Clinical letters to patients with intellectual disabilities after psychiatric review: A quality improvement project

Aim: This Quality Improvement Project sought to improve communication between patients with intellectual disabilities and their psychiatrists by sharing medical information using an easy read letter format following psychiatric review. Background: Writing directly to patients is in keeping with good medical practice. Previous studies have shown patients with intellectual disabilities prefer letters tailored to meet their needs. Method: An easy read letter was used by nine psychiatrists who handed them to 100 consecutive patients after review. Feedback of acceptability to patients was obtained using a three-item facial rating scale and the use of free text. Feedback of acceptability was obtained from participating psychiatrists. Results: Patients found the easy read letter helpful and felt it should be used routinely. Psychiatrists felt this approach was beneficial as well as aiding patient understanding of review. Conclusions: The easy read letter was reported to improve communication following psychiatric review. Limitations are acknowledged but it is concluded that an easy read letter should be adopted as routine practice following psychiatric review, for people with intellectual disabilities.

Good surgical practice

This chapter discusses the duties of a doctor, which are outlined in the General Medical Council (GMC)’s Good medical practice. These have been adapted by the Royal College of Surgeons of England for surgical practice. The four domains of good medical practice include: knowledge, skills, and performance; safety and quality; communication, partnership, and teamwork; and maintaining trust. Clinical governance is a quality assurance process through which a health service is accountable for maintaining and improving the quality of care. In practice, it involves setting standards, performance monitoring, and reporting medical errors and is commonly said to be held up by ‘seven pillars’: clinical effectiveness; audit; risk management; education and training; patient and public involvement; using information and information technology; and staffing and staff management. The chapter then looks at the legal aspects concerning informed consent for a surgical procedure and end-of-life issues. It also outlines the principles of good prescribing in surgery.

1469 Audit of Clinical Notes Filing in Vascular Surgery

Aim Assess the correctness of patient's notes filing following the Royal College of Physicians, Record Keeping Standards, and the General Medical Council, Good Medical Practice, guidance: medical notes must be filed in the correct section, in a chronological order, three key identifiers on each page. Method Over 3 months, the general surgical wards, using case notes and those using folders for the current admission were assessed to identify loose notes. The vascular surgery patients’ notes were reviewed for the following criteria: not loose, filed in the correct section, in chronological order, and had three key identifiers. Results Surgical wards using case notes had 28.6% of the notes filed (n = 21) compared with 78.9% filed on wards with admission folders (n = 57). Within vascular surgery (n = 15), 13.3% had all notes filed, 20% were in chronological order, 6.7% had notes filed in the correct section, and 20% had key identifiers on every page. Conclusions The filing of case notes on the vascular ward resulted in loose notes more than other wards that use admission folders. To resolve this, “Admission Folders” were introduced (alongside full case notes) to assist with filing and label sheets used to assist with fast identification of current admission documents. After implementation of Admission Folders, the staff found notes easier to access and follow, according to the staff surveys, and notes were correctly filed and given identifiers, ensuring continued quality care for the patients.

Perception of patient safety among Final year MBBS students at King Edward Medical University Lahore

Introduction: Patient safety is a vital part of healthcare. It is vital for the medical students that the concepts of the “Do no harm” theory must be understood. Those that do not understand this ultimately perform poorly in healthcare practice. Therefore, it is very important that medical students must be tutored for the concept of good medical practice.Objective: To assess the patient safety perception among medical students in a public sector Medical College.Methods: A sample size of 179 medical students (n=179) from the final year were selected. A questionnaire tool was used to calculate the understanding of medical students. Participants' responses were recorded and computed into SPSS 19 for descriptive analysis.Results: About 55% of participants indicated a lack of knowledge regarding patient safety.25% of the medical students could not understand the type and nature of the iatrogenic error in providing good healthcare and exercising good medical practice. Also, 57% and 48 % of medical students were unable to understand that how to explain the iatrogenic error to patients, their attendants,s and their superiors respectively and 59% did not know that patient safety can be improved by targeted medical practice.Conclusion: The majority of the medical students in final year MBBS were unaware of patient safety and how to improve it. However, they showed keen interest in understanding it and applying the concept of good medical practice to ensure patient safety. KEYWORDS: Patient safety, undergraduates, knowledge, attitude

An audit: fitness to drive assessment in inpatients of general adult and old age psychiatry

AimsTo determine if fitness to drive is assessed on admission and discharge, if applicable, and for this to be documented during clerking and on discharge notifications.To determine if patients are being educated about the impact of their condition on the ability to safely drive.To ascertain if patients are aware of the duty to inform the DVLA if they for any reason are not fit to drive.BackgroundRisk factors include social, behavior and iatrogenic factors such as social withdrawal, increased likelihood of substance abuse and side effects of anti-psychotic medication.MethodThis trust wide audit involved the random sampling of a total of 71 case notes, 4 case notes per Consultant team in general adult psychiatry and old age psychiatry across Dudley and Walsall sites (total of 3 sites). A data collection tool was developed and included relevant questions regarding fitness to drive. Data were collected between October and December 2019.Result18/49 patients had physical health screening prior to medication initiation.ConclusionAn important aspect of good medical practice is to educate patients about their condition, this includes their fitness to drive as this can be affected both by their diagnosis and medication. It is clear that clinicians also need to be educated about this responsibility to ensure assessment is performed especially on inpatient discharge.

176 Patient Perception on Fracture Healing

Introduction Effective communication skills are an extremely important aspect of good medical practice. Fractures are common with over 1 million fractures occurring each year in the UK; of which 5-10% may have problems with healing. Patient perceptions of factors harmful to the fracture healing process are unknown and our study investigates this. Method A total of 418 responses were collected from participants in a single centre in our survey based study to determine patient perception on factors potentially affecting bone-healing. Results 84% and 73% of patients believed tobacco and alcohol to be harmful to bone-healing. 31% thought that there was a harmful effect to bone-healing with ibuprofen and 25% perceived the same regarding caffeine. Paracetamol, vinegar, and chocolate were considered to be least harmful to bone-healing with 20%,15% and 11% responses respectively. Conclusions The majority of patients believed that there was a harmful association with tobacco and alcohol with regards to bone-healing. This harmful relationship is well understood in literature. However, we believe for the benefit of patients, they should all be aware of these detrimental effects. A clear possibility has been identified to improve fracture outcomes by empowering patients to take ownership of their injury by lifestyle modifications which are within their remit.

Nighttime Calls, Pages, and Interruptions to the On-Call Surgery Resident

Background Communication is a keystone to good medical practice. At night, as physician numbers decrease, frequent, nonurgent interruptions have shown to disrupt patient care and impact resident/physician wellness. Potentially, interruptions can lead to an increase in medical errors. The frequency and activities interrupted during night calls have not been fully described. Methods For a period of 44 days (August through September), all calls and pages received during the 12-hour night call session were documented. Calls were analyzed by caller, urgency, need for intervention, and resident interrupted by the communication. Results A total of 494 communications were identified with a mean of 10 calls per shift (IQR 7-14). Communications lasted a mean of 2.7 +/− 2.9 minutes. Direct calls occurred in 78% and pages in 22% of the cases. From the non-ED calls (n = 335), most of them came from nursing staff (85%), followed by other specialties (12%). Five percent of the calls were directed to the wrong service. Communications occurred during charting (41%), patient assessment (33%), interrupted resident’s sleep (12%), or during a surgical procedure (6%). Communication required no action in 47% of the cases. A physician order was needed in 41%, while bedside clinical assessment was required in 12% of the calls. Conclusions Communications are common at night, but most did not require clinical assessment. A large portion of communications interrupted direct patient care. An opportunity exists to eliminate nonproductive communications and improve the quality of medical education.

Practicing outcome-based medical care using pragmatic care trials

The current separation between medical research and care is an obstacle to essential aspects of good medical practice: the verification that care interventions actually deliver the good outcomes they promise, and the use of scientific methods to optimize care under uncertainty. Pragmatic care trials have been designed to address these problems. Care trials are all-inclusive randomized trials integrated into care. Every item of trial design is selected in the best medical interest of participating patients. Care trials can eventually show what constitutes good medical practice based on patient outcomes. In the meantime, care trials give clinicians and patients the scientific methods necessary for optimization of medical care when no one really knows what to do. We report the progress of 9 randomized care trials that were used to guide the endovascular or surgical management of 1212 patients with acute stroke, intracranial aneurysms, and arteriovenous malformations in a single center in an elective or acute care context. Care trials were used to address long-standing dilemmas regarding rival medical, surgical, or endovascular management options or to offer innovative instead of standard treatments. The trial methodology, by replacing unrepeatable treatment decisions by 1:1 randomized allocation whenever reliable knowledge was not available, had an immediate impact, transforming unverifiable dogmatic medical practice into verifiable outcome-based medical care. We believe the approach is applicable to all medical or surgical domains, but widespread adoption may require the revision of many currently prevalent views regarding the role of research in clinical practice.

Pharmaceutico analytical study of Ashwagandha Ghrita

Ashwagandha (Withania somnifera (L) Family - Solanaceae) known as Indian ginseng is an effective immunomodulator, aphrodisiac, sedative and adaptogen. Ashwagandha Ghrita is a ghee based Ayurvedic formulation which is available in the market, but Ashwagandha Ghrita containing Rasasindura and Tamra Bhasma along with Ashwagandha and Musta Churna is also mentioned in classical text which many of us are not aware of. As we all know that the action of Rasaushadhis are quick and require very less dose the one mentioned by Vagbhatacharya (author of Rasaratnasamuchaya) is the need of the hour for the immunomodulation. The current trend in applied instrumental medical research encourages good medical practice, clinical and research based drug analysis. The main aim of analytical study is to find out working standards for the formulations and safe use of therapeutics.