QI project: Improving the discharge advice from functional old age psychiatry wards for the monitoring of lithium and antipsychotic medication in the community

AimsNICE guidelines and Maudsley prescribing guidelines both stipulate that patients over the age of 65 prescribed lithium or antipsychotic medication should have their bloods and physical parameters monitored regularly. There is currently no provision from the community mental health teams in Edinburgh to provide this monitoring, which falls to the patients GP. Following an initial data collection, it was found that there was no monitoring advice being provided on immediate discharge letters (IDLs) for patients discharged from two functional old age psychiatry inpatient wards at the Royal Edinburgh Hospital. This patient group often have comorbid medical conditions and therefore monitoring of their psychotropic medication is especially important. The aim of the QI project was for 100% of patients discharged from thesewards on lithium or antipsychotic medication to have appropriate advice documented on their immediate discharge letter (IDL) with regards to medication monitoring.MethodData were collected monthly by reviewing the notes of all discharged patients to determine the frequency at which medication monitoring advice was documented on IDLs from the two wards. A proposed new template for discharge letters which included advice on medication monitoring was discussed and agreed with the old age psychiatry team in Edinburgh. This was disseminated to the appropriate medical staff members and was included in induction packs for junior doctors. Following this a new “canned text” template was implemented to automatically populate the discharge letter with advice depending on whether they were antipsychotics/lithium/neither.ResultIDLs for 91 patients discharged between May 2020 and February 2021 were reviewed. Baseline data showed that 0% of patients (n = 15) had appropriate monitoring advice documented on their IDL. Following initial introduction of monitoring advice to the induction pack for junior doctors, the mean frequency of completed advice on IDLs was 50.9% across 6 months. Following implementation of the canned text, the frequency of completed advice on discharge letters for February 2021 was 100% (n = 7).ConclusionThis QI project has been successful in improving the rate of appropriate advice for antipsychotic and lithium monitoring being provided on immediate discharge letters. It is hoped that this will help reduce adverse effects associated with antipsychotics and lithium in older psychiatric patients. Further work could be done on determining the frequency that the advised monitoring is being carried out.

Download Full-text

Old and new reasons for specialization

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.962 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S64-S65

Author(s):

G. Stoppe

Keyword(s):

Mental Illness ◽

Health Service ◽

Old Age ◽

Service System ◽

Psychiatric Patients ◽

The Elderly ◽

Current Evidence ◽

Ageing Population ◽

Old Age Psychiatry ◽

Competing Interest

Mental illness is one of the largest areas of activity in the health service, with mental disorders of the elderly an important part of it. This substantial ageing of the population is a new phenomenon, occurring over the last century. It has given prominence to mental illness in old age. There is a growing interest in making decisions about how many and which services to provide to the older community.The expertise of old age psychiatry services lies in the care and treatment of people with complex mixtures of psychological, cognitive, functional, behavioral, physical and social problems usually relating to ageing. Current evidence suggests specialist old age services are best equipped to diagnose and treat mental illness in our ageing population. However, the specialists should be integrated optimally into a service system to the benefit of the elderly. It will be crucial to improve access of older patients to the services. The service system and the partners in the system differ to those for younger adult psychiatric patients. Thus, not only knowledge and skills underline the necessity of specialization but also the increasingly complex health service structures of modern societies.Disclosure of interestThe author has not supplied his declaration of competing interest.

Download Full-text

Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals

Nordic Studies on Alcohol and Drugs ◽

10.1177/1455072517696323 ◽

2017 ◽

Vol 34 (3) ◽

pp. 243-254 ◽

Cited By ~ 1

Author(s):

Aud Johannessen ◽

Knut Engedal ◽

Anne-Sofie Helvik

Keyword(s):

Drug Use ◽

Old Age ◽

Psychotropic Drug ◽

Health Professionals ◽

Psychiatric Patients ◽

Psychiatric Hospitals ◽

Individual Interviews ◽

Psychotropic Drug Use ◽

Work Routines ◽

Old Age Psychiatry

Background: Increased awareness among health professionals regarding older people’s alcohol and prescribed psychotropic drug use may be beneficial for reducing their unhealthy consumption among elderly. Aim: This study explores how health professionals experienced their participation in a study in which they collected data on alcohol and psychotropic drug use among patients treated in old-age psychiatry departments and, subsequently, how they experienced their work day after the study ended. Method: Focus-group and individual interviews with 15 professionals in specialist psychiatric hospitals were performed in 2016. The data were analysed using content analysis. Results: Two themes emerged from the data: the informants’ “experiences with participation” and “consequences of participation”. These themes described how the informants had experienced their participation in the study and whether these experiences subsequently affected their work routines. The first theme included two subthemes: “approaching the topic” covered the challenges and “applying assessment scales” described the participants’ opinions about the scales. Two subthemes were included in the second theme: “increasing knowledge”, which covered their reflections on new knowledge; and “influencing work routines”, which described their new approach to the topic. Conclusion: Study participation positively affected the informants’ work routines regarding alcohol and psychotropic drug use. The results of this study may contribute to a better understanding, development, and organization of services for people with increased substance use and thus may more holistically promote the health of older people.

Download Full-text