scholarly journals A community service review of the quality of inpatient discharge summaries from six inpatient wards at St Charles Hospital: an initial audit and quality improvement recommendations

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S205-S205
Author(s):  
Omar Mahmoud ◽  
Jasna Munjiza ◽  
Jacob King
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Community Mental Health ◽  
Legal Status ◽  
Bimodal Distribution ◽  
Admission Diagnosis ◽  
List Type ◽  
Convenience Sample ◽  
Reason For Admission ◽  
Discharge Summaries

AimsTo discuss whether Discharge summaries include important information to community mental health teams .To identify patterns and produce recommendations for change by Quality improvement methods .MethodA convenience sample was selected of the first 5 patient discharges from each of the 6 adult inpatient wards at St Charles Hospital. This represented a total of 30 reviewed summaries. Outcome items were generated following discussion with community psychiatric colleagues based on those aspects of an admission thought to be of most use to a community mental health team. These were; reason for admission, diagnosis, circumstances of admission, progress on the ward, risk assessment, physical health, legal status on discharge, discharge medication, discharge management plan, contact details. Basic identification was also recorded as was the ward and date of dischargeResult•Only 3.3% (1/30) of discharge summaries were complete of all items.•However 23.3% (7/30) were almost complete, failing to record only a single item, and a further 2 missing only 2 of 10 items. There was a bimodal distribution (Graph 1).•Seven (7/30) discharge summaries provided no information. Of these, four (4/7) discharge summaries were written in the progress notes directly, rather than using the discharge summary proforma.•The ‘reason for admission’ item was a clear low outlier with only 2/30 reporting this piece of information. For a number of cases, this was recorded unhelpfully as “in crisis”.ConclusionThere was limited evidence of systemic patterns,however some wards showed internal stark differences with some summaries complete or almost complete and others empty.The key findings from this report are the high number of discharge summaries which have either no responses to them (7/30). This may indicate that the writer did not know how to use the current discharge template, and therefore support with using this is indicated. For those with a very low (7/30) number of item responses, we might conclude that these discharge summaries were written by someone with knowledge of using the system, but for another reason did not complete the majority of the items asked, and for this reasons are not immediately clear. Similarly, as highlighted above the main low outlying result relates to the apparent widespread practise of writing “in crisis” as the ‘reason for admission’, unfortunately to community teams this is an unhelpful and self-evident response.

Improving Adherence to Atypical Antipsychotic Agent Screening Guidelines in Pediatric Patients: A Quality Improvement Project Within an Integrated Community Mental Health Setting

2018 ◽  
Vol 24 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Elishia L. Featherston ◽  
Sharolyn Dihigo ◽  
Richard E. Gilder
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Community Mental Health ◽  
Children And Adolescents ◽  
Atypical Antipsychotic ◽  
Antipsychotic Agents ◽  
Mental Health Setting ◽  
Improvement Project ◽  
Screening Guidelines ◽  
Atypical Antipsychotic Agents

Background: Approximately 14% to 20% of children and adolescents have a mental health problem. Atypical antipsychotic agents are used to treat behavioral, emotional, and mental health problems in children and adolescents. A discrepancy between best practices and actual practices exists. Objective: The purpose of this quality improvement project was to increase adherence above baseline, through implementation of a checklist, to recommended screening guidelines in children, ages 4 to 18, prescribed atypical antipsychotic agents over 12 weeks. Design/Results: Aggregate comparison of the mean ranks of scores were tested with the Mann–Whitney U test, U = 1,087.5, n1 = n2 = 70, total N =140, p < .001. Variables of body mass index, blood pressure, waist circumference, fasting glucose, fasting lipids, personal history, and family history were observed and tested using the chi-square with Fisher’s exact tests and are significant at or above 99% confidence level ( p < .01). Conclusion: Educating mental health providers, child and adolescent psychiatrists, and psychiatric mental health nurse practitioners on recommended screening guidelines and implementing a checklist had a measurable effect on increasing adherence to the recommended screening guidelines in a community mental health setting.

scholarly journals The clinical complexity of cases of schizophrenia in a community mental health team: a 3 year comparison

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S340-S340
Author(s):  
Shay-Anne Pantall ◽  
Laxsan Karunanithy ◽  
Hayley Boden ◽  
Lisa Brownell
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Community Mental Health ◽  
List Type ◽  
Community Mental Health Team ◽  
Service Usage ◽  
Care Programme ◽  
Mental Health Team ◽  
Health Team ◽  
Long Acting

AimsTo describe the changes in complexity and management of individuals with schizophrenia in a community mental health team (CMHT) over a three year period.BackgroundIt is often believed that individuals receiving care from CMHTs are those with low levels of complexity and risk, and are relatively stable, with more complex individuals being managed by assertive outreach or other specialist teams. Here, we describe changes in the complexity, comorbidity, service-usage and management, of patients with a diagnosis of schizophrenia in a CMHT between 2016 and 2019.MethodData were collected from an electronic patient record system (RiO) for all individuals with schizophrenia in a CMHT in Birmingham (n = 84 in 2016, n = 71 in 2019), examining demographic variables, comorbidity, use of mental health services and current management.ResultKey findings included: - •63% were managed through care programme approach (CPA) in 2016, compared to only 31% in 2019.•21% had required home treatment or inpatient care in the preceding 12 months in 2016; this had improved to 8.5% in 2019.•Significant levels of psychiatric comorbidity, including addictions with almost half of patients (46.5%) having a known history of substance use in 2019, compared to only 15.5% noted in 2016.•Pharmacological management has remained broadly similar; in 2016 21% patients were taking a combination of 2 antipsychotics compared to only 10% in 2019 and 25% were taking clozapine in 2016 (21% in 2019). 39% were prescribed a long acting antipsychotic injection in 2016, compared to 32% in 2019.•In 2016, medication was being prescribed in the majority of cases within secondary care (55%) patients and in primary care in only 21%. GPs have now taken on greater prescribing responsibility in 2019, prescribing in 44% of cases, with 47% being prescribed by the CMHT.ConclusionThe acuity and management of individuals with a diagnosis of schizophrenia under the care of a CMHT has changed over a 3 year period. It is positive to note the reduced use of crisis services and lower rates of polypharmacy. There is a reduction in the proportion of patients receiving management through CPA, and a move towards more medication being prescribed in primary care. The reasons for this change are however unclear and may reflect change in available resources, given that more than half of this group receive clozapine or long acting injections, and have high levels of comorbidity.

scholarly journals Quality Improvement in Ambulatory Mental Health Settings

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Cauterman ◽  
S. Woynar ◽  
S. Vergnaud
Keyword(s):  
Mental Health ◽  
Quality Improvement ◽  
Information Sharing ◽  
List Type ◽  
Patient Pathway ◽  
Initial Appointment ◽  
Mental Health Settings ◽  
Discharge From Hospital ◽  
Pilot Intervention

Eight ambulatory Mental Health Settings have been commited in a national pilot intervention aiming at improving the quality of the service they deliver from April 2006 to december 2007. This twenty months intervention allowed teams to set operational bjectives, to describe their organization, to implement an actions’plan and to evaluate their results.The main operational objectives they chose were the following:•Delay for an initial appointment.•Delay for an appointment following a discharge from hospitalization.•Rate of non attendance.The framework to analyse their organisation included a focus on Human ressources, on Operations, on Strategy and on Information Sharing.The main findings were awide variations in performance from a setting to one another (median delay for a first appointment with a psychiatrist ranging from one to seven weeks, paid psychiatrist working time for a single appointment ranging from 0.6 to 2.5 hours...), lack of formalisation of processes (including major processes as intake, discharge from hospital...), the absence of objectives set by the managemers.Actions’plans included very basical actions as setting dashboards and objectives, setting strategy to decrease non attendance, sharing diaries, reorganising meetings, mapping patient’ pathway.Finally, some results were obtained as:•reduction of delays for first appointments (4 settings amongs 8);•reduction of delays for a appointment after hospital discharge (1 amongst 8).Furthermore, this pilot intervention allowed to create and develop tools, method and experience for accompaining other settings. Ten new volunteers are involved since july 2008.

scholarly journals An evaluation of predictors of dropout from an Emotional Coping Skills programme in a community mental health service

2019 ◽  
Vol 12 ◽  
Author(s):  
Shalini Raman ◽  
Thomas Richardson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Coping Skills ◽  
Evidence Base ◽  
Drop Out ◽  
List Type ◽  
Client Retention ◽  
Emotional Coping

Abstract Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base. Key learning aims (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.

Observational study of suicide attempts in a community mental health unit

2017 ◽  
Vol 41 (S1) ◽  
pp. s887-s888
Author(s):  
M. Guerrero Jiménez ◽  
C.M. Carrillo de Albornoz Calahorro ◽  
J.M. Gota Garcés
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Disorder ◽  
Suicide Attempts ◽  
Outpatient Setting ◽  
Suicide Mortality ◽  
List Type ◽  
Health Unit ◽  
Competing Interest ◽  
Mental Health Unit

IntroductionConcurrent with the recent global economic crisis there is a rising concern about the effect of recession on suicide mortality rates.AimTo record patients treated urgently in community mental health unit of Motril, Granada (Spain) by attempted suicide.MethodsDescriptive study recording patients treated urgently in Motril community mental health unit who have done any suicide gesture from February 2015 until December of that year.ResultsIn total, 39 urgent assessments were recorded during the observational period.The month of highest incidence was November, with 6 visits followed by August and October (5).The most common method was voluntary drug intake.Origin:– 59% were remitted from the general hospital emergency department;– critical care and emergency ambulatory devices: 1;– primary care: 10;– another specialist: 2;– own initiative: 2.Discharge diagnosis:– 35.8% individuals did not meet criteria for any mental disorder, although some of them were classified with V or Z diagnosis according to ICD-10 for making a reactive gesture to a emotional crisis, couple breakups or economic problems;– 11 of them meet criteria for various anxiety disorders, obsessive compulsive and adaptative crisis.DiscussionKnowing some peculiar characteristics in suicidal populations as well as the most prevalent pathologies, it could be adapted both the profile of nurse attendance and the type of resources needed to ensure effective patient care.ConclusionProfile of patients attended for suicide attempt in an outpatient setting in a semi-rural coastal area is variated. It is worth to mention that one-third of this population did not meet criteria for any mental disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Medicines reconciliation at the community mental health team–general practice interface: quality improvement study

2019 ◽  
Vol 44 (1) ◽  
pp. 12-18
Author(s):  
Chris F. Johnson ◽  
Karen Liddell ◽  
Claudio Guerri ◽  
Paul Findlay ◽  
Alex Thom
Keyword(s):  
Mental Health ◽  
General Practice ◽  
Quality Improvement ◽  
Community Mental Health ◽  
Electronic Prescribing ◽  
Team Approach ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Health Team ◽  
Medicines Reconciliation

Aims and methodTo increase the proportion of patients with no psychotropic drug discrepancies at the community mental health team (CMHT)–general practice interface. Three CMHTs participated. Over a 14 month period, quality improvement methodologies were used: individual patient-level feedback to patient's prescribers, run charts and meetings with CMHTs.ResultsOne CMHT improved medicines reconciliation accuracy and demonstrated significant reductions in prescribing discrepancies. One in three (119/356) patients had ≥1 discrepancy involving 20% (166/847) of all prescribed psychotropics. Discrepancies were graded as: ‘fatal’ (0%), ‘serious’ (17%) and ‘negligible/minor harm’ (83%) but were associated with extra avoidable prescribing costs. For medicines routinely supplied by secondary care, 68% were not recorded in general practice electronic prescribing systems.Clinical implicationsImprovements in medicines reconciliation accuracy were achieved for one CMHT. This may have been partly owing to a multidisciplinary team approach to sharing and addressing prescribing discrepancies. Improving prescribing accuracy may help to reduce avoidable drug-related harms to patients.

scholarly journals Compliance with nice guidelines for management of depression in a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S333-S334
Author(s):  
Sophie Mellor ◽  
Shay-Anne Pantall ◽  
Lisa Brownell
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Community Mental Health ◽  
Psychiatric Comorbidity ◽  
Stepped Care ◽  
List Type ◽  
Community Mental Health Team ◽  
Mental Health Team ◽  
Nice Guidelines ◽  
Health Team

AimsTo evaluate compliance within a Community Mental Health Team (CMHT) to the NICE guidelines for the management of depression.BackgroundReducing the prevalence of depression continues to be a major public health challenge.Given the complexity and recurrent nature of the condition, the NICE guideline CG90 is an invaluable resource to aid the effective management of depression. Here we present an audit of adherence to this guideline within a CMHT.MethodA retrospective electronic casenote review of all patients diagnosed with depression between January 2016 and October 2019 under the care of a Birmingham CMHT (n = 35), assessing key performance areas including: quality of assessment and coordinated care, risk assessment, choice of pharmacological and psychological treatment using the stepped care model and appropriate crisis resolution planning.ResultKey results include: The majority of patients were Caucasian (63%). Ages ranged from 27 to 69 (mean age 48 years old).Severity of disorder was typically moderate (46%) or severe (48%). Of those with a diagnosis of severe depression, 41% had associated psychotic symptoms.Psychiatric comorbidity was high (49%), of which generalised anxiety disorder was the most common (59%).Referrals were typically from primary care (77%). Approximately half (51%) had reported suicidal thoughts according to the referral.A quarter of patients (26%) were seen by CMHT within 8 weeks of referral; 20% of referrals however waited over 12 months before being assessed.Risk assessments were out of date for 71% of patients.100% of patients had a crisis plan noted within their most recent clinic letter; however, none of these met the required standards.Polypharmacy was common (60%), with 34% prescribed two antidepressants. Use of lithium augmentation was uncommon, with only one patient prescribed this. 43% were prescribed an antipsychotic; of which, 29% had appropriate physical health monitoring completed.Over half of patients (60%) had been referred to psychology services; of these, 38% had either completed or were in ongoing treatment at the time of review.ConclusionCMHTs manage the care of individuals with depression who have high levels of active symptoms and disability, psychiatric comorbidity, care requirements, and complex treatment plans. Pharmacological management was broadly in line with guidelines, and rates of referral to psychology were satisfactory. Risk assessment and crisis planning are clear areas in need of urgent attention in order to comply with guidelines and ensure patient safety.

Mental health services description. Prospects for the future

1997 ◽  
Vol 6 (S1) ◽  
pp. 91-103 ◽  
Author(s):  
Vivianne Kovess
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
International Collaboration ◽  
Private Practice ◽  
List Type ◽  
Precise Description ◽  
Services Evaluation ◽  
Medical Professions ◽  
Day Hospitals ◽  
Mode Versus

An abundant literature has been published about mental services evaluation and was used for purpose of comparisons between services.Comparisons have mainly concerned care in the traditional psychiatric hospital based mode versus community mental health (Tansella et al., 1982; Kraudy et al., 1987; Kovess et al., 1995) or care in different areas or countries (Sytema et al., 1989).Those comparisons have to rely on crude description of services (Tansella et al., 1986) like psychiatric hospitalisation, day hospitalisation or out patient intervention. Intensive international collaboration underpinned the importance of a more precise description about services which could have extremely different components under the same label.In fact services in mental health are complex to describe to allow meaningful comparisons because they cover many different actions given by a variety of providers and grouped into various structures as: •hospitals: specialised or general, large or small;•day hospitals and centre;•out patients clinics, crisis centres.Care could also be provided by independent workers from the diverse medical and non medical professions involved in the mental health fields in private practice settings.

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