scholarly journals Developing Best Practice Guidance for Discharge Planning Using the RAND/UCLA Appropriateness Method

2021 ◽  
Vol 12 ◽  
Author(s):  
Natasha Tyler ◽  
Claire Planner ◽  
Matthew Byrne ◽  
Thomas Blakeman ◽  
Richard N. Keers ◽  
...  
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Discharge Planning ◽  
Patient Flow ◽  
Psychiatric Nurses ◽  
Online Questionnaire ◽  
Post Discharge ◽  
Discharge Care ◽  
Senior Clinician ◽  
Mental Health Settings

Background: Discharge from acute mental health inpatient units is often a vulnerable period for patients. Multiple professionals and agencies are involved and processes and procedures are not standardized, often resulting in communication delays and co-ordination failures. Early and appropriate discharge planning and standardization of procedures could make inpatient care safer.Aim: To inform the development of a multi-component best practice guidance for discharge planning (including the 6 component SAFER patient flow bundle) to support safer patient transition from mental health hospitals to the community.Methods: Using the RAND/UCLA Appropriateness method, a panel of 10 professional stakeholders (psychiatrists, psychiatric nurses, clinical psychologists, pharmacists, academics, and policy makers) rated evidence-based statements. Six hundred and sixty-eight statements corresponding to 10 potential components of discharge planning best practice were rated on a 9-point integer scale for clarity, appropriateness and feasibility (median ≥ 7–9) using an online questionnaire then remote online face-to-face meetings.Results: Five of the six “SAFER” patient flow bundle components were appropriate and feasible for inpatient mental health. One component, “Early Flow,” was rated inappropriate as mental health settings require more flexibility. Overall, 285 statements were rated as appropriate and feasible. Forty-four statements were considered appropriate but not feasible to implement.Discussion: This consensus study has identified components of a best practice guidance/intervention for discharge planning for UK mental health settings. Although some components describe processes that already happen in everyday clinical interactions (i.e., review by a senior clinician), standardizing such processes could have important safety benefits alongside a tailored and timely approach to post-discharge care.

Anxiety Disorders’ Effect on College and University Students’ Mental Health: A Common and Growing Concern

2020 ◽  
Vol 9 (2) ◽  
pp. 82-90
Author(s):  
Matthew J. Pesko
Keyword(s):  
Mental Health ◽  
Anxiety Disorders ◽  
University Students ◽  
Best Practice ◽  
Epidemiological Studies ◽  
Student Population ◽  
Adult Student ◽  
College And University ◽  
The Past ◽  
Mental Health Settings

Anxiety disorders are commonly experienced by college and university students and should be routinely assessed in mental health settings. Epidemiological studies suggest that the burden of these illnesses has greatly expanded even over the past decade. Factors that contribute to the experience of an anxiety disorder in a young adult student population are considered herein. The best practice for evaluation and treatment of these disorders is presented based on the review of available literature in this field. Special attention is paid to the concept of resilience as it pertains to anxiety disorders in the student population.

scholarly journals A qualitative comparison of experiences of specialist mother and baby units versus general psychiatric wards

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jessica Griffiths ◽  
Billie Lever Taylor ◽  
Nicola Morant ◽  
Debra Bick ◽  
Louise M. Howard ◽  
...  
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Mental Health Problems ◽  
Perinatal Period ◽  
Psychiatric Ward ◽  
Structured Interviews ◽  
Post Discharge ◽  
Qualitative Comparison ◽  
Inpatient Settings ◽  
Perinatal Services

Abstract Background Mother and baby units (MBUs) are an inpatient mental health service where women experiencing acute severe postpartum psychiatric difficulties can be admitted with their babies. They are currently viewed as best practice in the UK and elsewhere. However, as service provision is fragmented, some women residing in areas without MBUs are admitted to acute general psychiatric wards without their infants. This study aimed to compare qualitatively experiences of these two service types from the perspectives of women and clinicians. Methods Semi-structured interviews were conducted with fifteen women who received treatment for perinatal mental health problems on a general psychiatric ward and/or MBU in England. Two focus groups were also conducted, one with MBU staff (n = 11) and one with acute ward staff (n = 6). Data were analysed thematically. Results Women generally preferred being co-admitted with their baby to an MBU over lone admission to a general psychiatric ward. Women and clinicians felt that MBUs provided more perinatally-focused, family-centred care, and were better-equipped to meet women’s needs. General wards were reported by women and staff to lack the necessary facilities and expertise to support perinatal women adequately, while separation of mothers and babies was often experienced by women as traumatic and detrimental to recovery. However, some areas for improvement were also identified across both service types, particularly relating to difficulties transitioning home post-discharge, inadequate support for family members, staffing issues and access problems (with MBUs). Conclusions Findings suggest that specialist perinatal inpatient care is considered preferable to generic care in the perinatal period from both service user and staff perspectives. Increased collaboration between perinatal and non-perinatal services could help improve perinatal expertise on general psychiatric wards, while further expansion of perinatal services (e.g. to cater for women currently considered too high risk for MBUs and for those discharged from inpatient settings) could tackle other shortfalls in care.

A charter for trainers in the prevention and management of workplace violence in mental health settings

2014 ◽  
Vol 9 (2) ◽  
pp. 101-108
Author(s):  
Brodie Paterson ◽  
Kevin McKenna ◽  
Vaughan Bowie
Keyword(s):  
Mental Health ◽  
Workplace Violence ◽  
Delphi Study ◽  
Best Practice ◽  
Content Type ◽  
Ethical Implications ◽  
Mental Health Settings ◽  
High Level ◽  
Level Of Agreement ◽  
Reference Document

Purpose – The purpose of this paper is to present the results of a Delphi study of trainers in the prevention and safer management of violence in mental health settings that sought to identify and clarify what represents best practice at a European level. Design/methodology/approach – A Delphi method was used to garner the views of a sample of 54 trainers involved in the training of managing violence and aggression on a draft charter of best practice. Findings – A high level of agreement was found with the suggested indicators of best practice but the levels of agreement varied in some key areas and respondents identified a series of omissions from the charter and a number of potential challenges to its implementation. Research limitations/implications – The sample was restricted to Europe and further research is planned to seek the views of a wider sample. Practical implications – The charter will provide a reference document for best practice in the interim. Social implications – Its implementation will require trainers to consciously identify the ethical implications not just of the content of their training buts its overall approach. Originality/value – The study is presently unique in its focus and context but further research in this area is underway designed to complement this study.

Improving outcomes for homeless inpatients in mental health

2018 ◽  
Vol 22 (1) ◽  
pp. 77-90 ◽  
Author(s):  
Zana Khan ◽  
Sophie Koehne ◽  
Philip Haine ◽  
Samantha Dorney-Smith
Keyword(s):  
Mental Health ◽  
Service Development ◽  
Post Discharge ◽  
College Hospital ◽  
Content Type ◽  
Housing Status ◽  
Unscheduled Care ◽  
Mental Health Settings ◽  
Housing Outcomes ◽  
Health Trust

Purpose The purpose of this paper is to describe the delivery of the first clinically led, inter-professional Pathway Homeless team in a mental health trust, within the King’s Health Partners hospitals in South London. The Kings Health Partners Pathway Homeless teams have been operating since January 2014 at Guy’s and St Thomas’ (GStT) and Kings College Hospital and expanded to the South London and Maudsley in 2015 as a charitable pilot, now continuing with short-term funding. Design/methodology/approach This paper outlines how the team delivered its key aim of improving health and housing outcomes for inpatients. It details the service development and integration within a mental health trust incorporating the experience of its sister teams at Kings and GStT. It goes on to show how the service works across multiple hospital sites and is embedded within the Trust’s management structures. Findings Innovations including the transitional arrangements for patients’ post-discharge are described. In the first three years of operation the team saw 237 patients. Improved housing status was achieved in 74 per cent of patients with reduced use of unscheduled care after discharge. Early analysis suggests a statistically significant reduction in bed days and reduced use of unscheduled care. Originality/value The paper suggests that this model serves as an example of person centred, value-based health that is focused on improving care and outcomes for homeless inpatients in mental health settings, with the potential to be rolled-out nationally to other mental health Trusts.

scholarly journals Best practice in managing violence and related risks

2008 ◽  
Vol 32 (11) ◽  
pp. 403-405 ◽  
Author(s):  
Quazi Haque ◽  
Adrian Cree ◽  
Christopher Webster ◽  
Bushra Hasnie
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Mental Health Professionals ◽  
Best Practice ◽  
Good Practice ◽  
Successful Implementation ◽  
Department Of Health ◽  
Mental Health Settings ◽  
Managing Risk ◽  
Principles Of Good Practice

SummaryBest Practice in Managing Risk is a recent Department of Health publication which provides a framework for mental health professionals working with service users to assess risk. It underpins risk assessment with principles of good practice for all mental health settings and provides a list of guides offering structure to risk management. We consider the potential issues that may influence successful implementation of this framework across services based on personal experience in the field of risk assessment.

Hospital discharge: recommendations for performance improvement for family carers of people with dementia

2011 ◽  
Vol 35 (3) ◽  
pp. 364 ◽  
Author(s):  
Leslie R. Fitzgerald ◽  
Michael Bauer ◽  
Susan H. Koch ◽  
Susan J. King
Keyword(s):  
Hospital Discharge ◽  
Health Professionals ◽  
Policy Process ◽  
Best Practice ◽  
Discharge Planning ◽  
Family Carer ◽  
Family Carers ◽  
Post Discharge ◽  
People With Dementia ◽  
The Family

Background. It is acknowledge that discharge planning benefits both consumers and hospitals. What is not widely understood is the experience that the family carer of a person with a dementia has and whether the hospitals meet their in-hospital and post-hospital needs. Objective. To explore whether metropolitan and rural hospital discharge practices meet the needs of the family carer of a person with dementia. Results. Although this and other research indicates that a continuum of care model is beneficial to family caregivers, no evidence has been identified that family carers currently experience this type of quality planning. Family carers were often unaware of the existence of a hospital discharge plan and were rarely engaged in communication about the care of their family member with a dementia or prepared for discharge. Conclusion and recommendations. Discharge planning processes for family carers of people with dementia could be substantially improved. It is recommended that hospitals develop policy, process and procedures that take into account the family carer’s needs, develop key performance indicators and adopt best practice standards that direct discharge planning activities and early engagement of the family carer in healthcare decisions. It is recommended that health professionals be educated on communication, consultation and needs of family carers. What is known about the topic? The literature shows discharge planning can increase in patient and caregiver satisfaction, reduce post-discharge anxiety, reduce unplanned readmissions and reduce post-discharge complications and mortality. To be effective, discharge planning requires interdisciplinary collaboration; yet for people with a dementia there are insufficient system processes to support discharge planning, routine breakdowns in communication between patient, family caregivers and health professionals and inadequate admission and aftercare plans. There is little known about the discharge planning as it effects the family carer’s of people with dementia. What does this paper add? This research provides evidence of the family carer’s experience of metropolitan and rural hospital discharge as it relates to planning, preparation and support. It investigates how well the discharge planning process met the needs of the family carer and what improvements are required if hospital discharge planning is to be more effective. The research identifies a range of initiatives that hospital and health professionals can implement to improve current discharge practices for family carers of people with dementia. What are the implications for practitioners? This report makes recommendations for changes to hospital health systems and the discharge practices of health professionals. Hospitals need to develop policy, process and procedure that take into account family carer’s needs, develop key performance indicators that measure discharge planning practices, and adopt best practice activities that include such items as early engagement of the primary carer’s, the identification of a liaison health professional and implementation of a policy that requires family carers to be involved in and notified of an impending discharge. It is recommended that health professionals be educated on the needs of family carers as it relates to communication and consultation. The primary carer is involved in discussions and decisions about in-hospital and post-hospital treatment regimes and is in agreement with, and competent in, post-discharge treatments, therapies and support services.

scholarly journals The waiting period: Challenges and opportunities to support caregivers and persons with dementia during transitions to long-term care

2021 ◽  
Author(s):  
◽  
Ashley Horner
Keyword(s):  
Literature Review ◽  
Long Term Care ◽  
Gap Analysis ◽  
Discharge Planning ◽  
Post Discharge ◽  
Term Care ◽  
Discharge Care ◽  
Challenges And Opportunities ◽  
Caregiver Coping

Transitions to long-term care are significant and often challenging experiences for older adults with dementia and their caregivers, with waiting lists a common occurrence due to an aging population and a limited supply of long-term care beds. To better understand the complexities related to transitions to long-term care and inform clinical practice, a comprehensive project was undertaken and included an integrative literature review and a gap analysis of local practices in the interior of British Columbia. The literature review and gap analysis findings were analyzed and presented thematically through interrelated themes, including key concepts surrounding the phases of a transition, caregiver coping, and professional support. Four key recommendations arose from this project regarding continuity and coordination of care, discharge planning, post-discharge care, and evaluation. The strengths, limitations, and implications of this project are discussed, including next steps to mobilize knowledge related to the recommendations and influence evidence-informed changes in practice.

scholarly journals Shared and Supported Decision Making in Medication in a Mental Health Setting: How Far Have We Come?

2021 ◽  
Author(s):  
Sofia Pappa ◽  
Joshua Barnett ◽  
Sally Gomme ◽  
Anthi Iliopoulou ◽  
Ivan Moore ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Lived Experience ◽  
Service User ◽  
Best Practice ◽  
Good Practice ◽  
Mental Health Provider ◽  
Service Users ◽  
Mental Health Settings ◽  
Formed Part

AbstractPersonalised care involves shared decision making (SDM) across all levels including choice in medication. However, there are a number of barriers which prevent its effective implementation in routine mental health settings. Therefore, we undertook a study to benchmark current practice across clinical services of a large urban mental health provider. The study formed part of the trust-wide ‘Supported Decision Making in Medication’ Co-Production Project and aims to inform future recommendations in delivering against contemporary best practice, guidance and policy. A survey exploring the views and experiences of service users and prescribers on shared and supported decision-making in medication was carried out in West London NHS Trust. Questionnaires were fully co-designed and co-delivered by a group of health professionals and individuals with lived experience. There were 100 responses from service users and 35 from prescribers. There was some good practice where both parties reported good quality conversations concerning dialogic styles, collaborative process, information provided and range of choice offered. However, prescriber’s perception of their practice was not always mirrored by service user feedback whose experiences often depended upon the prescriber, the time available or the part of the service. Generally, service user experience fell short of the good practice cited by clinicians though there was noticeable variability. Commitment from organizations and increasing understanding from practitioners are vital in transforming SDM from rhetoric into reality. From our findings a further challenge is to ensure that prescribers and service users have the time, information and tools to implement it consistently.

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