. Using serial Plan-Do-Study-Act (PDSA) cycles, a novel “IV fluid bundle” was developed, fine-tuned and trialled on five wards, (three surgical, two medical). The aim of the bundle was to ensure that patients were clinically reviewed in order to assess their volaemic status in order that appropriate IV fluids could then be selected and prescribed safely. The impact of these interventions was assessed on the trial wards via a weekly point prevalence audit of the IV fluid bundles for the duration of the trial. Parameters looked at were: incidence of deranged U&E’s, incidence of AKI and the number of days between the latest U&E’s and the patient’s IV fluid prescription. RESULTS These interventions were assessed on trial wards via a weekly point prevalence audit of the new IV fluid prescription chart (bundle; IFB) for the duration of the trial. Parameters monitored were: incidence of deranged U&E’s, incidence of acute kidney injury (AKI) and the number of days between the latest U&E’s and the patient’s IV fluid prescription. Of all of the patients on the IV fluid bundle, 100% had a documented weight, review of both fluid status and balance. The incidence of deranged U&E’s decreased from 48% to 35%. Incidence of AKI decreased from 24% to 10%. The average number of days between the latest U&E’s and a fluid prescription decreased from 2.2 days to 0.6 day. CONCLUSIONS Prescribing IV fluids is a complex task that requires significant improvement both locally and nationally. With 85% uptake of the IFB, we were able to significantly improve all measured outcomes. Through carefully structured interventions geared towards tackling the confounding issues identified from previous audits and process mapping we have shown that prescribing IV fluids can be made safer.

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Exploring the impact of COVID-19 and restrictions to daily living as a result of social distancing within veterans with pre-existing mental health difficulties

BMJ Military Health ◽

10.1136/bmjmilitary-2020-001622 ◽

2020 ◽

pp. bmjmilitary-2020-001622 ◽

Cited By ~ 1

Author(s):

Dominic Murphy ◽

C Williamson ◽

J Baumann ◽

W Busuttil ◽

N T Fear

Keyword(s):

Mental Health ◽

Social Support ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Post Traumatic Stress ◽

Increased Risk ◽

Mental Health Difficulties ◽

Post Traumatic ◽

The Impact

IntroductionData are emerging showing the adverse consequences on mental health of the general public due to the COVID-19 pandemic. Little is known about the needs of veterans with pre-existing mental health difficulties during the COVID-19 pandemic.MethodsData were collected through a cross-sectional online survey from a randomly selected sample (n=1092) of military veterans who have sought help for mental health difficulties from a veteran-specific UK-based charity. The response rate was 25.2% (n=275). Participants were asked to complete a range of standardised mental health outcomes (post-traumatic stress disorder (PTSD): Post-traumatic Stress Disorder Checklist, common mental health difficulties (CMDs): 12-Item General Health Questionnaire, difficulties with anger: 5-Item Dimensions of Anger Reactions—Revised and alcohol misuse: Alcohol Use Disorders Identification Test) and endorse a list of potential stressors related to changes to daily life resulting from COVID-19. Regression analyses were fitted to explore predictors of mental health severity.ResultsIt was observed that symptoms of common mental disorder and PTSD (69.3% and 65.0%, respectively) were the most commonly reported to have been exacerbated by the pandemic. Lack of social support and reporting increasing numbers of stressors related to COVID-19 were consistently associated with increasing severity of a range of mental health difficulties.ConclusionsOur findings suggest veterans who had pre-existing mental health difficulties prior to the outbreak of COVID-19 may be at increased risk of experiencing CMDs as a result of the pandemic. Intervening to improve levels of social support and offering practical guidance to better manage any additional stressors relating to the pandemic may provide strategies to help reduce the burden of mental health symptoms.

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Medical Studies during the COVID-19 Pandemic: The Impact of Digital Learning on Medical Students’ Burnout and Mental Health

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010349 ◽

2021 ◽

Vol 18 (1) ◽

pp. 349

Author(s):

Panagiotis Zis ◽

Artemios Artemiadis ◽

Panagiotis Bargiotas ◽

Antonios Nteveros ◽

Georgios M. Hadjigeorgiou

Keyword(s):

Mental Health ◽

Medical Students ◽

Emotional Exhaustion ◽

Short Form ◽

Maslach Burnout Inventory ◽

Junior Doctors ◽

Digital Learning ◽

Student Survey ◽

Medical Studies ◽

The Impact

Objectives: The aim of this ecological study was to investigate what the impact of digital learning due to the COVID-19 pandemic was on the burnout and overall mental health (MH) of medical students. Background: During the unprecedented era of the COVID-19 pandemic, the majority of countries worldwide adopted very strong measures. Universities closed their doors, and education continued through digital learning lectures. Methods: An anonymous questionnaire was administered to all 189 eligible candidates before and during the COVID-19 pandemic. Mental health was assessed via the MH domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory—Student Survey (MBI-SS). Results: The overall response rate was 81.5%. The overall burnout prevalence did not differ significantly between the two periods (pre-COVID-19 18.1% vs. COVID-19 18.2%). However, the burnout prevalence dropped significantly in year 4 (pre-COVID-19 40.7% vs. COVID-19 16.7%, p = 0.011), whereas it increased significantly in year 6 (pre-COVID-19 27.6% vs. COVID-19 50%, p = 0.01). When looking at each MBI-SS dimension separately, we found that emotional exhaustion decreased significantly in year 4 but increased in year 6, and cynicism increased in all years. The overall MH deteriorated significantly between the two periods (pre-COVID-19 58.8 ± 21.6 vs. COVID-19 48.3 ± 23, p < 0.001). Conclusions: Digital learning in medical studies carries significant risks. Not only does the MH deteriorate, but cynicism levels also increase. Emotional exhaustion was found to increase particularly in final year students, who struggle with the lack of clinical experience just before they start working as qualified junior doctors.

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Association of source country gender inequality with experiencing assault and poor mental health among young female immigrants to Ontario, Canada

BMC Public Health ◽

10.1186/s12889-021-10720-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Michael Lebenbaum ◽

Therese A. Stukel ◽

Natasha Ruth Saunders ◽

Hong Lu ◽

Marcelo Urquia ◽

...

Keyword(s):

Mental Health ◽

Violence Against Women ◽

Gender Inequality ◽

Poor Mental Health ◽

Sub Saharan Africa ◽

Source Country ◽

Community Based Research ◽

Increased Risk ◽

Female Immigrants ◽

Self Harm

Abstract Background Gender inequality varies across countries and is associated with poor outcomes including violence against women and depression. Little is known about the relationship of source county gender inequality and poor health outcomes in female immigrants. Methods We used administrative databases to conduct a cohort study of 299,228 female immigrants ages 6–29 years becoming permanent residence in Ontario, Canada between 2003 and 2017 and followed up to March 31, 2020 for severe presentations of suffering assault, and selected mental health disorders (mood or anxiety, self-harm) as measured by hospital visits or death. Poisson regression examined the influence of source-country Gender Inequality Index (GII) quartile (Q) accounting for individual and country level characteristics. Results Immigrants from countries with the highest gender inequality (GII Q4) accounted for 40% of the sample, of whom 83% were from South Asia (SA) or Sub-Saharan Africa (SSA). The overall rate of assault was 10.9/10,000 person years (PY) while the rate of the poor mental health outcome was 77.5/10,000 PY. Both GII Q2 (Incident Rate Ratio (IRR): 1.48, 95% Confidence Interval (CI): 1.08, 2.01) and GII Q4 (IRR: 1.58, 95%CI: 1.08, 2.31) were significantly associated with experiencing assault but not with poor mental health. For females from countries with the highest gender inequality, there were significant regional differences in rates of assault, with SSA migrants experiencing high rates compared with those from SA. Relative to economic immigrants, refugees were at increased risk of sustaining assaults (IRR: 2.96, 95%CI: 2.32, 3.76) and poor mental health (IRR: 1.73, 95%CI: 1.50, 2.01). Higher educational attainment (bachelor’s degree or higher) at immigration was protective (assaults IRR: 0.64, 95%CI: 0.51, 0.80; poor mental health IRR: 0.69, 95% CI: 0.60, 0.80). Conclusion Source country gender inequality is not consistently associated with post-migration violence against women or severe depression, anxiety and self-harm in Ontario, Canada. Community-based research and intervention to address the documented socio-demographic disparities in outcomes of female immigrants is needed.

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Joint assessment out of hours: assessing the benefits for patients and junior doctors

The Psychiatrist ◽

10.1192/pb.bp.112.041210 ◽

2013 ◽

Vol 37 (8) ◽

pp. 272-275

Author(s):

Laura Boyd ◽

Colin Crawford ◽

Eugene Wong

Keyword(s):

Mental Health ◽

Clinical Implications ◽

Junior Doctors ◽

Out Of Hours ◽

Assessment Protocol ◽

Admission Rates ◽

Mental Health Nurse ◽

Health Nurse ◽

The Impact ◽

Joint Assessment

Aims and methodWe examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.ResultsIn the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.Clinical implicationsJoint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.

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Using Record Linkage to Examine the Impact of Poor Mental Health on Breast Screening Uptake

International Journal for Population Data Science ◽

10.23889/ijpds.v3i2.474 ◽

2018 ◽

Vol 3 (2) ◽

Author(s):

Emma Ross ◽

Dermot O'Reilly

Keyword(s):

Mental Health ◽

Breast Screening ◽

Census Data ◽

Breast Cancer Mortality ◽

Poor Mental Health ◽

Breast Screening Programme ◽

Screening Uptake ◽

National Breast ◽

The Impact ◽

Prescribing Information

BackgroundThe UK National Breast Screening Programme is estimated to reduce breast cancer mortality by 20%. To maximise the benefits of the programme, we first need to understand the underlying factors contributing to variations in screening uptake. One potentially significant factor which may contribute to these gradients in screening uptake is poor mental health. ObjectivesThe objectives of this study were to examine the impact of poor mental health on breast screening uptake, and whether this explained any of the previously observed socio-demographic gradients in screening uptake. MethodsBreast screening records were obtained from the National Breast Screening System (NBSS) and were subsequently linked to 2011 Census data within the Northern Ireland Longitudinal Study (NILS). The NILS encompasses 28\% of Census data. This was then linked to psychotropic prescribing information from the Enhanced Prescribing Database (EPD), to produce a de-identified research dataset containing 57,328 women. FindingsWomen with self-reported poor mental health were over 20% less likely to attend screening compared to their counterparts who didn't have poor mental health. Using psychotropic prescribing information as a proxy for the presence of mental illness yielded similar results, with those taking anxiolytics, antipsychotics or hypnotics in the three months before screening invitation significantly less likely to attend than those who were not. ConclusionWomen with poor mental health were significantly less likely to attend breast screening. However, poor mental health did not explain any of the previously determined socio-demographic gradients in screening uptake.

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In their own words: Understanding Australians’ priority concerns regarding mental health in the context of COVID-19

10.31234/osf.io/pwfdm ◽

2021 ◽

Author(s):

Marlee Bower ◽

Amarina Donohoe-Bales ◽

Scarlett Smout ◽

Andre Quan Ho Nguyen ◽

Julia Boyle ◽

...

Keyword(s):

Mental Health ◽

Lived Experience ◽

Financial Stability ◽

Community Sample ◽

Poor Mental Health ◽

Community Members ◽

Good Mental Health ◽

Australian Community ◽

Seeking Help ◽

The Impact

The COVID-19 pandemic, as well as the recent bushfires and flash floods, have resulted in significant and unprecedented mental health impacts in Australia. Despite the known impacts, there is a paucity of research directly asking Australian community members about their mental health experiences and what they perceive to be the most important mental health issues in the context of the pandemic. This study utilises qualitative data from Alone Together, a longitudinal mixed-methods study investigating the effects of COVID-19 on mental health in an Australian community sample (N = 2,056). Of the 1,350 participants who completed the first follow-up survey, a total of 1,037 participants, who ranged in sex (69.9% female), age (M = 40-49 years), state/territory of residence, and socioeconomic status, shared responses to two open-ended questions regarding the most important issues for mental health in Australia and the impact of COVID-19 on their individual mental health. Responses were analysed using thematic analysis. Participants described COVID-19 as primarily impacting their mental health through the disruption it posed to their social world and financial stability. A key concern for participants who reported having poor mental health was the existence of multiple competing barriers to accessing good mental health care. According to participant responses, the pandemic had pressurized an already over-burdened mental health service system, leaving many without timely, appropriate support. Further absent or stigmatising rhetoric around mental health, at both a political and community level, also prevented participants from seeking help. Insights gained from the present research provide opportunities for policymakers and health practitioners to draw on the expertise of Australians’ lived experience and address priority issues through targeted policy planning. This could ultimately support a more responsive, integrated and effective mental health system, during and beyond the COVID-19 pandemic.

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Cross sectional analysis of depression and stress in medical students

10.31234/osf.io/ymfpb ◽

2018 ◽

Author(s):

Tyler S. Jones ◽

Deborah Rupert

Keyword(s):

Mental Health ◽

Medical Students ◽

Help Seeking ◽

Health Issues ◽

Cross Sectional ◽

Help Seeking Behaviors ◽

Mental Health Issues ◽

Increased Risk ◽

Sectional Analysis ◽

The Impact

Medical student wellbeing is a topic of growing concern. Medical students experience high levels of stress and burnout and are at increased risk for depression and suicidal ideation compared to the general population. Even more concerning, medical students are disproportionately less likely to seek help for their mental health issues. Identifying and preventing these problems early can have lasting positive consequences over the course of a physician’s lifetime. We implemented a wellness program at our medical school in the spring of 2016 with the goals of decreasing burnout and depression, heightening awareness of mental health issues, and encouraging help-seeking behaviors. To analyze the impact of our program, we have implemented a quality assurance survey. Here we report lifestyle factors associated with positive screens for depression from that data and propose institutional initiatives that can be spearheaded by medical students for medical students to impact positive change.

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An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales

BJPsych Open ◽

10.1192/bjo.2021.238 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S75-S75

Author(s):

Asha Dhandapani ◽

Sathyan Soundararajan ◽

Manjula Simiyon ◽

Vinila Zachariah ◽

Rajvinder Sambhi

Keyword(s):

Mental Health ◽

Physical Examination ◽

Junior Doctors ◽

Physical And Mental Health ◽

Improvement Project ◽

North Wales ◽

History Of ◽

Mental Health Unit ◽

State Examination ◽

Source Of Information

AimsTo ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.Our aim is to achieve 100 % compliance in clerkingResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.Apart from this, it also is needed for further continuity of care.Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic

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Improving knowledge and confidence in the acute management of eating disorders and resulting complications

BJPsych Open ◽

10.1192/bjo.2021.503 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S186-S186

Author(s):

Sarah Fynes-Clinton ◽

Clare Price ◽

Louisa Beckford ◽

Maisha Shahjahan ◽

Brendan McKeown

Keyword(s):

Eating Disorders ◽

Clinical Information ◽

Easy Access ◽

Average Score ◽

Junior Doctors ◽

Refeeding Syndrome ◽

Improvement Project ◽

Positive Effects ◽

The Creation ◽

The Impact

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

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