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Contents
Medical Student/FY1 Poster Presentations
MSP1 Ms Alana Ahmet
This history of Child and Adolescent Psychiatry: Why Childhood
matters
MSP2 Mr Ragu Prakash Ratnakumaran Sarah Costantino, Arnaldo Silva,
Sabrina Leigh-Hunt, Sumir Punnoose
Documentation and performance of ECGs and pregnancy tests in
acute women services
MSP3 Ms Rhiannon Davison Elizabeth Romer
Awareness of and experiences with mental support services in
medical students
MSP4 Mr Sverrir Kristinsson Niall Robinson
Documentation and performance of ECGs and pregnancy tests in
acute women services
FY2/Trainee Oral Presentations
TO1 Dr Claire Pocklington Dean McMillan, Simon Gilbody,
Laura Manea
The diagnostic accuracy of brief versions of the Geriatric Depression Scale: A systematic review and meta-analysis
TO2 Dr Helen Singhateh Yasmin Ahmed
Yorkshire and Humber Psychiatry Recruitment Survey
3
TO3 Dr Joanne Georgina Parry Trevor Gedeon, Mary-Jane Tacchi
Are all Forensic Psychiatrists arrogant? A survey of specialty stereotypes held within Psychiatry
TO4 Dr Kanmani Balaji Sarah Talari, Amanda Spencer,
Oliver Duprez, Dominik Klinikowski
Citalopram Monitoring Audit in Community Learning Disability Team
FY2/Trainee Poster Presentations
TP1 Dr Alexandros Chatziagorakis Mark Knights, Surendra Buggineni
HIV infection and the neuropsychiatric manifestations. A literature
review.
TP2 Dr Oliver James Fenton Anna Kilsby, Fiona Lacey
Clinical Audit – Junior Doctor On-Call Handover
TP3 Dr Helen Henfrey Helen Singhateh, Alison Burrows
Clinical Audit of the Initial Assessment and Ongoing Monitoring of
Physical Health in the Psychiatric Rehabilitation Setting
TP4 Dr Sabrina Leigh-Hunt Viji Saravanan, Stephen Curran,
Shabir Musa
Environmental audit of older peoples inpatient facilities
TP5 Dr Soumaya Nasser El Din Alistair Cardno, Tariq Mahmood,
David Yeomans, Mahmood Khan,
Shona McLlrae, Niki Taylor,
Hannele Variend, Rano Bhadoria,
Deline Du Toit, Sandip Deshpande
4
Clinical Variation in Psychosis: The relationships between diagnoses,
symptom dimensions, potential risk/protective factors and outcomes
in psychotic disorders.
TP6 Dr Rosalind Oliphant
Audit of Memantine Prescribing and Follow Up in an Older Persons CMHT
TP7 Dr Mary Parker Jane Leigh
Audit of clinic letters from MHSOP Consultants to GPs: Improving quality of communication to enhance patient safety.
TP8 Dr Joanne Georgina Parry Bruce Owen
Establishing Simulation Training in Health Education North East- STEP
Project
TP9 Dr Joanne Georgina Parry Patrick Keown, Iain McKinnon,
Paul Brown, Steve Cull,
Joanne French
The impact of Street Triage in Northumberland, Tyne and Wear NHS Foundation Trust
TP10 Dr Christopher Wood Hannah Arnstein, Prathibha Rao
Staff and Service User Perception of New Smoking Legislation in a Single NHS Mental Health Institution in the North East of England
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MSP1 Ms Alana Ahmet
This history of Child and Adolescent Psychiatry: Why Childhood matters
Introduction
Throughout history, children have always had behavioural and psychological difficulties. These have been recognised and dealt in numerous ways throughout
the centuries. Personality disorders have been seen as the work of the devil,
behavioural disorders have been thought to be a manifestation of brain matter disease and children with mental health problems have been regarded as small
adults and thus treated or punished as such.
In most branches of medicine, positive advances have been so rapid that historical aspects have had relatively little application in modern practice,
however psychiatry is polar to this trend as obtaining a historical sense is key. One must have a perception of the past to unlock reasons in the present.
Method
Over a 6-week period I researched the Internet and attended many of the psychiatric historical museums in London. Using the knowledge I obtained this
work explores the birth and development of child and adolescent psychiatry from the medieval to the modern world using many sources for information. It aims to
be the most comprehensive piece of work available to date.
Conclusion
Child and adolescent psychiatry in Britain is now a well-established sub-specialty
of general psychiatry. As specialties increasingly compete for a place on the therapeutic spectrum and at a time when funding and the cost of health care are
crucial political issues, the challenge is to develop more effective ways of using the skills of the child psychiatrist.
MSP2 Mr Ragu Prakash Ratnakumaran Sarah Costantino, Arnaldo Silva,
Sabrina Leigh-Hunt, Sumir Punnoose
Documentation and performance of ECGs and pregnancy tests in acute women services
Background
Many service users (SU) are started on psychotropic medications, which can be teratogenic or cause metabolic, labour and perinatal complications or electrical
cardiac abnormalities. Therefore all SUs should have Electrocardiograms (ECG) on admission and pregnancy tests (PT) where appropriate, the results of which
should be clearly documented.
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Standards
We audited the documentation of PTs and ECGs in an inpatient women psychiatric department against the standards:
All women of reproductive age should be offered a pregnancy test on admission.
Before starting antipsychotic medication, an ECG should be offered
Methods A total of 47 female SUs admitted during a one month period were included in
the study. We analysed each SU’s electronic notes (PARIS), and assessed whether PTs and ECGs were performed and documented under the ‘test results’
section.
Results No PTs were performed or documented in the correct location in PARIS. 87% of
service users had ECGs performed, though only 10% of all SU had ECGs
documented under ‘test results’.
Impact PTs are rarely done and documented in inpatient services, which we believe is
due to the lack of awareness of the relevant standards. ECGs are done for the majority of services users though the results for most were documented in the
incorrect location. In order to improve awareness of the requirement to undertake and correctly document these tests, we have implemented a
communication system known as (Purposeful In-patient admission) PIPA, which displays all the daily tasks required (including PTs and ECGs) for each SU.
References Royal College of Psychiatrists (2009) Physical health in mental health, London:
Royal College of Psychiatrists.
NICE (2014) Psychosis and Schizophrenia in Adults, London: National Collaborating Centre for Mental Health.
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MSP3 Ms Rhiannon Davison Elizabeth Romer
Awareness of and experiences with mental support services in medical
students
Background Mental health problems are more common among medical students compared to
the general population. Limited research exists in this area especially within the UK but literature broadly suggests that students often feel inadequately
supported.
Objectives This research aims to evaluate the awareness of and experiences with mental
health support in medical students at Leeds University and to identify what improvements could be made.
Methods This cross-sectional observational study collected quantitative and qualitative
data between January and October 2015 via an anonymous electronic questionnaire sent to years 1, 3 and 5 of the MBChB programme.
Results
N=156. Almost half of respondents reported personal experience of mental health problems, with 20.5% starting whilst at medical school. Most respondents
(73.1%) knew where to access support but were not confident to seek help (55%). Personal tutors and GP were the most widely known sources of support.
Students were most likely to access the GP and student counselling centre. They were least likely to access the academic subdean and disability support. The main
barriers to support were academic threat and lack of time. Free text responses revealed a variety of positive and negative experiences. Respondents felt they
received the right amount or too little information and wanted to receive more
information via a website.
Conclusions Students favour sources of support which are confidential, easy to access,
independent from the medical school, involved someone they had rapport with and without threat to academic progress. Recommendations for change are
made based on the conclusions.
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MSP4 Mr Sverrir Kristinsson Niall Robinson
Documentation and performance of ECGs and pregnancy tests in acute women services
Background The Calderdale Flexible Assertive Community Treatment (FACT) model of care
comprises a multi-disciplinary team to provide a flexible period of intensive contact and support to service users, within the enhanced pathway, who are
suffering from severe mental illness. FACT is a new service that is replacing the assertive outreach team (AOT) in Calderdale due to its more beneficial effect of
reducing hospital admissions, bed use and hence overall cost. The aim of this project is to develop an informative patient information leaflet in the style of an
NHS leaflet (with adherence to trust policies) explaining the Calderdale FACT.
Method
This project is an example of descriptive/inductive research whereby qualitative data was obtained via focus group discussions to assist in the development of a
leaflet. Data was collected during the meetings via recording the group focus discussions. The focus group was ‘Dual Moderated’ meaning one moderator
encouraged group discussion through open questions whilst the other moderator ensured that discussions remained relevant, that all topics were addressed and in
time. Data was analysed using recursive abstraction. This involved typing up the
transcript of the meeting, and then summarizing the content into main themes which formed the basis of headings for the leaflet.
Impact
The leaflet will be available to all service users, carers, and anyone else involved with the Calderdale FACT team. It will be a useful tool for practitioners to use to
help engage people with the service, promoting patient education.
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TO1 Dr Claire Pocklington Dean McMillan, Simon Gilbody, Laura Manea
The diagnostic accuracy of brief versions of the Geriatric
Depression Scale: A systematic review and meta-analysis
Background
Depression in older adults is under recognised. It poses diagnostic difficulties and is associated with worse outcomes in comparison to younger adults. Depression
in older adults is likely to become a more pressing issue in the future due to increasing life expectancy and population size. The GDS is the most well used
depression rating scale in older adults. Brief versions have become more popular due to their suitability for busy clinical practice.
Objective
To establish the diagnostic accuracy of brief GDS versions
Methods Twelve electronic databases were searched. Study selection was in accordance
with predefined criteria. The population of interest was older adults. Intervention
referred to a brief GDS version. Comparator was a recognised gold-standard diagnostic instrument. Outcome was data pertaining to diagnostic accuracy.
Quality assessment was performed using the QUADAS-II. Narrative analysis and, where possible, meta-analysis and meta-regression were performed.
Results
32 studies providing diagnostic data were identified providing diagnostic data for seven brief versions of the GDS; 1-item, 4-item, 5-item, 7-item, 8-item, 10-item
and 15-item. Meta-analysis was only possible for the GDS-15; a sensitivity of 0.77 and a specificity of 0.89 were found for the recommended cut-off score of 5.
Meta-analysis was not possible for other brief versions due to insufficient study numbers.
Conclusion
Results suggest the possibility of selective reporting of cut-off scores post-hoc,
therefore findings should be approached cautiously. Studies should report all cut-off scores and all brief versions should have standardised items. Further
diagnostic accuracy studies of brief versions of the GDS are required.
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TO2 Dr Helen Singhateh Yasmin Ahmed
Yorkshire and Humber Psychiatry Recruitment Survey
Background • Recruitment to Psychiatry in Yorkshire & Humber deanery identified as poor
• Fill rate of 46.7% after 2 rounds in 2014 • Senior Management Committee – suggested focus group to address this
problem • Focus group – TPDs, Higher trainees, Core trainees
Research
F2 Career Destination Report 2014 Questionnaire - CT1 trainees in deanery
Quantitative Data Yorkshire Medical Schools psychiatry uptake:
• Hull & York 2.5% • Leeds 1.9%
• Sheffield 3.4% • UK Total average: 3.0%
Foundation Schools psychiatry uptake
• NYEC 3.2% • South Yorkshire 3.1%
• West Yorkshire 2.2% • UK Total average: 3.3%
Qualitative Date Themes
Why Psychiatry?
• Inspirational Consultants / Positive Placement • Personal / Family history of mental health issues
• Future planning /work/life balance • Transfer from other specialties due to lack of job satisfaction
Why Yorkshire? • Outdoor pursuits
• Local to the area (e.g family/friends locally) • Cheaper than training down South
Why Yorkshire training schemes? • TPDs very helpful / enthusiastic
• Size of schools • Word of mouth
• Academic Fellow Job
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Results
Positives
• 80% straight from F2 • 95% of UK graduates undertook foundation placement and chose
psychiatry Negatives
• Only 23% local graduates • West Yorkshire – poor uptake from both medical and foundation schools
Reflections
• Lack of professional (rather than personal) reasons to choose Yorkshire • Those already interested in Psychiatry would have chosen an FY track that
included this. • What are other deaneries doing that we are not?
Recommendations
• Liaise with more successful medical and foundation schools for feedback
and suggestions • Improve awareness of trainees success in Yorkshire (MRCPsych pass rates)
• Improve awareness of training quality • Address quality of medical student/foundation placements
TO3 Dr Joanne Georgina Parry Trevor Gedeon, Mary-Jane Tacchi Are all Forensic Psychiatrists arrogant? A survey of specialty stereotypes
held within Psychiatry
Aims
To explore potential stereotypes, held by trainees, of psychiatric specialty
members and if these are in keeping with the views of consultants within these fields.
Background
Stereotypes continue to be portrayed throughout the medical profession with psychiatrists often being viewed negatively which has been proposed as a barrier
to recruitment. Do we however continue to express stereotypes, be it positive or negative, within the specialties of psychiatry and what impact do these have
upon future employment decisions?
Method An anonymous survey was constructed using character trait descriptive
adjectives to explore the stereotypes held by trainees on members of the different specialties. Nationally psychiatry trainees were asked to anonymously
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identify the 10 most appropriate adjectives to describe psychiatrists in the field of
CAMHS, general adult, older persons, psychiatry of learning disabilities, forensics
and psychotherapy.
Results The survey commenced in November 2015 and will close in January 2016.
Preliminary results are certainly interesting and there are strong patterns of stereotyped characteristics within each specialty. The results will be fully
available by the Conference and results displayed for each specialty via a word cloud, where the size of the word is proportional to the popularity of the word in
the list.
Conclusions Whilst the surveys data continues to populate it is apparent that stereotypes and
stigma have now become endemic within psychiatry. Whilst light-hearted the survey results will bring into question the need to unite as a profession to fight
the wider stigma that Psychiatry continues to face.
TO4 Dr Kanmani Balaji Sarah Talari, Amanda Spencer,
Oliver Duprez, Dominik Klinikowski
Citalopram Monitoring Audit in Community Learning Disability Team
Background Following FDA recommendations in August 2011 with regards to safety of
Citalopram, an audit was conducted in March 2014 by the CLDT to establish how well the guidelines were adhered to. A re-audit was conducted in October 2015 to
measure the performance.
Standards The standards were taken from the CISSG meeting in November 2011.
Maximum dose should be 40 mg or 20mg if elderly or abnormal liver
function. Should have ECG in their notes with the QTc documented or an
explanation, if not done.
If doses greater than 20mg, they should have documented LFTs. If QTc prolonged, dose to be reduced or discontinued or referred to
cardiology. If on other QTc prolonging medication , should have an ECG
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Method
Those on citalopram were identified from the caseload (August 2015). Those
previously on Citalopram but have discontinued it presently have been excluded. Clinical notes were reviewed for age, dose, other medication that prolongs QTc,
whether there was an ECG, QTc & LFT. Data was analysed using Microsoft Excel.
Results On comparing the audit and re-audit, the results are as follows:
Audit Re-audit
Sample 23/137 10/114
Age over 65 3 0
Dose over 20 10 2
ECG documentation 55% 89%
Other QTc prolonging medications 35% 50%
LFT 50% 0%
QTc documentation 45% 89%
Impact
Significant increase in adherence to guidelines thereby ensuring patient safety.
Where appropriate, the dose was reduced or switched to other antidepressants
Pro-active at investigations by liaising with GPs.
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TP1 Dr Alexandros Chatziagorakis Mark Knights, Surendra Buggineni
HIV infection and the neuropsychiatric manifestations. A literature
review.
Highly Active Antiretroviral Therapy (HARRT) has led to a reduction in HIV-related morbidity and mortality and the life expectancy of HIV-positive individuals
has improved significantly. It is therefore becoming even more likely that
clinicians will encounter patients with neuropsychiatric manifestations of the disease.
Our objective was to summarise the evidence on prevalence, pathophysiology,
manifestations and treatment of neuropsychiatric conditions in HIV-positive individuals, with particular emphasis on HIV associated neurocognitive disorders
(HAND).
We searched multiple healthcare databases for English-language publications. Titles and abstracts were screened and potentially relevant papers were acquired
and evaluated for eligibility. References from eligible papers were also searched by hand. Heterogeneity allowed only for narrative synthesis.
We found 92 eligible articles. The most prevalent neuropsychiatric condition in
HIV-positive individuals is depression (35.6%), followed by substance misuse,
anxiety, psychosis, adjustment disorder and bipolar disorder. Neurocognitive impairment is also frequent. The spectrum of neurocognitive deficiency is
delineated into three categories of severity: 1. HIV-associated asymptomatic neurocognitive impairment (ANI), the least severe but most frequent, 2. HIV-1
associated mild neurocognitive disorder (MND) and 3. HIV-1 associated dementia (HAD), the most severe but least frequent.
In conclusion, HARRT has made a substantial impact on suppressing HIV; despite
this, neuropsychiatric complications persist and are likely to impose a significant burden on affected individuals. Although the degree of direct impact the virus has
on these complications remains uncertain, it is clear that effective treatment of both HIV and neuropsychiatric complications is critically important in order to
maximize life expectancy and quality of life.
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TP2 Dr Oliver James Fenton Anna Kilsby, Fiona Lacey
Clinical Audit – Junior Doctor On-Call Handover
Background Concerns were raised regarding identifying junior doctors recording handover and
clinical work acknowledged for resident on-call rota.
Baseline audit identified current levels of record keeping showing concern
identifying handover taking place and junior doctor identification. Action plan recommendation of development of handover proforma and protocol.
Completed audit cycle with re-audit showing improvement following period of
implementation of handover proforma.
Standards Following discussion standards developed based on Trust Clinical Handover of
Care Procedure principles as well as BMA, NPSA and GMC recommendations.
Standards based audit of recording date, time, doctor, shift, transfer of information and if information required acting on and acknowledged as well as
relevance of information were agreed on.
Re-audit standards as above corresponding to sections of newly developed
handover proforma.
Method For baseline audit one month’s records from previous handover book were
analysed and recorded using data collection tool and manually calculated totals. For re-audit two weeks’ data collected from new audit proformas analysed.
Results
Baseline audit showed only 86% handovers recorded and re-audit showed increase to 100% handovers recorded. Similar improvement in record of junior
doctors being identifiable, date, shift and relevance of information recorded.
Impact
The impact of the initial audit was to highlight areas of concern in recording of junior doctor handover. This led to developing a new handover proforma and
protocol. Re-audit showed improvement using new proforma. Also, new proforma received positive feedback from junior doctors and audit team and it continues to
be in use.
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TP3 Dr Helen Henfrey Helen Singhateh, Alison Burrows
Clinical Audit of the Initial Assessment and Ongoing Monitoring of
Physical Health in the Psychiatric Rehabilitation Setting
Background People with mental health problems live shorter lives than the general
population, mainly due to physical illness [1]. The RCPsych has produced pragmatic advice about improving the physical health of people with mental
health problems [2] and local guidelines have been generated [3]. The authors are concerned that these guidelines are not being implemented.
Standards
The criteria are taken from local policies, all are 100% standards. 1. Physical examination within 12 hours of admission
2. If the patient refuses examination this must be recorded and a review date set 3. Symptoms or signs identified and investigations recommended should be
followed up, and a management plan recorded on PARIS.
Methods
The audit was conducted in The Orchards rehabilitation unit in Ripon. All patients admitted to the unit 1st June 2014 - 31st May 2015 were included. The
information was collected from PARIS (electronic records system) using a designated audit tool.
Results
A total of 18 records were assessed.
Criteria Yes No N/A
22% (4)
78% (14)
-
Standard 2 0% (0)
100% (2)
16
Standard 3 0%
(0)
100%
(3) 15
Impact Induction for new doctors to include requirements regarding physical health.
Clarification to be sought from the trust Physical Healthcare Team regarding
the need for physical examinations for transferred patients. Implementation of proforma that will help the medical team accurately record
and monitor physical health parameters during admission. Re-audit in 6 months’ time.
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References
[1] - Marc De Hert et al. Physical illness in patients with severe mental disorders.
I. Prevalence, impact of medications and disparities in health care. WPA EDUCATIONAL MODULE. World Psychiatry. 2011 Feb;10(1):52-77.
[2] - RCPsych: Improving physical health for people with mental illness: what can
be done? Published 2013. Accessed online 15/10/15 [http://www.rcpsych.ac.uk/pdf/FR%20GAP%2001-%20final2013.pdf]
[3] – Guidance CLIN / 0052 / v3: Physical healthcare assessment of patients
(admission, annual and ongoing). Tees, Esk and Wear Valleys NHS Foundation Trust. Published 2013. Accessed onling 15/10/15
[http://intouch/Docs/Documents/Policies/TEWV/Clinical/Physical%20Healthcare%20Assessment%20of%20Patient.pdf]
TP4 Dr Sabrina Leigh-Hunt Viji Saravanan, Stephen Curran,
Shabir Musa
Environmental audit of older peoples inpatient facilities
Background
The National Audit of Dementia report provide recommendations on how to make the acute inpatient environment conducive to the care of dementia patients. This
audit was undertaken to gain an understanding of the environment for patients with dementia in two psychiatric inpatient facilities.
Standards Inpatient facilities were assessed against the National Audit of Dementia 2011
Report recommendations.
Methods Site visits were undertaken on the same day to the two inpatient psychiatric
wards (total 31 beds) and assessed against the National Audit of Dementia Environmental checklist. Two assessors were assigned to each site to ensure
validity of findings.
Results The wards were clearly signed with words and pictures, adapted for safety and
for individuals with mobility difficulties, as well as providing safe space for walking. While both wards provided hearing aids, only one was fitted with a
hearing loop. Toilets and bathing facilities were segregated by gender and
adapted for those with mobility difficulties, with clearly visible alarm buttons, though not fully signed with pictures. All patients had individual rooms with space
for personal belongings, and access to a quiet room, though most patients could not see a clock or calendar from their bed area.
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Impact
Both wards were broadly compliant with national recommendations. Recommendations based on findings are that every room should have a clock and
calendar to help with orientation, a hearing loop should be fitted and toilet and washing facilities need to be labelled clearly.
TP5 Dr Soumaya Nasser El Din Alistair Cardno, Tariq Mahmood,
David Yeomans, Mahmood Khan,
Shona McLlrae, Niki Taylor,
Hannele Variend, Rano Bhadoria,
Deline Du Toit, Sandip Deshpande
Clinical Variation in Psychosis: The relationships between diagnoses,
symptom dimensions, potential risk/protective factors and outcomes in
psychotic disorders.
Background
Over the last few decades, there has been much debate regarding the categorical and dimensional approaches and their use in clinical settings. Few studies
concluded that one is better than the other and few more were of the opinion that both strategies complement each other in providing valuable information
about pre-morbid risk factors and clinical outcomes.
Methods Formal clinical research interviews (SCAN version 2.1), questionnaires about risk
factors and psychosis-related experiences, and medical records were reviewed and analysed for 76 patients. Descriptive and non-descriptive analyses were
used. This research worked on previously used dimensions and mixed them
together to be able to come up with useful conclusions.
Results Seven dimensions of BADDS and SANS/SAPS items were analysed (mania,
depression, psychosis, mood incongruence, negative, positive and disorganised); all were tested against categorical diagnoses and risk factors. Mania seemed to
be the best discriminator for affective disorders, and both psychosis and mood incongruence for schizophrenia. The negative symptoms dimension correlated
strongly with poorer premorbid functioning, younger age of abusing cannabis and worse outcomes. The positive symptom dimension linked more to a better
response to neuroleptics.
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Conclusions
Both categorical and dimensional approaches seemed to complement each other
and neither on its own was sufficient to clarify the associations with all variables or risk factors. The categorical model seemed to be more instructive for age of
onset, poor social adjustment, cannabis use, and course of disorder. The dimensions used, on the other hand, were more associated with education level,
being anxious before onset, life traumas and course of disorder.
TP6 Dr Rosalind Oliphant
Audit of Memantine Prescribing and Follow Up in an Older Persons CMHT
Background NICE recommends that memantine is used only in severe Alzheimer’s disease &
moderate Alzheimer’s disease with an intolerance of or contra-indication to
acetylcholinesterase inhibitors (AChEIs). It was noted there was significant variation in reasons for prescribing memantine & subsequent follow up of
patients prescribed memantine in clinic. An audit of NICE Technology Appraisal 217 guidance for prescription & follow up of patients taking memantine was
carried out on all patients prescribed memantine under CMHT care.
Standards Patients prescribed memantine should have:
- severe Alzheimer’s or; moderate Alzheimer’s with a contraindication to or intolerance of AChEIs – 100%
- treatment initiated by a specialist – 100% - their carer’s views sought at baseline & follow up – 100%
- treatment continued only if considered to have worthwhile effect on cognitive, global, functional or behavioural symptoms – 100%
- regular cognitive, global, functional & behavioural assessment – 100%
- treatment reviewed by specialist team – 100%
Method Data was collected from online records using NICE TA 217 audit support data
collection tool.
Results 10 patients (32%) met prescribing criteria. 31 patients (100%) had treatement
initiated by a specialist.. 24 patients (77%) had their carers’ views sought at baseline & at follow up. At follow up, 21 patients (68%) had cognition assessed,
26 (84%) had a functional assessment & 28 (90%) had a behavioural assessment. All patients had a brief global assessment.
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Impact
Suggestions for intervention include: extension of the audit, institution of a
standardised monitoring service, standardized review protocols & more robust usage of off-licence prescribing procedures.
TP7 Dr Mary Parker Jane Leigh
Audit of clinic letters from MHSOP Consultants to GPs: Improving quality
of communication to enhance patient safety
Background
The audit aimed to ascertain if clinic letters provided easily accessible information needed by GPs for the care of their patients; and to identify areas for
improvement.
TEWV trust had identified a need to improve the quality of GPs letters under its CQUIN Target for safe care transfer.
Standards
The criteria for the audit were based on the SBAR communication system
adopted by the NHS improving quality initiative. A set of 12 criteria was developed including a highlighted section for:
Diagnosis Psychotropic Medication (including no change)
Plan
Standards were set at 100% as an aspirational level for quality of communication and to optimise patient safety but, with recognition that initially this may not be
achieved.
Method 50 consecutive clinic letters were analysed against the agreed criteria using an
excel spreadsheet, with 10% rechecked for data validation. Results were presented to consultants, MDT and Trust GP advisor and model letter template
devised. Re-audit performed after 3 months: re-presented to team and at trust-
wide audit event.
Results Good performance (compliance in brackets) in key clinical areas re management
plans (100%), follow up (98%) and accessibility of key information (90%). Improvement needed in timely communication (64%) and use of abbreviations
(14%).
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Impact
Good practice was demonstrated in vital areas of clinical care; however improvement needed in other key areas leading to adoption of a model template
for clinical letters.
Re-audit demonstrated improved achievement of communication standards. The Audit is currently being repeated in another area of the trust disseminating good
practice.
TP8 Dr Joanne Georgina Parry Bruce Owen
Establishing Simulation Training in Health Education North East- STEP Project
Aims and Background
In line with other medical specialities Psychiatry has begun to embrace to power
of simulation. However within HENE this has not been embraced as actively as around the country. Funded by HENE Patient safety fund a bespoke simulation
training package has been developed.
Method
Simulation Training in Emergency Psychiatry (STEP) is an interactive simulation based training session for Core Psychiatry Trainees which allows the experience
of a number of “typical emergencies” faced by Psychiatric Trainees. These include examples such as managing medical problems such as an elderly patient with a
fractured neck of femur to managing an attempted ligature on the ward and Psychiatric scenarios such as managing an acutely agitated patient with rapid
tranquilisation or assessing a patient’s capacity following overdose.
The scenarios have been written in collaboration with multi-disciplinary experts.
They are as realistic as possible, as simulation must be valid or it is unlikely to produce effective learning, and follow a real-time approach. There are actors
playing the roles of the patient and members of the wider MDT including support workers and nursing staff also contributing to the role play.
There is a Consultant Psychiatrist facilitator who will ensure space for reflective
practise which is also a crucial element post Simulation.
Conclusions
The STEP project aims to improve patient safety through exposing trainees to challenging scenarios they may face in their careers in a controlled manner and
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also through experiencing a variety of scenarios reinforcing parity of esteem
between mental and physical health emergencies.
TP9 Dr Joanne Georgina Parry Patrick Keown, Iain McKinnon,
Paul Brown, Steve Cull,
Joanne French
The impact of Street Triage in Northumberland, Tyne and Wear NHS Foundation
Trust
Background In 2014 NTW Trust committed to the principles and aims of the Crisis Care
Concordat. One central commitment was the development of “Street Triage” of people coming to the attention of the police, either through a jointly shared
telephone triage service or through the implementation of mobile Street Triage
Teams.
The impact of Street triage has been evaluated within NTW focusing on the number and rate of section 136 detentions before and after the introduction of
street triage. Rates were calculated prior to street triage operating, for the ten months when the first street team was operating, and for four months when both
street triage teams were was operating.
Method Data were obtained from three sources involved in section 136 detentions and
street triage; 1. Northumbria Police;
2. The mental health service provider (NTW NHS Foundation Trust); 3. The social work department of the local authority (Sunderland).
Results and conclusion
Our opinion is that there is strong evidence to support the hypothesis that Street Triage causes a reduction in the rate of section 136 detentions. Certainly the idea
is plausible and coherent as street triage was specifically introduced to address the dramatic increase in the use of section 136 in recent years.
There was a clear temporal relationship between the introduction of street triage
and the reduction in section 136 detentions. The greatest reduction was seen in the first few months of street triage, but there were further reductions through
the course of the first year as the service embedded.
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TP10 Dr Christopher Wood Hannah Arnstein, Prathibha Rao
Staff and Service User Perception of New Smoking Legislation in a Single NHS Mental Health Institution in the North East of England
The prevalence of tobacco use within an inpatient setting can reach 80%.
Government legislation is enforcing trusts to adhere to smoke free polices. The study design included (1) Survey of sixty-three members of staff and thirty-five
inpatient service users; and (2) a semi-structured focus group of inpatients. Questionnaires covered a range of areas encompassing quantitative and
qualitative data, which assessed smoking behaviour, opinions surrounding smoking ban and smoking cessation interventions. A third of staff disagreed with
the ban with concerns of increased violence, agitation and negative impact on mental health. Majority of staff felt their workload and stress level would increase
and smoking restrictions would contribute to increased admissions under detention. 80% of staff perceived smoking cessation interventions as an
important role. 52% of service users strongly opposed the smoking ban with
perceptions that these were violation of human rights despite 68% reporting that nicotine addiction had a negative effect on their mental health. Many patients
predicted increased violence towards staff with concerns that this would lead to covert behaviours and resumption of smoking once discharged. Despite this, they
welcomed offer of medical interventions; but indicating importance of will power over interventions. Although similar themes, staff anxieties were higher than
service users. More work needs to be done in changing staff attitudes and knowledge and dedicated staff training offered for successful implementation of
the ban. Inpatient programmes need to be tailored to patient preference and integrated with community programmes for longer term abstinence.