BJPsych Open
Evaluating Completeness of Admissions Clerking
Procedure for Patients Admitted to an Acute
Psychiatric Inpatient Unit
Dr Neha Karthikeyan*, Dr Charlotte Little, Dr Anjali Nair
and Dr Andrew Sandor
Sussex Partnership NHS Foundation Trust, Chichester,
United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.311
Aims. There is a well-known bidirectional relationship between
mental and physical health. A thorough mental and physical
health assessment of new inpatients on admission is crucial to
assess possible organic causes of psychiatric presentations and
enable appropriate treatment to be commenced in a timely manner. We noted a pattern of incomplete clerking, leading to delays
in commencing treatment and increased workload pressure on
the ward medical team. Our audit aims to assess how thoroughly
and in what time frame patients’ admission assessments are being
completed on an acute psychiatric inpatient unit.
Methods. A sample of 20 patients was used for each cycle. Eight
components were identified from the Trust clerking procedure.
These were a full psychiatric history, capacity assessment, prescription chart, physical health systems review, physical examination, blood tests, ECG and VTE assessment. The expected
standard was completion of all of the above at the point of admission or, if applicable, adequate documentation of patient refusal
with documented reattempt within 24 hours.
Electronic patient records were retrospectively reviewed to
identify whether each component was completed, the number
of days from admission to completion and if completed by the
clerking doctor. Evidence of documented patient refusals and
the number of incomplete draft entries were noted.
Results. Initial results showed only 20% of patients (n = 4) had the
full expected clerking procedure completed at admission. Physical
health assessments (ECG, blood test, physical examination) had
the lowest completion rates. When components were not completed
by the clerking doctor, there was often a delay of several days from
admission to completion of by the ward day team. For 50% of
patients, some assessments were never completed (without adequate
refusal documented). Eight patients did not have a completed VTE
assessment by the point of discharge.
Conclusion. Reasons were identified for the poor completion
rates of clerking assessments. These included a lack of understanding by on-call doctors about the importance of completing all assessments, unfamiliarity with ward equipment, lack
of adequate handover to the ward medical team and staffing
pressures. A new handover checklist was introduced for clerking doctors to use and enable better communication with the
ward team. Clerking procedure summaries were displayed in
on-call rooms and additional teaching was organised.
Quality Improvement Project to Improve COVID-19
Vaccination Uptake on an Old Age Psychiatric Ward
(Meridian Ward)
Dr Fariah Khan1*, Dr Emma Etherington2 and Dr Potan Kheder1
1
Hammersmith and Fulham Mental Health Unit, London, United
Kingdom and 2Imperial Health Trust, London, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.312
https://doi.org/10.1192/bjo.2022.313 Published online by Cambridge University Press
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Aims. People with mental health issues have challenges in accessing medical care and it is hypothesised that this may result in a
significant number failing to receive protection from COVID -19
by means of vaccination. This study aimed to identify the number
of inpatients on a psychiatric general ward (Meridian ward)
between May 2021 and June 2021 who were fully vaccinated
against COVID-19 so that unvaccinated patients could be offered
vaccination during their inpatient stay.
Methods. Data were gathered on the COVID-19 vaccination status
of all patients on Meridian ward (inpatient mental health ward)
admitted between May and June 2021. This was a total of 10
patients. This information was gathered directly from the patients,
their summary care records and GP records. We also audited
whether the patient’s vaccination status was recorded in the notes.
Results. 50% of the patients were fully vaccinated. 20% had received
one vaccine and 30% of patients were unvaccinated. 20% of the
unvaccinated patients received their first dose during admission.
Conclusion. Patients with mental health issues sufficient to result
in psychiatric admission face additional challenges when it comes
to receiving a COVID-19 vaccine. It is important that healthcare
workers are aware of this and facilitate interventions that maximise vaccination in this at-risk group. To improve uptake
among this group it is recommended:
• Patients’ vaccination status is assessed and recorded during
inpatient admissions.
• GP surgeries should identify patients on their database with
mental health issues who are unvaccinated and providing
these individuals with support around accessing information,
transport or providing vaccinations at patient’s homes.
• There should be clear documentation of vaccination status on
summary care record and ward notes.
Hertfordshire Partnership NHS Trust - Improving
VTE Risk Assessments in an Older Adult Psychiatric
Inpatient Unit
Dr Bhavna Khanna* and Dr Christina O’Dowd
Hertfordshire Partnership University NHS Foundation Trust,
St Albans, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.313
Aims. VTE-related deaths are a leading cause of preventable mortality amongst all hospital inpatients. Psychiatric inpatients are at
greater risk of this, due to administration of antipsychotic medication and longer inpatient stay. This is particularly significant
during the COVID-19 pandemic, not least as it is a disease
known to cause hypercoagulability, but also due to an increase
in mental illness and extended admission, resulting from an overwhelmingly run social service. The objective is to analyse VTE
risk assessments performed for the 23 patients at Lambourn
Grove, a continuing care unit for old age psychiatric inpatients,
diagnosed with dementia. The aims are to assess; the frequency
at which VTE risk assessments are performed, the accuracy of
each assessment and the subsequent management and appropriateness of preventative measures taken.
Methods. A retrospective study was conducted of 23 service users.
Data were collected from the VTE assessment form on the local
electronic patient record system, and analysed to assess compliance with local guidance. GP records were consulted to cross
check data and ensure accuracy of information inputted.
Improvement measures include presenting at the local teaching
session and implementing a mandatory monthly review onto
the ward round proforma. A second cycle will be carried out to
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assess the success of these interventions in improving best medical
practice.
Results. Of the 23 service users, 20 patients had their VTE risk
assessment completed on admission and there was a delay of
over a month with the remaining 3 patients. Of significance is
that of all initial VTEs, 6 out of 23 contained inaccurate details,
such as omission of comorbidities or a subjective assessment of
mobility, indicating the need to use a standardized tool which
allows for comparison across time. The mean admission duration
for all 23 inpatients, as of February 2022 was calculated to be 16.2
months, with a range of 2 and 59 months. 15 patients did not
have their VTE risk assessment repeated during admission, and
of these 2 did have a change in their risk profile, indicating nonadherence with NICE guidelines.
Conclusion. This study has identified significant areas for improvement, specifically the need for clear timing for repeated VTE assessments, consistent sources of patient’s medical history and
documentation of mobility status. The project has highlighted the
need for a more robust VTE assessment protocol which is currently
being developed, to improve patient mortality and outcomes.
Pre-Menstrual Dysphoric Disorder (PMDD) in Young
People: What We Know About It, the Role of CBT as a
Treatment Option, and the Development of HighQuality Psychoeducation Material for Clinical Use
Dr Judy King* and Miss Hannah Wilkinson
Berkshire Healthcare NHS Foundation Trust, Berkshire, United
Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.314
Aims. We aim to explain more about PMDD in young people and
explore the evidence looking at the role of CBT as an intervention.
We aim to develop high-quality psychoeducation material with
the involvement of young people, to be able to offer clinically relevant information and empower young people with PMDD.
Methods. A literature search was conducted in 2019 and updated
in February 2022 using the Cochrane Library, Psych-info,
MEDLINE, Cinahl, EMBASE and Google Scholar, to look at
the evidence available for CBT in young people with PMDD or
PMS. The search included PMS as well as PMDD due to the heterogeneity in definitions used in studies.
Focus groups with young people are underway to develop high
quality written psychoeducation material about PMDD.
Results. There were no specific studies looking at CBT as an intervention in young women under the age of 18 with PMS or
PMDD. There was one intervention study with a treatment arm
of psychoeducation in 62 young people under 18 with PMS versus
a no treatment group (Taghizadeh 2013), with improvement in
symptoms after 3 months from baseline reported.
There were more studies available in women over the age of 18.
The search identified 3 meta- analyses in 2009 and 2012 (Busse
2009, Lusty, 2009; Kleinstauber 2012) and a more recent systematic review (Landolt 2020). Kleinsteiber et al included 22 RCTs,
with a median age of 39, and broadly showed CBT to have a
small to medium positive effect size, although any conclusions
were limited due to the small numbers involved in the individual
trials and methodological flaws. Landolt 2020 looked at CBT or
elements of CBT as an intervention arm over the last 30 years
or so in woman of all ages. Variations of CBT including virtual,
group, couple and psychoeducation alone were included, and all
were reported to have favourable outcomes.
https://doi.org/10.1192/bjo.2022.313 Published online by Cambridge University Press
Poster Presentations
Conclusion. There is a huge gap in research looking at PMDD in
the adolescent population. Translating research from adults is not
ideal. Increasing awareness and developing psychoeducation is a
step in the right direction.
An Evaluation of Admissions to an Old Age Psychiatry
Ward: A Quality Improvement Project
Dr Michael Cooper, Dr Clare Langan*, Dr Christopher Haxton,
Dr Philip Andrew and Dr Mohd Yazid
NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.315
Aims. It has been well publicised the pressures on inpatient bed
capacity within mental health services in recent years. The
RCPsych have stated in their publication ‘Exploring mental health
inpatient capacity’ that bed occupancy has risen above their recommended 85% occupancy target in most areas. Waiting lists for beds
have also grown. The aim of this project was to identify whether
there could have been any extra community resources in place
that could have prevented admissions to hospital within an older
adult CMHT. This in turn reducing the demand on inpatient beds.
Methods. Inclusion criteria: All patients from the older adult
CMHT admitted to either an organic or functional mental health
inpatient bed between the 1st September and 31st December 2021.
All patients who met the inclusion criteria were discussed as part
of a panel consisting of members of the MDT who were involved in
the patients’ ongoing care. The panel discussed each patient and
individually scored each admission on a scale of 1–5 (where 1
was deemed to be very avoidable and 5 completely unavoidable).
Where an admission did not score a 5 we considered whether anything could have been in place to have prevented the admission.
Results. Our search identified 21 patients who had been admitted
to the respective old age psychiatry ward during our period of
interest. The predominant diagnosis of these patients was vascular
dementia (n = 5), followed by Alzheimer’s disease (n = 3).
Following our consensus panel discussion, we identified that the
most common reason for admission to hospital was for management of behavioural and psychological symptoms of dementia
(n = 10), followed by increasing patient vulnerability (n = 4) in
the community. Carer stress was a theme in 2 admissions.
Following panel discussion regarding potential avoidability of
admission, we identified that 14 out of the total of 21 admissions
scored a 5, 1 scored 4, 1 scored 3, and 5 scored 2.
Conclusion. Behavioural and psychological symptoms of dementia continues to remain a significant clinical challenge and was the
most common reason for admission in our patient cohort. The
majority of admissions to hospital in our cohort were deemed
unavoidable as a result. However, we identified that carer stress
was a significant theme in 2 out of our 21 admissions, suggesting
potential scope to implement services which may reduce carer
stress and ultimately, prevent hospital admission.
The HDAT Helper - Developing an Online Tool to
Improve the Safety and Accuracy of Antipsychotic
Prescribing
Dr Christopher Lawrence*
Southern Health NHS Foundation Trust, Southampton, United
Kingdom
*Presenting author.
doi: 10.1192/bjo.2022.316