scholarly journals Testing a computerised tool to improve physical health monitoring in a medium secure forensic setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S222-S223
Author(s):  
Mike Smith ◽  
Mustafa Abbas
Keyword(s):  
Physical Examination ◽  
Physical Health ◽  
Health Monitoring ◽  
Mental Health Problems ◽  
Relevant Information ◽  
Substantial Improvement ◽  
Due Date ◽  
Blood Tests ◽  
The Past ◽  
Health Checks

AimsThis project aimed to improve adherence to regular monitoring of the physical health of inpatients within a medium secure forensic psychiatric unit. A computerised tool to remind doctors to do checks was created, which was proposed would improve adherence.BackgroundThe physical health of people with mental health problems is of some concern, with higher rates of physical comorbidity and mortality compared to the general population.The forensic inpatient population has a high burden of both severe mental illness and physical ill health, and a high medication burden with potential adverse effects on physical health.To support the health of patients in our medium secure unit, each should routinely have three physical health checks done at least every six months. These are 1) an electrocardiogram (ECG), 2) a set of blood tests and 3) a full physical examination.MethodPatient records for 26 patients across two medium secure psychiatric wards were checked for 1) an ECG, 2) a full set of blood tests and 3) a full general physical examination within the past 6 months.A tool was created that automatically calculated the next due date for each check and colour coded which were overdue (red) or within 30 days of the due date (yellow). This tool was given to the core trainees working on these wards to help them keep track of which checks needed to be done.The records for patients on the same two wards were rechecked four months later and the adherence rates compared.ResultOn both wards, for each of the three physical health checks, a substantial improvement was seen in the proportion completed within the past 6 months.ConclusionThe tool created was a useful means of presenting, in one place, relevant information needed by doctors working in medium secure forensic wards regarding physical health checks, and drawing their attention to tasks that needed to be done. This led to an improvement in the adherence to physical health monitoring in these wards. An area for future improvement was identified regarding the unit's capacity to perform ECGs in a timely manner.

scholarly journals Annual physical health checks within a forensic inpatient service

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S72-S72
Author(s):  
Michael Cooper ◽  
Partha Gangopadhyay
Keyword(s):  
Blood Pressure ◽  
Physical Examination ◽  
Physical Health ◽  
Local System ◽  
Health Examination ◽  
Inclusion Criteria ◽  
The Past ◽  
Health Checks ◽  
Blood Monitoring ◽  
Physical Examinations

AimsPatients prescribed antipsychotics are at risk of ill effects to their physical health. Our aims were to assess whether inpatients within a forensic service, on antipsychotic medications, were receiving annual physical health monitoring in accordance with current NICE and SIGN Guidelines. Based on these Guidelines the following objectives were identified: 1: Physical examination, BMI and blood pressure recorded within the past year2: FBC recorded within the past year3: U&Es recorded within past year4: LFTs recorded within the past year5: HbA1C / random glucose / fasting glucose recorded within the past year6: Random lipids / fasting lipids recorded within the past yearMethodInclusion Criteria: Patients admitted for longer than a year currently prescribed an antipsychotic.Data were collected cross-sectionally on 24/7/20 for all inpatients meeting the inclusion criteria. Medical notes and the blood results system were reviewed for results of any annual physical examinations and blood monitoring over the past year.Anonymized data were analysed using Excel.Result13 out of 17 inpatients fulfilled the inclusion criteria. Of these 13 inpatients, 9 (69.2%) were prescribed clozapine, 1 (7.7%) zuclopenthixol, 1 (7.7%) paliperidone and 1 (7.7%) amisulpride.All patients had BMI and blood pressures recorded within the preceding month. Only 1 patient (7.7%) had an annual physical health examination within the past year.Findings for bloods taken within the past year were as follows:12 patients (92.3%) had an FBC recorded9 patients (69.2%) had U + Es recorded9 patients (69.2%) had LFTs recorded11 patients (84.6%) had HBA1c recorded7 patients (53.8%) had lipids recordedConclusionThere is scope for improvement with both annual physical examinations and blood monitoring.All patients had regular BMIs and blood pressure recorded which is largely attributable to nursing staff protocols. Low compliance with full annual physical examination could be explained by there being no local system in place for annual physical health checks and also frequent changes in junior doctor ward cover.Blood monitoring showed variable compliance with established standards. FBC monitoring had the best compliance, likely because the vast majority of our patients are prescribed clozapine, which necessitates minimal monthly FBC monitoring.This audit was presented to the Forensic Team and thereafter it was agreed for a local system to be put in place for annual physical health checks in the summer each year. This will improve oportunities to optimise our patients health. We plan to re-audit at this time.

scholarly journals Physical health of patients under EIP - a service evaluation

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S342-S342
Author(s):  
Anu Priya ◽  
Keerthan Dhanasekar ◽  
James Hill-Cousins ◽  
Mudasar Aziz ◽  
Osama Suleiman ◽  
...  
Keyword(s):  
Physical Health ◽  
Reporting System ◽  
Service Evaluation ◽  
Test Results ◽  
Antipsychotic Medications ◽  
Blood Tests ◽  
The Past ◽  
Health Checks ◽  
Number Of Patients ◽  
Early Intervention In Psychosis

AimsThe aim of the project was to get a baseline of the number of patients who have had blood tests, ECG and physical health observations completed in the past 12 months.MethodThere are 30 patients under Early Intervention in Psychosis team at Bassetlaw Hospital , Nottinghamshire. The elctronic notes and blood reporting system were checked for each of the patients, to get the data on blood test results , ECG reports and Physical health (Blood pressure, heart rate and weight) .ResultIt was noted that 19/30 patients had Blood tests completed, 14/30 had ECG completed and 19/30 had physical health checks completed. All these patients except one were on antipsychotic medications.ConclusionFurther work is still required in getting 100% results for all these different variables. This may include the need to review the process of how we engage the patients for physical healthcare checks. With the inclusion of a physical healthcare worker now, we might be able to improve results. Hence this evaluation would be redone in a years' time.

scholarly journals Are we meeting local and national guidelines for physical health assessment following admission to the meadows?

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S304-S305
Author(s):  
Yasmin Abbasi ◽  
Ruairidh Morgan ◽  
Alice O'Docherty
Keyword(s):  
Physical Examination ◽  
Physical Health ◽  
Psychotropic Medication ◽  
Health Assessment ◽  
Health Examination ◽  
Nice Guidelines ◽  
Blood Tests ◽  
Healthcare Needs ◽  
Common Diagnosis ◽  
Level Of Consciousness

AimsWe audited practice at the Meadows Inpatient Unit regarding physical health assessment, against standards set by Surrey and Borders Partnership and NICE.BackgroundSABP policy states that within 24 hours of admission to inpatient services, physical health assessment should be offered. It should be completed within 72 hours. Refusal should be documented.These guidelines state that within 2 weeks of admission blood tests should be completed, and for specific individuals an ECG should be performed.NICE guidelines state that “physical healthcare needs” should be discussed with newly admitted patients. NICE guidelines regarding physical health monitoring for individuals with psychosis or schizophrenia recommend that assessment includes “full physical examination to identify physical illness”.NICE suggests use of antipsychotics for individuals with dementia who have severe distress, or are at risk of harming themselves or others. Those with behavioural and psychological symptoms of dementia (BPSD) should therefore be physically assessed to ensure safe use of antipsychotics may be implemented.MethodAll admissions to The Meadows over seven months were audited retrospectively. The clinical notes were accessed from Systm1.Consensus medical opinion was reached that full examination should include: GCS/level of consciousness, cardiorespiratory, abdominal and neurological examinations.Age, gender, diagnosis and prescriptions of psychotropic medication at time of admission were recorded.The sample included 35 patients.Result55% of patients had a diagnosis of dementia.63.8% of patients were prescribed antipsychotics on admission, more than other psychotropic medication. This may reflect that the most common diagnosis was dementia, commonly with associated BPSD.97% of patients had a physical examination completed within 24 hours; most excluded neurological examination. 91% of patients had blood tests completed in two weeks, with the most commonly excluded tests being lipids and glucose. 86% of patients had an ECG in two weeks. In general, documentation of reason for not completing an examination was completed.ConclusionWe found good compliance with recommendations for physical health assessment. Areas for improvement include better assessment of neurology and more thorough blood tests.Recommended physical health examination for new admissions is not outlined in SABP policy. We recommend the following:GCS/level of consciousness, cardiovascular, respiratory, abdominal, and neurological examinations, and baseline observations.ECG should be a requirement of admission. In order to facilitate this, staff need to be trained to perform ECGs.NICE guidelines refer to HBA1c rather than glucose, which should be reflected in SABP policy.

How writing and using Insight Poetry helped me to overcome my illness

2003 ◽  
Vol 27 (2) ◽  
pp. 71-72 ◽  
Author(s):  
Anonymous
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Mental Health Problems ◽  
Health Problems ◽  
The Past ◽  
Mental And Physical Health

In 1986 I suffered a severe mental breakdown. I have had serious mental health problems for 15 years. Over the past 15 months, my mental and physical health have improved considerably. During this time, I have been writing and using Insight Poetry to help overcome my illness.

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 Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S352-S352
Author(s):  
Andreea Steiu ◽  
Emma Diggins ◽  
Nagulan Thevarajan
Keyword(s):  
Mental Health ◽  
Young People ◽  
Physical Examination ◽  
Physical Health ◽  
Health Assessment ◽  
Health Problems ◽  
Inpatient Unit ◽  
Junior Doctors ◽  
Blood Tests ◽  
Service Specification

AimsThis audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.BackgroundMental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.MethodElectronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.Simple statistical analysis was carried out using excel.ResultOver 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.ConclusionTaken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.

scholarly journals High dose antipsychotic treatment monitoring audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S348-S348
Author(s):  
Jake Scott ◽  
Jose Belda
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Clinical Benefit ◽  
Health Assessment ◽  
Antipsychotic Treatment ◽  
High Dose ◽  
Health Checks ◽  
Increased Risk ◽  
Multi Disciplinary Team

AimsTo quantify how many patients were prescribed high dose antipsychotic treatment (HDAT) and establish whether guidance for monitoring HDAT was being followed in an Assertive Outreach Team.BackgroundSevere mental health disorders are associated with significant premature mortality, predominantly due to physical health conditions. Antipsychotic medications are associated with side effects, including metabolic syndrome and QT prolongation, which increase the risk of serious physical illness. HDAT is defined as when the total dose of antipsychotics prescribed exceeds 100% of the maximum BNF dose, if each dose is expressed a percentage of its maximum dose. There is limited evidence of clinical benefit with HDAT but an increased risk of side effects. Patients prescribed HDAT should therefore be monitored for side effects and clinical benefit. Sussex Partnership NHS Foundation Trust developed a form specifically for this purpose, to be completed in addition to a physical health assessment.MethodAll patients on caseload were audited using the electronic notes. Current inpatients were excluded, as inpatient HDAT monitoring forms are attached to paper drug charts and therefore were not available for review.ResultA total of 61 patients were audited. Nine were excluded due to being inpatients. 16 were on community treatment orders and 26 were prescribed a long-acting antipsychotic injection. 10 were prescribed clozapine. The median number of medications prescribed was one. Four patients were prescribed HDAT ranging from 117-150% of the maximum BNF dose. Of these four, one had a HDAT form but this was out of date. 39 of 52 (75%) patients audited had had a physical health assessment in the past 12 months. Two of the 13 missing a physical health assessment were on HDAT.ConclusionPhysical health monitoring should be carried out for all patients on antipsychotics, but is particularly important for patients on HDAT. This audit identified a problem in both general physical health checks and HDAT monitoring. On discussion with the multi-disciplinary team a number of barriers to appropriate physical health monitoring were identified. There was a lack of awareness within the multi-disciplinary team that patients were receiving HDAT and regarding the implications for side effects. A reliable system to highlight the need for physical health checks was also missing and the team did not have sufficient equipment to perform the necessary checks. Identifying these barriers should enable improvements in physical health and HDAT monitoring which can be re-audited.

Assessment

2009 ◽  
pp. 77-108
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Social Functioning ◽  
Rating Scales ◽  
Mental Health Problems ◽  
Health Problems ◽  
Adaptive Behaviour ◽  
Nursing Assessment ◽  
Health Checks ◽  
Behaviour Rating

Purpose and principles of assessment 78 Framework for nursing assessment 80 Adaptive behaviour rating scales 82 Health checks 84 Screening of physical health 86 Assessing pain 88 Assessing distress 90 Screening of mental health problems 92 Assessment of independence and social functioning 94 Measurement of IQ ...

scholarly journals Improving physical health form completion on a general inpatient adult ward

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S227-S228
Author(s):  
Brandon Wong ◽  
Anjna Vekaria
Keyword(s):  
Mental Health ◽  
Physical Health ◽  
Mental Health Problems ◽  
Electronic Record ◽  
Psychiatric Ward ◽  
Excel Spreadsheet ◽  
Record Keeping ◽  
Blood Tests ◽  
Cholesterol Levels ◽  
Adult Psychiatry

AimsThe government's Five Year Forward View Plan for Mental Health has set a target for 280,000 people with severe mental health problems to be offered screening and appropriate intervention based on physical health risk stratification, including obesity, diabetes and heart disease. As such, physical health review for patients on a general inpatient adult psychiatry ward includes routine blood tests for cholesterol levels and HbA1c. They are recorded together in a Physical Health (PH) Form in the patient's electronic record and used to stratify cardiovascular risk factors and risk of diabetes. If a patient declines these blood tests it should be recorded on the PH form.This study aims to improve the completion of Physical Health forms to ≥95% by within a 4-month period on a general adult inpatient psychiatric ward.MethodPH form completion was measured using Tableau Software for a 4-week period as a baseline then fortnightly during the study. PH form completion required HbA1c and cholesterol levels to be inputted, or to be marked as declined where the patient had declined these tests. Potential interventions were discussed by clinicians and implemented using PDSA cycles with iterative changes tested and analysed. PH form completion was re-audited monthly for a 6-month period.ResultBaseline data showed 61.54% of patients had physical health forms completed (n = 26; 61.54% with HbA1c, 76.92% with cholesterol completed). Iterative changes and improvements included; (i) paper list to track PH form completion, (ii) table on Microsoft Word, (iii) Excel spreadsheet, and (iv) a conditionally formatted Excel spreadsheet. The conditionally formatted Excel spreadsheet was colour-coded to show completed elements as green and incomplete elements as red.Paper lists increased PH completion to 84.85% (n = 33). Word table increased PH completion to 96.43% (n = 28). Excel spreadsheet had PH completion of 96.67% (n = 30). Colour coded excel spreadsheet increased PH completion to 100% (n = 28). This was used as standard practice with sustained 100% completion in November (n = 34) and December (n = 39). The improvement was sustained to January 2021, although there was a decrease to 97.7% (n = 30).ConclusionIt was hypothesised an intervention to track completion of PH forms would improve completion rate. The use of a colour-coded conditionally formatted Excel spreadsheet improved PH form completion to 100% within an 8-week period and a sustained increase of >95% 6 months after the study began. This study recommends the use of such an electronic record keeping system to assist with PH form completion.

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