scholarly journals Implementing a physical healthcare clinic in a CAMHS neurodevelopmental population

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S312-S313
Author(s):  
Helen Bruce ◽  
Sharika Mansoor ◽  
Sacha Evans
Keyword(s):  
Blood Pressure ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Stimulant Medication ◽  
Population Monitoring ◽  
Health Check ◽  
Health Clinic ◽  
Challenging Behaviour ◽  
Local Policy ◽  
Test Form

AimsTo establish a physical health clinic in a community CAMHS to monitor patients in the NDT who are on stimulant/antipsychotic medicationTo re-audit to assess adherence to physical health monitoring in accordance with guidelinesBackgroundStudies have indicated that people with severe mental illness have higher rates of mortality and are prone to development of physical health problems compared to the general population. Monitoring physical health is therefore important as it allows early detection and intervention where appropriate.Method17 out of 120 patients in the NDT were identified as taking either an antipsychotic (8 patients) or stimulant medication (9 patients). Physical health data required were determined by local policy and the Maudsley guidelines.Parents were invited to attend the clinic with their child through telephone calls. Height, weight, blood pressure and pulse were measured in the appointment. A blood test form was provided for parents to take to local outpatient phlebotomy services. A GP letter was sent with the results of the physical health check with a request to conduct an ECG and notify us of any abnormal results. Feedback forms were collected from parents to share their experience of attending the physical health clinic.Five patients were identified as having difficulty attending the CAMHS clinic due to refusal/challenging behaviour. For three patients, school visits were organised to conduct a physical health check.ResultThe results from the second round of the audit indicate an overall improvement in the adherence to monitoring guidelines for antipsychotic and stimulant medication. This was particularly evident for the patients on antipsychotic medication. Feedback collected from parents regarding the service provided was also positive.ConclusionThe physical health clinic identified challenges preventing 100% compliance in all patients. This included difficulties with parents bringing their child to CAMHS due to challenging behaviour. In a few of the patients, it was possible to solve this issue by conducting a school visit.It was also observed that there were multiple instances where challenging behaviour lead to inability to conduct certain tests including blood pressure, blood tests and ECG. Additional strategies should be considered to improve compliance.A notable issue that also arose from the development of the physical health clinic was that it was unclear how to obtain an ECG at CAMHS.Continuation of the clinic as well as extension to include patients within other teams at Tower Hamlets CAMHs would be recommended.

scholarly journals Mind and body: physical health monitoring in clozapine treatment

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S168-S168
Author(s):  
Moataz Abdelreheem ◽  
Olivia Connell ◽  
Daniel McNally ◽  
Itunuayo Veronica Ayeni ◽  
Clare Smith
Keyword(s):  
Mental Health ◽  
Blood Pressure ◽  
Waist Circumference ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Blood Count ◽  
Full Blood Count ◽  
Clozapine Treatment ◽  
Health Review

AimsTo evaluate physical health monitoring standards in patients on Clozapine in the community.StandardsNICE and BNF guidelines for patients on established clozapine treatment advise annual monitoring of weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c, blood lipids and overall physical health assessment. Full blood count is monitored 1-4 weekly.BackgroundIn the management of schizophrenia, antipsychotic medication remains the cornerstone of treatment. Patients affected carry a significant physical health burden with a reduced life expectancy of 10-25 years. Factors that contribute include sedentary lifestyles, consequent obesity and cardiovascular disease, disengagement from health services, a higher incidence of suicide and the physical side effects of antipsychotic medication. For these reasons, comprehensive routine physical assessment of patients on antipsychotic treatment is of central importance.MethodThis audit is a retrospective study of patients known to South Kensington & Chelsea Community Mental Health Team (CMHT). Patients (n = 48) were audited from the Clozapine clinic SystemOne database over a one year period (October 2018-2019) to assess annual monitoring of full blood count (FBC), urea and electrolytes (U&Es), lipid profile, liver function tests (LFTs), HbA1C, thyroid function tests (TFTs), clozapine levels, ECG, and general physical and mental health review.ResultOf the 48 patients, one was transferred to a different service so was excluded (n = 47 total).All (100.0%) of the patients had annual FBC tests. All but one (97.9%) of the patients had a physical health review including blood pressure, pulse, weight and BMI measurement. Three quarters (74.5%) received annual U&Es and LFTs. Almost two thirds of patients had annual lipid and HBA1c screening (63.8%) and over half the cohort had annual TFTs (61.7%). Regarding annual multidisciplinary mental health review, this was performed for the majority of the patients (70.2%).Contrastingly, only a quarter of the patients received annual screening of glucose and Clozapine levels (27.7% for both). Only 12 patients had annual ECG (25.5%).ConclusionFollowing review it is clear that most parameters were monitored annually in a majority of patients. However, shortcomings were detected, specifically annual ECG and waist circumference monitoring.In order to ensure comprehensive monitoring of mental and physical health of patients on Clozapine, flow charts of tests and reviews needed for each patient were written up clearly and will be included in the management pathway for every patient on Clozapine. This was agreed to minimise missing any step, particularly annual ECGs.

scholarly journals Improving the quality of physical health monitoring in CAMHS for children and adolescents prescribed medication for ADHD

2018 ◽  
Vol 7 (2) ◽  
pp. e000213 ◽  
Author(s):  
Cristal Oxley ◽  
Omer S Moghraby ◽  
Rani Samuel ◽  
Dan W Joyce
Keyword(s):  
Blood Pressure ◽  
Physical Health ◽  
Children And Adolescents ◽  
Health Monitoring ◽  
Stimulant Medication ◽  
Growth Monitoring ◽  
High Quality ◽  
Improvement Project ◽  
Targeted Interventions

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterised by a persistent, pervasive pattern of inattention, impulsivity and hyperactivity. Stimulant medication such as methylphenidate has an established evidence base in the treatment of children and adolescents with ADHD. However, it is also associated with a risk of side effects which may include decreased appetite, increased blood pressure and possible reduced growth. Monitoring physical health in children and adolescents prescribed medication for ADHD is a key clinical responsibility and includes a number of parameters as outlined in the National Institute for Health and Care Excellence Guidelines. Ascertaining the centiles of physical observations is essential to put these into developmental context and accurately inform treatment decisions. This quality improvement project aimed to improve physical health monitoring in children and adolescents prescribed stimulant medication for ADHD within a large specialist urban inner-city Child and Adolescent Mental Health Service (CAMHS) in South London and Maudsley NHS Foundation Trust. Baseline data were obtained to establish the quality of physical monitoring including blood pressure, height, weight and centiles. Targeted interventions included the development of a novel web-based application designed to calculate and record centiles. We report an improvement in total proportion compliance with physical health monitoring from 24% to 75%. The frequency of recording baseline blood pressure centiles increased from 0% to 62%; recording baseline height centiles increased from 37% to 81% and recording baseline weight centiles increased from 37% to 81%. Improvement in the delivery of high-quality care was achieved and sustained through close collaboration with clinicians involved in the treatment pathway in order to elicit and respond effectively to feedback for improvement and codevelop interventions which were highly effective within the clinical system. We believe this model to be replicable in other CAMHS services and ADHD clinics to improve the delivery of high-quality clinical care.

scholarly journals Clinical audit of cardio-metabolic monitoring in people with intellectual disability (PWID) taking antipsychotic medication

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S88
Author(s):  
Sandar Kyaw ◽  
Fadzlien Bintizahari ◽  
Peter Speight
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Intellectual Disability ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Clinical Audit ◽  
Successful Implementation ◽  
Close Monitoring ◽  
Metabolic Monitoring ◽  
The Impact

AimsTo ensure close monitoring of physical health parameters when antipsychotics are prescribed and to liaise with primary care to ensure appropriate interventions are implemented.BackgroundAntipsychotics are the most frequently prescribed psychotropic medication for PwID. Treatment with antipsychotic agent is associated with cardio-metabolic risks such as obesity, diabetes, and dyslipidemia. A strong association is well documented between antipsychotic use and the risk of stroke in schizophrenia although the magnitude of this association has yet to be studied in PwID.PwID have an increased risk of premature death. Cardio-metabolic monitoring and appropriate intervention to this vulnerable cohort will improve the preventable cardio-metabolic multi-morbidity. The NICE guideline (CG11) recommends antipsychotic medication should only be initially prescribed and monitored by the secondary care professionals for at least 12 months. They also should work together with primary care to ensure appropriate interventions are arranged where necessary.MethodA retrospective audit was performed for 40 service users, taking antipsychotic medication. Quota sampling was used to identify 10 cases each from the caseload of 4 consultant psychiatrists, within the Intellectual Disability community setting, between September 2019 and October 2019.An audit tool was designed, in accordance with cardio-metabolic measures (smoking status, height, weight, Blood Pressure, HbA1c, Lipid profile), based on physical health CQUIN targets and the Lester adaptation tool. Collection of data was performed from electronic case records and electronic blood results service. The work was performed with the approval of local clinical audit team and analysed by using Microsoft Excel.ResultBaseline cardio-metabolic assessment was observed in over a half of the sample population (50–65%) whilst only less than 15% was noted at 3–6 months. Documentation Evaluation of physical health assessments for new admissions to the Oleaster during the first wave of COVID-19 on body weight and blood pressure was seen only in 15% and 2.5% of population respectively at 3–6 months. Collaboration with GP for annual health check was observed in 78–100% of population.Intriguingly, our finding indicates a significant improvement in all required compliance when nursing team is involved.ConclusionImproving physical healthcare is essential to reduce the cardio metabolic outcome in PwID taking antipsychotic medication. Better involvement of community nurses as well as availability of Sphygmomanometers at every outpatient clinic will determine the successful implementation of cardio metabolic monitoring and effective collaboration with primary care clinicians.Once the action plan is disseminated to the teams, the impact of change will be reassessed by a re-audit in one year's time.

Historical Loss: Implications for Health of American Indians in the Blackfeet Community

2021 ◽  
Author(s):  
Neha A John-Henderson ◽  
Benjamin Oosterhoff ◽  
Taylor D Kampf ◽  
Brad Hall ◽  
Lester R Johnson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Physical Health ◽  
Psychological Stress ◽  
American Indians ◽  
Ambulatory Blood Pressure ◽  
Community Based Participatory Research ◽  
Linear Regression Models ◽  
Historical Loss ◽  
Blackfeet Reservation ◽  
Relevant Covariates

Abstract Background Historical loss in American Indians (AIs) is believed to contribute to high incidence of mental health disorders, yet less is known about the associations between historical loss and physical health. Purpose To investigate whether frequency of thought about historical loss predicts risk factors for chronic physical health conditions in an AI community. Methods Using Community Based Participatory research (CBPR) and Ecological Momentary Assessment (EMA), we measured frequency of thoughts about historical loss in 100 AI adults residing on the Blackfeet reservation. Participants completed a 1-week monitoring period, during which ambulatory blood pressure and daily levels of psychological stress were measured. At the end of the week, we collected a dried blood spot sample for measurement of C-reactive protein (CRP). Results In hierarchical linear regression models controlling for demographics and relevant covariates, greater frequency of thoughts about historical loss predicted higher average daily psychological stress (B = .55, t = 6.47, p < .001, ΔR2 = .30) and higher levels of CRP (B = .33, t = 3.93, p < .001, ΔR2 = .10). Using linear mixed modeling with relevant covariates, we found that greater thoughts about historical loss were associated with higher systolic ambulatory blood pressure (B = .32, 95% CI = .22–.42, t = 6.48, p < .001, ΔR2 = .25; Fig. 1c) and greater diastolic ambulatory blood pressure (B = .19, 95% CI = .11–.27, t = 4.73, p < .001, ΔR2 = .19). Conclusions The data suggest that frequency of thought about historical loss may contribute to increased subclinical risk for cardiovascular disease in the Blackfeet community.

scholarly journals Do you mind if I take your blood pressure? Physical health monitoring of children and young people on ADHD medication amidst a pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S183-S184
Author(s):  
Emma Davies ◽  
Maham Khan ◽  
Claire Jones
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Young People ◽  
Physical Health ◽  
Health Monitoring ◽  
Neurodevelopmental Disorder ◽  
Adhd Medication ◽  
Children And Young People ◽  
Nice Guidance ◽  
The Impact

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

scholarly journals Audit of physical health monitoring during initiation and ongoing treatment with antipsychotic medication in a tier 3 outpatient CAMHS service, Belfast

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S323-S324
Author(s):  
Pam Hamlyn ◽  
Aaron McMenamin ◽  
Hilary Boyd ◽  
Lara Patton
Keyword(s):  
Young People ◽  
Physical Health ◽  
Antipsychotic Medication ◽  
Health Monitoring ◽  
Care Pathway ◽  
Electronic System ◽  
Clinical Notes ◽  
Medication Monitoring ◽  
Tier 3 ◽  
Health Parameters

AimsTo evidence that physical health monitoring during antipsychotic initiation and continued treatment within the Child and Family Clinic is current, as per the agreed Antipsychotic Medication Monitoring Schedule for Belfast Trust CAMHS (2015), supporting Quality Network for Community CAMHS(QNCC) accreditation.BackgroundThe Antipsychotic Medication Monitoring Schedule CAMHS(2015) was agreed by a working group of consultant psychiatrists and pharmacists, based on evidence from The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMSEA), NICE Guidelines CG 185(2014), CG155(2013) and Maudsley Guidelines, and was to be located on the electronic system (PARIS).MethodIn January 2019, a list of all children/young people on antipsychotic medication was collated (n = 12). Presence of the monitoring schedule in the clinical notes or PARIS was recorded. The Electronic Care Record was reviewed for blood results and PARIS letters for documentation of physical health parameters (heart rate, blood pressure, height, weight, BMI, extrapyramidal side effects, ECG) and to identify documentation of risk/benefit review where monitoring was declined. Re-audit January 2020 (n = 9). Criteria:All patients commenced on antipsychotic medication will have baseline blood investigations and other physical health parameters documented as per the monitoring schedule. If monitoring was declined, the reason for this and indications for prescribing must be documented as a risk/benefit analysis.All patients on antipsychotic medication will be current with their physical health Monitoring Schedule.All patients will have their Monitoring Schedule completed in clinical notes or on PARIS.ResultFirst cycle results (n = 12):Baseline bloods (or documented declined) = 92%, Baseline ECG (or documented declined) = 75%Complete monitoring bloods = 33%, Physical health monitoring parameters complete = 42%Monitoring schedule present in the notes and current = 42% (0% on PARIS).Initial Recommendations: Standardised recording of monitoring using PARIS clinic letters and the schedule in front of clinical notes; Baseline ECG mandatorySecond cycle results (n = 9):Baseline bloods (or declined) = 89%, Baseline ECG (or declined) = 67%Complete monitoring bloods = 44%, Physical health monitoring parameters complete = 56%Monitoring schedule present in notes and current = 38%, Present, not current = 50% (0% on PARIS).ConclusionLower numbers at re-audit limit interpretation.Further recommendations: Antipsychotic initiation checklist; Central bloods diary for clinicians; Antipsychotic care-pathway booklet, co-produced with young people, incorporating the monitoring schedule.

scholarly journals Reduction of stress and blood pressure with meditation therapy in elderly groups in balai pelayanan sosial tresna werdha (BPSTW) in Yogyakarta

2019 ◽  
Vol 1 (1) ◽  
pp. 31-38
Author(s):  
Fajarina Lathu A
Keyword(s):  
Blood Pressure ◽  
Physical Health ◽  
Stress Measurement ◽  
Intervention Group ◽  
The Elderly ◽  
Nursing Intervention ◽  
Health Problems ◽  
Control Group ◽  
Depression Anxiety Stress Scale ◽  
Physical Health Problems

Stress in elderly institution residents is an interesting phenomenon to study. Sustained stress in the elderly can be harmful and cause mental and physical health problems. Hypertension is one of the physical health problems that can result from stress. Nursing Intervention Classification 2013 recommends the use of Meditation Therapy to address the problem. Meditation is a self-directed exercise to relax and calm the mind, besides that meditation is an easy and inexpensive activity. This certainly provides benefits for the institution in caring for the elderly. Less information on meditation therapy, challenging nurses to perform scientific verification.Scientific proof of reduced stress and blood pressure in elderly groups at the Balap Pelayanan Tresna Werdha (BPSTW) in Yogyakarta This research is a quasy experiment with pretest and posttest with control group. The treatment group was given meditation therapy for 7 times a week, while the control group was not given treatment. Respondents were selected using simple random sampling. Stress measurement using the DASS (Depression Anxiety Stress Scale) and blood pressure were measured using a digital sphygmomanometer. The stress in intervention group of elderly after being treated results decreased by 1.8, whereas in the control group it increased by 0.029. The systole blood pressure in the intervention group of elderly decreased 6.257 mmHg and 0.457 mmHg in the control group. When the elderly diastole blood pressure in the intervention group experienced an average decrease of 3.4 mmHg, while in the control group it increased by 1.057 mmHg. Conclusion: Meditation therapy is significant for reducing stress and blood pressure in the elderly at the Balai Pelayanan Tresna Werdha (BPSTW) in Yogyakarta

scholarly journals Beta Inflated Regression Models on the Physical and Mental Health of Nigerian Stroke Survivors

2021 ◽  
Vol 7 (3) ◽  
pp. 302-312
Author(s):  
KS Oritogun ◽  
OO Oyewole
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Blood Pressure ◽  
Health Risk ◽  
Physical Health ◽  
Regression Models ◽  
Outcome Variable ◽  
Stroke Survivors ◽  
Physical And Mental Health ◽  
Health Risk Factors

Background: Stroke is one of the major public health problems worldwide. Physical and mental health data of stroke survivors are often expressed in proportions. Therefore, the Beta Regression models family for data between zero and one will be appropriate. Objectives: To identify a suitable model and the likely risk factors of physical and mental health of stroke survivors. Method: Secondary data of stroke survivors from two tertiary health Institutions in Ogun State, Nigeria, were analysed. Inflated Beta (BEINF) and Inflated-at-one-Beta (BEINF1) models were compared using Deviance (DEV), Akaike Information Criterion (AIC) and Bayesian Information Criteria (BIC) for model selection. The model with minimum DEV, AIC and BIC was considered to be better. Results: The deviance (-86.0604,), AIC (-46.0604) and BIC (6.4391) values of the BEINF1 model for physical health and the deviance (-20.1217), AIC (19.8783) and BIC (72.3778) values of BEINF1 model for mental health were smaller than BEINF models. Therefore, BEINF1 was the better model to identify the health risk factors of stroke survivors. Age, marital status, diastolic blood pressure, disability duration and systolic blood pressure had a significant association with physical health, while BMI had a significant positive association with mental health.  Conclusion: The beta-inflated-at-one (BEINF1) model is suitable for identifying health risk factors of stroke survivors when the outcome variable is a proportion. Both demographic and clinical characteristics were significantly associated with the health of stroke survivors. This study would assist researchers in knowing the appropriate model for analysing proportion or percentage response variables.

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.

Ensuring patient safety: Physical health monitoring in rapid tranquillisation for aggression and violence of adult acute inpatients

2016 ◽  
Vol 33 (S1) ◽  
pp. S170-S171 ◽  
Author(s):  
R. Talukdar ◽  
M. Ludlam ◽  
L. Pout ◽  
N.P. Lekka
Keyword(s):  
Patient Safety ◽  
Physical Health ◽  
Health Monitoring ◽  
Improve Patient Safety ◽  
Further Education ◽  
Local Policy ◽  
Nice Guideline ◽  
Level Of Consciousness ◽  
Competing Interest ◽  
Monitoring Protocols

IntroductionIntramuscular (IM) medications used in rapid tranquillisation (RT) to manage violent/aggressive behaviour can cause serious physical side effects including sudden death, therefore comprehensive physical health monitoring is advised.ObjectivesTo assess whether physical health monitoring of patients who received IM medication for RT was completed as per the Aggression/Violence NICE-guideline based local Policy.MethodsAll patients that received IM benzodiazepines or antipsychotics for RT were identified amongst 822 discharges from February 2014 to February 2015. Demographics, diagnoses, non-pharmacological interventions, types/doses of medication, and associated seclusion/restraint episodes were recorded. Notes were examined to determine whether physical health monitoring protocols involving blood pressure, pulse, temperature, oxygen saturation, respiratory rate and level of consciousness were followed.ResultsThere were a total of 218 episodes where these medications were used, in which only 19 (8.8%) had any physical observations completed; only one case (0.5%) was completed fully as per the protocol. Of the cases that did not have observations taken, in 12 (5.5%) cases observations were attempted but the patient was too agitated/aggressive. A doctor was contacted in only 53 (24.3%) cases and an ECG was completed in 120 (55%) cases, of which only 11 were completed within 24 hours.ConclusionsThe results show poor compliance (or at least recording) with the guidance, demonstrating the need for further education of nursing and medical staff on the potential dangers of RT and for better physical health monitoring of patients on RT. To improve patient safety, staff training and well-timed recording of physical observations on electronic tablets will commence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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