scholarly journals A quality improvement project on timely completion of bloods and ECGs on a tier 4 child and adolescent inpatient unit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S217-S217
Author(s):  
Emma Salter ◽  
Philippa Snow ◽  
Kiera Friel ◽  
Nicola Biddiscombe
Keyword(s):  
Physical Health ◽  
Child And Adolescent ◽  
Inpatient Unit ◽  
List Type ◽  
Due Date ◽  
Optimal Care ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
Timely Completion ◽  
Adolescent Inpatient

AimsPhysical health monitoring is paramount to optimal care for psychiatric patients. Blood tests and ECGs are invaluable tests throughout a patient's care. At baseline, they aid investigation of potential organic causes of psychiatric presentations and provide organ and electrolyte status before starting medication. Common psychotropic medications carry physical health risks: bloods and ECGs aid in monitoring potential side effects of prescribed medication.In this local Tier 4 inpatient unit, anecdotal observation revealed completion of these basic investigations was noted to be suboptimal.This project aimed to improve timely completion of baseline (within 72 hours of admission) and monitoring (within one week of due date) bloods and ECGS.MethodThis project was completed within a 12-bed child and adolescent inpatient unit. Using Plan Do Study Act (PDSA) methodology, the multidisciplinary team collated driver diagrams to identify potential areas for intervention. Following baseline analysis, colleague communication was considered key. Consequently, a chart for bloods and ECG completion was created.Each monthly PDSA cycle included the following consecutive interventions: PDSA cycle 1: chart implementationPDSA cycle 2: chart simplification and font size increasePDSA cycle 3: allocated change in team leader for this cyclePDSA cycle 4: Blood request pocket in officePDSA cycle 5: chart simplification through removal of datesPDSA cycle 6: ECG pocketPDSA cycle 7: box on handover listResultMonthly investigations and admission numbers are unpredictable and inconsistent in this cohort: relevant case numbers per PDSA ranged from zero to ten. The results were presented as percentages to allow for direct comparison between cycles.Baseline and results of each consecutive PDSA cycle described above were as follows (N/A represents a cycle where no investigations were required):Admission bloods were completed within 72 hours in 50%, 100%, 50%, 80%, N/A, 100%, 100%, 100%Admission ECG was completed within 72 hours in 30%, 66%, 50%, 70%, N/A, 100%, 100%, 100%Monitoring bloods were completed within one week of due date in 25%, 33%, 0%, 80%, 100%, 100%, 100%, 100%Monitoring ECG was completed within one week of due date in 0%, 0%, N/A, 66%, 100%, 66%, N/A 100%ConclusionThrough close multidisciplinary collaboration and chart implementation, completion of bloods and ECGs improved. Low patient numbers per PDSA cycle resulted in large changes in percentage results, limiting the significance of these findings. Wider implementation of the chart within local Trust inpatient wards is considered.

Wellbeing Wednesdays: nurse-led clinic for improving physical health care in a general adolescent inpatient unit

2020 ◽  
Vol 29 (4) ◽  
pp. 230-235
Author(s):  
Catriona Mellor ◽  
Jonathan Blackman ◽  
Emily Barker ◽  
Zaakirah Bhula ◽  
Evelyn Sibanda ◽  
...  
Keyword(s):  
Physical Health ◽  
Inpatient Unit ◽  
National Standards ◽  
Health Clinic ◽  
Post Intervention ◽  
Improvement Project ◽  
People With Mental Illness ◽  
Health Domains ◽  
Adolescent Inpatient ◽  
Improved Performance

Background: Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex. Aim: To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion. Methods: Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes. Results: Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area. Conclusions: Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.

Physical Aggression During Admission to a Child and Adolescent Inpatient Unit: Predictors and Impact on Clinical Outcomes

2008 ◽  
Vol 42 (6) ◽  
pp. 536-543 ◽  
Author(s):  
Angela J. Dean ◽  
Suzanne G. Duke ◽  
James Scott ◽  
William Bor ◽  
Michelle George ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Physical Aggression ◽  
Child And Adolescent ◽  
Inpatient Unit ◽  
Adolescent Inpatient

Reducing seclusion and restraint in a child and adolescent inpatient area: implementation of a collaborative problem-solving approach

2020 ◽  
Vol 28 (5) ◽  
pp. 578-584
Author(s):  
Valerie Black ◽  
Candace Bobier ◽  
Baiju Thomas ◽  
Fiona Prest ◽  
Chris Ansley ◽  
...  
Keyword(s):  
Problem Solving ◽  
Outcome Measures ◽  
Child And Adolescent ◽  
Inpatient Unit ◽  
Collaborative Problem Solving ◽  
Naturalistic Study ◽  
Collaborative Problem ◽  
Length Of Treatment ◽  
Adolescent Inpatient

Objective: The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit. Method: A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation. Results: The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful. Conclusions: A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.

scholarly journals Clozapine clinics in north Wales - service evaluation audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S343-S343
Author(s):  
Jawad Raja ◽  
Zeenish Azhar ◽  
Masood Malik
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Plasma Lipid ◽  
Service Evaluation ◽  
List Type ◽  
Close Monitoring ◽  
Type Number ◽  
Care Coordinator ◽  
Improvement Project ◽  
Clozapine Treatment

Aims1.Quality of clozapine clinic appointment2.Effectiveness of clozapine clinic servive3.Compliance with BCUHB guidelines for physical health monitoring in clozapine clinics4.We retrospectively audited 40 case notes 10 each from 4 differtent CMHT clozapine clinicsMy role in the Project & How does this represent my practice? 1.I was the audit and overall lead for this project2.I formulated the audit tool and registered my project with Audit Registration Team3.I lead data collection and compilation of resultsBackground1.This audit followed up from a Coroner's investigation for a clozapine clinic patient2.Clozapine is used for Treatment Resistant Schizophrenia but needs close monitoring due to potentially fatal side effects3.NICE recommends annual monitoring of weight, blood pressure, waist measurement, blood glucose and plasma lipid levelsMethod1.Has the patient been seen in the past year by clinician to monitor response to clozapine treatment?2.Has the clozapine plasma level been measured during the last year of treatment?3.Is brief MSE & Risk assessment documented during review?4.Has Life style modification advice been provided?5.Has annual physical health been completed?6.Has Annual CTP/CPA been completed and documented?7.Has the patient been allocated a named care coordinator?8.Has clozapine side effects monitoring been documented?Conclusion1.Clozapine is a superior medication for the treatment of refractory schizophrenia and is also be effective for other conditions2.Clozapine is underused due to a variety of barriers related to the drug and its properties, the health care system & regulatory requirements3.This service evaluation/quality improvement project provides the framework for clozapine clinics evaluation and recommends strategies for improvement

Exposure to Aggression and the Impact on Staff in a Child and Adolescent Inpatient Unit

2010 ◽  
Vol 24 (1) ◽  
pp. 15-26 ◽  
Author(s):  
Angela J. Dean ◽  
Peter Gibbon ◽  
Brett M. McDermott ◽  
Tim Davidson ◽  
James Scott
Keyword(s):  
Child And Adolescent ◽  
Inpatient Unit ◽  
Adolescent Inpatient ◽  
The Impact

scholarly journals Physical health monitoring before commencing regular antipsychotics in a Psychiatric Intensive Care Unit (PICU) - A Quality Improvement project

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S185-S185
Author(s):  
Divyanish Divyanish ◽  
Afshan Channa
Keyword(s):  
Family History ◽  
Physical Examination ◽  
Physical Health ◽  
Inpatient Admission ◽  
Initial Assessment ◽  
List Type ◽  
Medical Conditions ◽  
Improvement Project ◽  
History Of

AimsTo compare the practice in a PICU setting against the standard practicing guidelines before commencing antipsychotics with regards to: 1.Physical examination2.ECG3.Baseline blood investigations4.Physical health conditions5.Family history of medical conditions.MethodData were collected from the PICU, Black Country Healthcare NHS Foundation Trust which covers four different hospital sites. 37 patients were admitted in PICU from 1st March 2020 to 30th September 2020, out of which 30 were included. 6 case notes were not available and one patient was admitted twice, thus case notes for only one admission was included in data collection.The standard guidelines for PICU outline that each admitted patient should have physical examination, vitals monitoring and baseline investigations including routine blood tests and ECG within first 24 hours. The data were collected as per standards retrospectively within two weeks from case notes in health records. Investigations were accessed through electronic information system for current inpatient admission and 12 months prior to the admission to the PICU.ResultMean age of the sample (n = 30) was 34.26 years. 37% of patients had physical comorbidities and a family history of medical conditions was documented for only 3% of cases. A large proportion of inpatients (53%) refused to have blood investigations before treatment and only 13% of blood investigations were completed before commencing treatment. Only 7% of patients consented to an ECG prior to commencing treatment. 27% of patients had a physical examination, including vitals, before starting treatment, a further 37% had just their vitals taken within 24 hours of admission and 20% refused any form of physical examination during their inpatient admission. 7% of cases had complications due to a lack of investigation.ConclusionAlthough there are standard guidelines for the PICU setting, it has been noted that these guidelines aren't always implemented. Multiple factors have a role to play such as: non-consenting patients, inaccessibility of previous records, initial assessment forms being incomplete including assessment of mental capacity and lack of follow-up with physical investigations by both primary care and secondary mental health services. As per findings, a few recommendations were proposed to meet the standards.

scholarly journals The experience of parents faced with the admission of their adolescent to a child and adolescent psychiatric inpatient unit. A qualitative study with focus groups

2021 ◽  
Author(s):  
Beatriz Merayo-Sereno ◽  
Aránzazu Fernández-Rivas ◽  
Keyth Lany de Oliveira-Silva ◽  
Francisco-Javier Sánchez-Andérez ◽  
Eva Sesma-Pardo ◽  
...  
Keyword(s):  
Focus Groups ◽  
Psychiatric Hospitalization ◽  
Emotional Experience ◽  
Psychiatric Inpatient ◽  
Health Behavior Change ◽  
Child And Adolescent ◽  
Inpatient Unit ◽  
Entire Family ◽  
Parental Experience ◽  
Psychiatric Inpatient Unit

AbstractThe admission of an adolescent to a child and adolescent psychiatric inpatient unit has a serious impact on the entire family unit. The emotional experience of those primary caregivers has been scarcely studied qualitatively despite being recommended by previous research. This study aims to examine the experience of parents of adolescents with mental health needs that required psychiatric hospitalization in a child and adolescent unit. Qualitative cross-sectional research was carried out under the recommendations of Grounded Theory with three Focus Groups of parents (N = 22) of adolescents who required psychiatric hospitalization in a child and adolescent ward. The COREQ quality criteria were applied. The parental experience implies a high level of emotional suffering modulated by feelings of guilt, stigma, parental awareness of their child’s illness and the passage of time. The use of Prochaska’s and Diclemente’s trans-theoretical model of health behavior change is useful in understanding the parental experience.

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