Physical health monitoring in antipsychotic depot clinic

AimsA service evaluation project to look at if annual bloods, ECG, physical examination, and medical review was completed within the last year for patients attending anti-psychotic depot clinic at Bassetlaw mental health services in Nottinghamshire HealthCare NHS Foundation Trust.MethodElectronic notes were examined in October 2020 for 25 patients who attend anti-psychotic depot clinic to ascertain if medical review and physical examination had been completed along with annual bloods and ECG.ResultOut of 25 patients attending depot clinic in 2020 at Bassetlaw Hospital, 21 had all their blood tests done, 1 patient had refused bloods and 2 patients did not have blood tests done. ECG was completed for 3 patients at Bassetlaw hospital and 8 patients had it requested from primary care with 2 patients refusing to have ECG done. For 12 patients there was no evidence of ECG being requested or completed. 8 patients had physical examination completed and rest 17 patients did not have the physical examination completed including due to refusal. Out of 25, only 14 patients had a medical review conducted.ConclusionPatients who attend depot clinic may have an allocated community psychiatric nurse (CPN) or get reviewed by medics in outpatient clinics and would usually have their blood tests, physical health examination and ECGs requested and monitored by them. Patients who do not have any allocated CPN or medic tend to miss out on blood tests and ECG. General Practitioners are expected to complete physical health checks for patients who do not have CPN or regular outpatient review. The results of these investigations may not always be received in depot clinic, hence there is no documentation on electronic RIO system. When these patients disengage from the depot clinic, it is often very difficult to track them. As a follow-up from this service evaluation, all depot clinic patients will be allocated a key worker/CPN. This will ensure that they have a responsible person to facilitate annual checks. This will be reviewed in a years' time to evaluate the effectiveness of this intervention.

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

BJPsych Open ◽

10.1192/bjo.2021.805 ◽

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.

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Annual physical health checks within a forensic inpatient service

BJPsych Open ◽

10.1192/bjo.2021.232 ◽

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.

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Validation and reliability of a simplified food frequency questionnaire:A cross sectional study among physical health examination adults in southwest region of China

10.21203/rs.2.23239/v2 ◽

2020 ◽

Author(s):

Zhengyan Cheng ◽

Ping Shuai ◽

Qichuan Qiao ◽

Tingxin Li

Keyword(s):

Physical Examination ◽

Physical Health ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Cross Sectional Study ◽

Health Examination ◽

Sectional Study ◽

Cross Sectional ◽

Food Frequency ◽

Southwest Region

Abstract Background: In China, many people are apt to participate in regular physical examination as a prevention. Some simplified food frequency questionnaire have been designed and used. However, the accuracy of questionnaire is absent. This study was conducted to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among physical examination adults in southwest region of China.Methods: This study was a cross sectional study among physical health examination adults in Southwest region of China. A total of 239 participants aged 20-65 were conducted during February to June in 2019. The performance of the SFFQ was evaluated by the mean of three-day 24-hour dietary record (3R24). The relative validity and agreement was assessed by the Pearson`s correlation and intra-class correlation coefficients(ICC) respectively. Results: The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49-0.73) and the ICC of nutrients was 0.47(range: 0.39-0.76). The Pearson correlation showed the validity between the SFFQ1 and 3R24, which ranged from -0.086 to 0.93 for food and and 0.21 to 0.71 for nutritions, respectively. Energy-adjustment slightly increased the correlation coefficients.Conclusions: The reliability and validity of the SFFQ was acceptable. It could be an appropriate dietary assessment tool for future epidemiological studies among physical health examination adults in southwest China.Trial registration:CHiCTR, ChiCTR1900020934, Registered 22 January 2019, http://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.

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Validity and reliability of a simplified food frequency questionnaire: A cross sectional study among physical health examination adults in southwest region of China

10.21203/rs.2.23239/v3 ◽

2020 ◽

Author(s):

Zhengyan Cheng ◽

Ping Shuai ◽

Qichuan Qiao ◽

Tingxin Li

Keyword(s):

Physical Examination ◽

Physical Health ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Cross Sectional Study ◽

Health Examination ◽

Sectional Study ◽

Cross Sectional ◽

Food Frequency ◽

Southwest Region

Abstract Background: In China, many people are suitable for participating in regular physical examination for prevention. Some simplified food frequency questionnaires have been designed and used. However, the accuracy of questionnaire is absent. This study aimed to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among physical examination adults in southwest region of China.Methods: This was a cross-sectional study conducted among physical health examination adults in Southwest region of China. A total of 239 participants aged 20-65 were included from February 2019 to June 2019. The performance of SFFQ was evaluated by means of a three-day 24-hour dietary record (3R24). The relative validity and agreement was assessed by Pearson`s correlation and intra-class correlation coefficients (ICC), respectively. Results: The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49-0.73) and the ICC of nutrients was 0.47(range: 0.39-0.76). The Pearson correlation showed a validity between SFFQ1 and 3R24, which ranged from -0.086 to 0.93 for food and 0.21 to 0.71 for nutrition, respectively. The energy-adjustment slightly increased the correlation coefficients.Conclusions: The reliability and validity of SFFQ was acceptable. It could be an appropriate dietary assessment tool for future epidemiological studies among physical health examination adults in southwest China.Trial registration:CHiCTR, ChiCTR1900020934, Registered 22 January 2019, http://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.

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

BJPsych Open ◽

10.1192/bjo.2021.593 ◽

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.

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

BJPsych Open ◽

10.1192/bjo.2021.930 ◽

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.

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Physical health of patients under EIP - a service evaluation

BJPsych Open ◽

10.1192/bjo.2021.897 ◽

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.

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Validity and reliability of a simplified food frequency questionnaire: a cross sectional study among physical health examination adults in southwest region of China

Nutrition Journal ◽

10.1186/s12937-020-00630-z ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Zhengyan Cheng ◽

Ping Shuai ◽

Qichuan Qiao ◽

Tingxin Li

Keyword(s):

Physical Examination ◽

Physical Health ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Cross Sectional Study ◽

Health Examination ◽

Sectional Study ◽

Cross Sectional ◽

Food Frequency ◽

Southwest Region

Abstract Background In China, many people are regarded suitable for participating in regular physical examination for diagnosis and prevention of diseases. Some simplified food frequency questionnaires have been designed and used; however, the accuracy of the questionnaire is absent. This study aimed to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among adults undergoing physical examination in southwest region of China. Methods This was a cross-sectional study conducted among physical health examination adults in the Southwest region of China. A total of 239 participants aged 20–65 were included from February 2019 to June 2019. The performance of SFFQ was evaluated by means of a three-day 24-h dietary record (3R24). The relative validity and agreement was assessed by Pearson’s correlation and intra-class correlation coefficients (ICC), respectively. Results The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49–0.73) and the ICC of nutrients was 0.47(range: 0.39–0.76). The Pearson correlation showed a valid comparisons between SFFQ1 and 3R24, ranging from -0.086 to 0.93 for food and 0.21 to 0.71 for nutrition, respectively. The energy-adjustment slightly increased the correlation coefficients. Conclusions The reliability and validity of SFFQ was acceptable, and it could be an appropriate dietary assessment tool for the future epidemiological studies conducted among physical health examination adults of southwest China. Trial registration CHiCTR, ChiCTR1900020934, Registered 22 January 2019, https://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.

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Validity and reliability of a simplified food frequency questionnaire: A cross sectional study among physical health examination adults in southwest region of China

10.21203/rs.2.23239/v4 ◽

2020 ◽

Author(s):

Zhengyan Cheng ◽

Ping Shuai ◽

Qichuan Qiao ◽

Tingxin Li

Keyword(s):

Physical Examination ◽

Physical Health ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Cross Sectional Study ◽

Health Examination ◽

Sectional Study ◽

Cross Sectional ◽

Food Frequency ◽

Southwest Region

Abstract Background: In China, many people are regarded suitable for participating in regular physical examination for diagnosis and prevention of diseases. Some simplified food frequency questionnaires have been designed and used; however, the accuracy of the questionnaire is absent. This study aimed to examine the reliability and validity of simplified food frequency questionnaire (SFFQ) used among adults undergoing physical examination in southwest region of China.Methods: This was a cross-sectional study conducted among physical health examination adults in the Southwest region of China. A total of 239 participants aged 20-65 were included from February 2019 to June 2019. The performance of SFFQ was evaluated by means of a three-day 24-hour dietary record (3R24). The relative validity and agreement was assessed by Pearson’s correlation and intra-class correlation coefficients (ICC), respectively.Results: The median energy-adjusted ICC of food groups between SFFQ2 and SFFQ1 was 0.59 (range: 0.49-0.73) and the ICC of nutrients was 0.47(range: 0.39-0.76). The Pearson correlation showed a valid comparisons between SFFQ1 and 3R24, ranging from -0.086 to 0.93 for food and 0.21 to 0.71 for nutrition, respectively. The energy-adjustment slightly increased the correlation coefficients.Conclusions: The reliability and validity of SFFQ was acceptable, and it could be an appropriate dietary assessment tool for the future epidemiological studies conducted among physical health examination adults of southwest China.Trial registration:CHiCTR, ChiCTR1900020934, Registered 22 January 2019, http://www.chictr.org.cn/edit.aspx?pid=35414&htm=4.

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

BJPsych Open ◽

10.1192/bjo.2021.501 ◽

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.

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