Advanced nurse practitioners- the missing link on old age pyschiatry inpatient wards?

Aims1. This project aimed to review the medical cover available to an Old Age Psychiatry inpatient ward.2. To discuss with ward staff their view for potential improvements and areas of clinical development.3. To review the potential of a Full Time Nurse Practitioner role on the ward.One junior doctor (CT1 or equivalent) was allocated to cover the ward whilst balancing their other training needs and clinical commitments. The inpatient ward was based in a community hospital with no onsite medical team. The patients mostly had complex medical needs and multiple comorbidities.MethodThe Junior Doctor's timetable and the time allocated to the ward was reviewed. Questionnaires were conducted with nursing staff to assess their views on the support of physical health cover. The patient notes were analysed for the time taken to review patients after falls over a one month period.ResultThere were 14.5hours allocated to ward cover. An additional 4 hours was provided by another visiting junior doctor totalling 18.5hours per week- 11% of the time. This figure does not account for annual leave, on call commitments or study days whereby there was no additional cover.A short survey completed by ward staff showed- (1 = Very Poor/Difficult 5 = Excellent/Easy) •They rated medical cover of physical health needs on ward 7 as 1.3.•They found contacting a Doctor to discuss a physical problem as 1.7- with particular concern for OOH.•It was rated to be extremely difficult for a same day review of physical health problems- 1.7•It was rated extremely difficult to get a physical review following a fall on ward 7- 1.4•Continuity of care for the patients on ward 7 was rated as 1.6.The patient case files reviewed over a one month period showed x8 falls. These took on average 14 hours before having a review.ConclusionMedical cover for the old age psychiatry inpatient ward was inconsistent and a challenge for a single trainee to manage alongside their other clinical commitments and training needs. A case was proposed to management with an SBAR for a Full Time Advanced Nurse Practitioner which has been approved. This role should provide patients with appropriate cover of their physical health needs. It will allow the junior doctor to work alongside them on the ward supporting each other to provide optimal care for the inpatients.

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Recruitment into old age psychiatry

BJPsych Bulletin ◽

10.1192/bjb.2018.112 ◽

2019 ◽

Vol 43 (3) ◽

pp. 131-135 ◽

Cited By ~ 2

Author(s):

Lynsey McAlpine ◽

Alex Bailey ◽

Kate Milward ◽

Charlotte Blewett

Keyword(s):

Physical Health ◽

Old Age ◽

Thematic Analysis ◽

Social Care ◽

Health Needs ◽

Recruitment Strategy ◽

Factors Affecting ◽

Qualitative Survey ◽

Old Age Psychiatry ◽

The Uk

This research aimed to explore the trainee perspective on factors affecting recruitment into old age psychiatry higher training in the UK. A qualitative survey was created by the Faculty of Old Age Psychiatry and distributed to current higher trainees in all psychiatric subspecialties. A total of 324 higher trainees responded to the survey, representing a broad demographic range. Thematic analysis was carried out, with sufficient responses to achieve saturation. Key themes included concerns about the future of the specialty, issues with social care, lack of support with patients’ physical health needs, issues with training posts, and workload. The need to improve core trainees’ experience of the specialty was highlighted. Many positive themes arose from the data; however, a number of barriers to recruitment were also identified. The findings have implications for recruitment to the specialty and should be used to inform recruitment strategy moving forward.Declaration of interestNone.

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Clinicians' attitudes to spirituality in old age psychiatry

International Psychogeriatrics ◽

10.1017/s1041610206004339 ◽

2006 ◽

Vol 19 (5) ◽

pp. 962-973 ◽

Cited By ~ 16

Author(s):

Robert M. Lawrence ◽

Julia Head ◽

Georgina Christodoulou ◽

Biljana Andonovska ◽

Samina Karamat ◽

...

Keyword(s):

Mental Health ◽

Older People ◽

Old Age ◽

Spiritual Care ◽

Health Needs ◽

Mental Health Needs ◽

Care Services ◽

The United Kingdom ◽

Old Age Psychiatry ◽

Chaplaincy Service

Background: The aim of this survey is to investigate professional attitudes to the presence and value of spiritual care from Old Age Psychiatrists.Method: All registered members of the Faculty of the Psychiatry of Old Age in the United Kingdom were asked to complete a 21-question semi-structured questionnaire. The first mail shot took place in 2002 and the second mail shot to non-respondents in 2003. Quantitative and qualitative analyses were carried out on the answers received.Results: The response rate was 46%. The majority of respondents (92%) recognize the importance of spiritual dimensions of care for older people with mental health needs and about a quarter of respondents appear to consider referring patients to the chaplaincy service. In contrast, integration of spiritual advisors within the assessment and management of individual cases is rare.Conclusions: Opinions vary as to whether provision of spiritual care should become widely available to older people with mental health needs who are admitted to hospital. Old age psychiatrists recognize that awareness of spiritual dimensions may be important for their patients. They seem less clear about the role of spiritual advisors and how NHS multidisciplinary clinical teams and spiritual and pastoral care services can be best integrated. Much work needs to be done on developing effective training and operational policies in this area.

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Ethical dilemmas in old age psychiatry

Psychiatric Bulletin ◽

10.1192/pb.18.9.541 ◽

1994 ◽

Vol 18 (9) ◽

pp. 541-544 ◽

Cited By ~ 1

Author(s):

Catherine Oppenheimer ◽

Gwen Adshead ◽

Jeanette Smith

Keyword(s):

Old Age ◽

Ethical Dilemmas ◽

The Elderly ◽

Health Needs ◽

Financial Responsibility ◽

Financial Interests ◽

Old Age Psychiatry

Patients and their relatives sometimes make what to others appear to be unfortunate decisions. In this paper the ethical dilemmas raised by such decisions in the context of old age psychiatry are examined. The case also raises questions about financial responsibility for the care of the elderly and suggests that the health needs of patients can no longer be separated from their financial interests.

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Speech therapy for psychogeriatric services

Psychiatric Bulletin ◽

10.1192/pb.13.2.57 ◽

1989 ◽

Vol 13 (2) ◽

pp. 57-59 ◽

Cited By ~ 3

Author(s):

Helen Griffiths ◽

Bob Baldwin

Keyword(s):

Old Age ◽

Mentally Ill ◽

Health Authority ◽

Speech Therapy ◽

The Elderly ◽

Full Time ◽

Team Working ◽

Old Age Psychiatry ◽

Time Position ◽

Speech Therapist

A psychogeriatrician was recently given the opportunity of five sessions of speech therapy for his service. His response was that he had no need of a speech therapist as he was perfectly well able to do his own assessment of dysphasia. This attitude is perhaps understandable since there has been so little exposure to the skills of speech therapists within this clinical field. In 1985 a full-time speech therapist was appointed by Central Manchester Health Authority to be part of the multidisciplinary team working in old age psychiatry. At the time this was, to our knowledge, the first full-time position of its kind. This article reviews progress thus far and outlines the contribution of speech therapy skills to the management of the elderly mentally ill.

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Improving physical health assessment of old age inpatients on the Oaks Acute Admission Ward

BJPsych Open ◽

10.1192/bjo.2021.536 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S200-S200

Author(s):

Dr Karen Aus ◽

Marilia Gougoulaki ◽

Maja Elia ◽

Emily Wall

Keyword(s):

Vitamin D ◽

Physical Health ◽

Old Age ◽

Thyroid Function ◽

Health Assessment ◽

Glycated Haemoglobin ◽

Cognitive Testing ◽

Full Blood Count ◽

Improvement Project ◽

Old Age Psychiatry

AimsOld age psychiatry patients are subject to increased frailty, comorbid load and medication adverse events than equivalent older age populations without psychiatric illness. Timely physical health assessment and monitoring is therefore an essential part of treatment provision. The Oaks is a 20-bed old age acute admissions ward in Barnet, Enfield and Haringey Mental Health Trust. With this quality improvement project, we aimed to deliver high-quality assessment and treatment of physical health for our patients.MethodUsing NICE guidelines as a blueprint, we devised a list of parameters essential to the management of old age inpatients. This included blood tests (full blood count, urea and electrolytes, liver function, thyroid function, cholesterol, lipids, iron studies, vitamin D, glycated haemoglobin, prolactin), investigations (imaging, ECG, physical examination, cognitive testing) and assessments (body mass index [BMI], functional review, mobility, Rockwood Frailty Score). The implementation goal was to ensure all parameters were acted on within 24 hours of admission (or 48 hours for patients admitted on weekends).We initially audited these parameters in patients admitted to the Oaks in October and November 2020 (n = 24). We subsequently collated all parameters into an online spreadsheet, which was distributed to ward medical staff. For each new admission, parameters could be marked as pending or complete. The spreadsheet was reviewed in daily ward handover. Following implementation, we collected data on the parameters for patients admitted in December 2020 and January 2021 (n = 16).ResultPrior to implementation of the spreadsheet, 42.0% of all parameters had been actioned within 24 hours of admission. Following the implementation of the spreadsheet, 86.2% of parameters had been actioned within 24 hours (mean difference 44.2%, 95% CI 13.5% to 64%, p = 0.006).In detail, there were significant increases in timely actioning of magnesium (increased by 61.7%, p < 0.001), cholesterol (61.7%, p < 0.001), glycated haemoglobin (65.8%, p < 0.001), vitamin D (65.8%. p < 0.001), prolactin (61.7% p < 0.001), lipids (61.7%, p < 0.001), thyroid function (51.7%, p < 0.01), iron studies (80.9%, p < 0.001), imaging (42.5%, p = 0.01), frailty scores (60.0%, p < 0.01), BMI measurement (55.9%, p < 0.001), and functional review (42.5%, p = 0.01).ConclusionImplementation of a monitoring spreadsheet with relevant parameters linked to daily ward handover resulted in widespread and significant improvement in the assessment of physical health among old age psychiatry inpatients.

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