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1
Wagner, Cora, Undine E. Lang, and Karin Hediger. "“There Is a Cat on Our Ward”: Inpatient and Staff Member Attitudes toward and Experiences with Cats in a Psychiatric Ward." International Journal of Environmental Research and Public Health 16, no. 17 (August 27, 2019): 3108. http://dx.doi.org/10.3390/ijerph16173108.
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The aim of this study was to investigate inpatient and staff member attitudes toward and experiences with ward cats, and identify possible mechanisms for how cats affect patient satisfaction in a psychiatric clinic. Thirty-three inpatients diagnosed with depression or psychosis residing on wards with and without cats and 17 staff members working on wards with cats participated in semi-structured interviews using a cross-sectional study design. Data analysis included descriptive statistics and correlations. The results showed that 17 out of 19 inpatients and all the staff members liked having a cat on their ward. Further, 12 out of 14 inpatients on wards without cats would like having a cat on their ward. Inpatient perceptions of the cat’s impact on the ward atmosphere correlated significantly with their emotional relationship with the cat (p = 0.015, r = 0.561), how often they saw the cat (p = 0.002, r = 0.676), and if they liked cats in general (p = 0.041, r = 0.486). Our results highlight the positive attitudes of inpatients and staff members toward ward cats and the potential of ward cats to enhance patient satisfaction. This influence might be mediated by factors such as the frequency of contact, the relationship between each patient and the cat, and each patient’s attitude toward cats in general.
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Powell, Harriet, and Josie Jenkinson. "Venous thromboembolism (VTE) risk assessment completion in psychiatric inpatients." BJPsych Open 7, S1 (June 2021): S98—S99. http://dx.doi.org/10.1192/bjo.2021.296.
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AimsTo audit VTE risk assessment compliance across psychiatric inpatient wards at three different sites within Surrey and Borders Partnership NHS Foundation Trust (SABP), and to highlight the importance of completing VTE risk assessments for psychiatric inpatient safety and care as set out by NICE guidelines (2019).MethodNumbers of VTE risk assessments completed (within 24 hours, and those completed any time during inpatient stay) and VTE risk assessments not completed were collected via SABP electronic mental health records. Percentage compliance for each ward and hospital involved in the study were calculated. Chi square statistical t tests were conducted using Excel to check for associations between type of ward (older adult and working age) and VTE risk assessment completion.A total of 3004 patients were included in the study. Ages ranged from 18–82 years of age, and both males and females included in the study. A total of 2060 were working age (WA) patients (aged 18–64 years) and 944 were older adults (OA) (aged > 65 years).ResultAcross all three sites, more than 90% of all inpatients admitted between May 2018 and October 2020 did not have a formal VTE risk assessment completed. Across all sites, less than 1% of all inpatients had a completed VTE risk assessment done within 24 hours, as recommended by the NICE guidelines. Older Adult wards showed better compliance with VTE risk assessment completion with 38% of patients on one OA ward having had a completed VTE risk assessment, and 28% on another completed OA ward. Being admitted to an OA ward was strongly associated with VTE risk assessment completion (p < 0.05).ConclusionOA wards have hosted QI programmes with regards to VTE risk assessment which may be why VTE risk assessment was more likely to have been completed on OA wards. VTE risk assessment compliance overall is inadequate across all sites included in the study. Recommendations include further education for all ward staff on how, why and when VTE risk assessment should be completed, greater accessibility of an improved VTE risk assessment form and for QI initiatives on OA wards to be rolled out on WA wards. These findings have been presented and discussed at regional Trust teaching days, and this audit will be repeated in one year.
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Hyland, Declan, Millie Prime, and Rabia Khaliq. "An audit to assess the measurement of Body Mass Index (BMI) and referral to the dietetics service following admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust." BJPsych Open 7, S1 (June 2021): S83. http://dx.doi.org/10.1192/bjo.2021.258.
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AimsThis audit aims to establish whether patients have their BMI measured and recorded following admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust and whether, in those with a BMI >30 kg/m2, or >28 kg/m2 in those with weight-related comorbidities, they are referred to the dietetics service for input.BackgroundObesity has an increased prevalence in those with mental disorder. There are many factors that influence this, e.g. sedentary lifestyle and poor dietary intake. Medication prescribed to treat mental disorders may increase risk of weight gain. Patients with severe mental illness are at increased likelihood of developing weight-related comorbidities, particularly type II diabetes mellitus.Many patients with severe and enduring mental illness do not regularly access primary care services. Admission to the psychiatric ward therefore provides an opportunity to address, not only the patient's mental health issues, but also any physical health issues.MethodA list of all inpatients on the eight general adult wards was obtained on 3rd of December 2020. Inpatients on the Psychiatric Intensive Care Unit were also incorporated, providing a final sample of 148 inpatients.An audit tool was designed, to collect demographic data for each inpatient – gender, age, ethnicity, psychiatric diagnosis, as well as BMI on admission and, if applicable, whether a referral to the dietetics service was made.ResultOf the 148 inpatients, 91 were male, 57 female. Patient age ranged from 19 to 71 years. The majority were of “white British” ethnicity. The most common mental disorder diagnosis was schizophrenia (35 patients). For 14 of the 148 inpatients, no BMI was measured on admission. In the 134 inpatients that had BMI measured, 74 were in one of the “overweight”, “obese”, “very obese” and “morbidly obese” categories. Thirty-four patients met the criteria for requiring referral to the dietetics service. Of these, four were not referred, five were offered referral but declined, 17 referrals were made for other reasons, e.g. BMI <18 kg/m2, and one patient was referred despite no BMI being recorded.ConclusionCurrent practice across the general adult inpatient wards in the trust indicates a proportion of patients do not have BMI recorded following admission. This may result in a valuable opportunity to address obesity being lost. There is a need to emphasise to ward staff the importance of recording BMI as part of the admission physical health screen and of the criteria for referring an inpatient to the dietetics service.
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Ciausu, Vlad, Marcin Ostrowski, Bethany Dudley, Iain McKinnon, and Chris Ince. "Revisiting vitamin D status and supplementation for inpatients with intellectual and developmental disability in the north of England, UK." BJPsych Open 7, S1 (June 2021): S14. http://dx.doi.org/10.1192/bjo.2021.95.
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AimsVitamin D deficiency is common among people with Intellectual and Developmental Disability (IDD) and is linked to worse health outcomes.Our aims were to re-evaluate vitamin D testing and supplementation among inpatients with IDD, examine any correlates with physical health conditions including COVID-19 and make recommendations for the current regime of supplementation and testing within inpatient IDD services.MethodThe study population comprised inpatients who were in any of the Northgate Hospital IDD inpatient services in Northumberland, UK. The wards sampled were the Medium Secure Unit, Low Secure Unit, Hospital Based Rehabilitation Wards and Specialist Autism Inpatient Service. Records of all inpatients between January 2019 and July 2020 were examined for 25-hydroxyvitamin D [25(OH)D] level, ward area, supplementation status, test seasonality, medication, and health status.We performed a correlation to see whether there was an association between vitamin D level and length of time on treatment. In addition, comparison of the replete and inadequate group for age, ethnicity, seasonality, ward location and psychotropic medication was undertaken.Data on physical health risk factors, obesity and COVID-19 infection were also collected. The physical comorbidities were described in order to evaluate whether any emerging patterns relating to COVID-19 infection were emerging.ResultThere were 67 inpatients in Northgate IDD services on 1 January 2019, with 11 further patients admitted up to the end of the sampling period on 31 July 2020. Nineteen patients were discharged during that period, so the sample comprised 78 patients.Ages were comparable across three of the ward areas, except for an older group of patients in the hospital-based rehabilitation setting. Mean 25(OH)D level for supplemented (800IU/day) patients was 75nmol/l (SD 20) compared to 40nmol/l (SD 19) in the non-supplemented group (p < 0.001).Thirty-eight percent of those who were inpatients during the first wave of the COVID-19 pandemic developed symptoms, but the small sample size could not establish vitamin D levels as a predictor of outcome.ConclusionOur findings show that clinicians continue to offer vitamin D supplementation for inpatients, at a dose of 800IU (20μg) per day.The mean vitamin D levels we observed were higher for those on supplements compared to our 2013 baseline data, whereas patients not on supplementation now had levels akin to those found previously. Vitamin D (800IU/day) supplementation is effective but adequacy of the nationally recommended dose of 400IU/day is unclear. Links to COVID-19 merit further research.
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Ikeda, Yukihiro. "Estimation of Infectious Medical Waste Quantities on a Per-patient Basis: An Observational Study at a Hospital." Open Waste Management Journal 12, no. 1 (December 31, 2019): 1–5. http://dx.doi.org/10.2174/1874347101912010001.
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Introduction: Infectious medical waste management in hospitals is very important. The potential impacts of infectious medical waste discharged from hospitals on populations and society are considered greater than those of general industrial waste. Therefore, the estimation of infectious medical waste discharged from healthcare facilities should be accurate. The present study reports the quantity of infectious medical waste discharged per ward per day per inpatient by weight. Methods: In medical wards, the digestive surgery ward discharged the most infectious medical waste. In addition, the digestive surgery ward had the highest quantity of infectious medical waste per day per inpatient. Infectious medical waste quantity estimates based on beds were lower than those based on inpatients, with minimum and maximum underestimates of 6% and 21%, respectively. Results & Discussion: Infectious medical waste discharged per patient per day was low in the outpatient department. The operating room and the emergency department discharged 10-fold more infectious medical waste than the wards. The operating room, the emergency department, and the clinical inspection department accounted for 60% of infectious medical waste discharged from hospitals. Conclusion: Notably, there are considerable differences among departments when evaluating hospital waste, particularly in hospitals with surgery and critical care departments, which is different in the case of evaluations based on bed counts.
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O' Donnell, Desmond, Anne O'Mahony, Alice O' Donoghue, Clare McMahon, Marie Doyle, Millie O' Gorman, Riona Mulcahy, George Pope, and John Cooke. "244 Point Prevalence of Frailty and Confusion Exceeds the Capacity of a Single Ward - Specialist Geriatric Wards to Lead Best Practice." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.148.
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Abstract Background Our Model 4 Hospital will open a Specialist Geriatric Ward in the coming months. This ward will focus on the provision of evidence-based care to confused and frail older adults. Careful selection of patients who would most benefit from this care will be vital to ensure success. We aim to determine the prevalence of frailty and confusion in our inpatient cohort to determine expected demand on this new service and to inform admission criteria. Methods All adult inpatients were screened for frailty (pre-admission status) using the Rockwood Clinical Frailty Scale (CFS). Point prevalence of confusion (combination of pre-existing dementia and incident delirium) was calculated by measuring 4AT scores on all adult inpatients (>16 years of age), with the exclusion of obstetric, paediatric, critical care and psychiatric wards. Eleven wards were visited by a team of six experienced geriatric practitioners during a one-week period in April 2019. Results In total, 257 patients were assessed. The median age was 74 years (16-99). The majority were male (54.9 %). 152 patients resided on a dedicated medical ward (59.1%). The point prevalence of pre-morbid frailty (CFS Score ≥ 5) was 39.9%. The point prevalence of confusion (4AT score ≥4) was 24.4%. Conclusion Our data show that frailty and delirium are highly prevalent in hospital inpatients. It is not feasible for this number of frail and confused patients to be cohorted in a single specialist area. It is therefore important that each hospital determine admission criteria to identify those at greatest need. Clearly, given the prevalence outlined here, there will be a large number of patients likely to benefit from but unable to access a Specialist Geriatric Ward. These wards therefore need to also serve as exemplars of best practice so that evidence-based care for this vulnerable cohort can be disseminated within an institution.
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Wykes, T., E. Csipke, P. Williams, L. Koeser, S. Nash, D. Rose, T. Craig, and P. McCrone. "Improving patient experiences of mental health inpatient care: a randomised controlled trial." Psychological Medicine 48, no. 3 (July 20, 2017): 488–97. http://dx.doi.org/10.1017/s003329171700188x.
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BackgroundPoorer patient views of mental health inpatient treatment predict both further admissions and, for those admitted involuntarily, longer admissions. As advocated in the UK Francis report, we investigated the hypothesis that improving staff training improves patients’ views of ward care.MethodCluster randomised trial with stepped wedge design in 16 acute mental health wards randomised (using the ralloc procedure in Stata) by an independent statistician in three waves to staff training. A psychologist trained ward staff on evidence-based group interventions and then supported their introduction to each ward. The main outcome was blind self-report of perceptions of care (VOICE) before or up to 2 years after staff training between November 2008 and January 2013.ResultsIn total, 1108 inpatients took part (616 admitted involuntarily under the English Mental Health Act). On average 51.6 staff training sessions were provided per ward. Involuntary patient's perceptions of, and satisfaction with, mental health wards improved after staff training (N582, standardised effect −0·35, 95% CI −0·57 to −0·12, p = 0·002; interaction p value 0·006) but no benefit to those admitted voluntarily (N469, −0.01, 95% CI −0.23 to 0.22, p = 0.955) and no strong evidence of an overall effect (N1058, standardised effect −0.18 s.d., 95% CI −0.38 to 0.01, p = 0.062). The training costs around £10 per patient per week. Resource allocation changed towards patient perceived meaningful contacts by an average of £12 (95% CI −£76 to £98, p = 0.774).ConclusionStaff training improved the perceptions of the therapeutic environment in those least likely to want an inpatient admission, those formally detained. This change might enhance future engagement with all mental health services and prevent the more costly admissions.
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Glennon, Ciara, and Marilyn A. Sher. "Evaluation of the EssenCES in a neurodevelopmental inpatient service for adolescents." Journal of Intellectual Disabilities 22, no. 3 (February 7, 2017): 233–45. http://dx.doi.org/10.1177/1744629517691654.
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Ward climate is a key element within psychiatric settings, associated with positive clinical outcomes. The Essen Climate Evaluation Schema (EssenCES) is a ward climate measure, which is validated for use within UK forensic settings. It has been studied within neurodevelopmental psychiatric inpatient settings with mixed findings on its appropriateness, and there is a dearth of EssenCES research which has been conducted within an adolescent psychiatric inpatient setting. The present study piloted the EssenCES within an inpatient psychiatric neurodevelopmental setting for adolescents in the East of England, in order to explore its usefulness within this setting and to provide preliminary normative data for a child and adolescent mental health services inpatient learning disability population. Staff and service users from a locked ward ( N = 28) and low secure ward ( N = 31) participated in the pilot. Results are discussed in relation to the body of the literature on ward climate, including consideration of discrepancies in the results between wards and discrepancies between staff and service.
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Redley, Bernice, Lauren McTier, Mari Botti, Alison Hutchinson, Harvey Newnham, Donald Campbell, and Tracey Bucknall. "Patient participation in inpatient ward rounds on acute inpatient medical wards: a descriptive study." BMJ Quality & Safety 28, no. 1 (February 23, 2018): 15–23. http://dx.doi.org/10.1136/bmjqs-2017-007292.
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BackgroundMeaningful partnering with patients is advocated to enhance care delivery. Little is known about how this is operationalised at the point of care during hospital ward rounds, where decision-making concerning patient care frequently occurs.ObjectiveDescribe participation of patients, with differing preferences for participation, during ward rounds in acute medical inpatient services.MethodsNaturalistic, multimethod design. Data were collected using surveys and observations of ward rounds at two hospitals in Melbourne, Australia. Using convenience sampling, a stratified sample of acute general medical patients were recruited. Prior to observation and interview, patient responses to the Control Preference Scale were used to stratify them into three groups representing diverse participation preferences: active control where the patient makes decisions; shared control where the patient prefers to make decisions jointly with clinicians; and passive control where the patient prefers clinicians make decisions.ResultsOf the 52 patients observed over 133 ward rounds, 30.8% (n=16) reported an active control preference for participation in decision-making during ward rounds, 25% (n=13) expressed shared control preference and 44.2% (n=23) expressed low control preference. Patients’ participation was observed in 75% (n=85) of ward rounds, but few rounds (18%, n=20) involved patient contribution to decisions about their care. Clinicians prompted patient participation in 54% of rounds; and in 15% patients initiated their own participation. Thematic analysis of qualitative observation and patient interview data revealed two themes, supporting patient capability and clinician-led opportunity, that contributed to patient participation or non-participation in ward rounds.ConclusionsParticipation in ward rounds was similar for patients irrespective of control preference. This study demonstrates the need to better understand clinician roles in supporting strategies that promote patient participation in day-to-day hospital care.
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Ellilä, Heikki, Maritta Välimäki, Tony Warne, and Andre Sourander. "Ideology of Nursing Care in Child Psychiatric Inpatient Treatment." Nursing Ethics 14, no. 5 (September 2007): 583–96. http://dx.doi.org/10.1177/0969733007077887.
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Research on nursing ideology and the ethics of child and adolescent psychiatric nursing care is limited. The aim of this study was to describe and explore the ideological approaches guiding psychiatric nursing in child and adolescent psychiatric inpatient wards in Finland, and discuss the ethical, theoretical and practical concerns related to nursing ideologies. Data were collected by means of a national questionnaire survey, which included one open-ended question seeking managers' opinions on the nursing ideology used in their area of practice. Questionnaires were sent to all child and adolescent psychiatric inpatient wards (n = 69) in Finland; 61 ward mangers responded. Data were analysed by qualitative and quantitative content analysis. Six categories - family centred care, individual care, milieu centred care, integrated care, educational care and psychodynamic care - were formed to specify ideological approaches used in inpatient nursing. The majority of the wards were guided by two or more approaches. Nursing models, theories and codes of ethics were almost totally ignored in the ward managers' ideological descriptions.
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Roshi, Ambrina, Rose McGowan, Lauren Roberts, Stuart Watson, Kirstie Anderson, Patrick Keown, Rod Bowles, Ron Weddle, and Sophie Connolly. "A pilot to assess the feasibility and potential clinical utility of enhanced sleep management on inpatient wards in a mental health trust." BJPsych Open 7, S1 (June 2021): S215. http://dx.doi.org/10.1192/bjo.2021.575.
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AimsTo assess the feasibility and utility of introducing the following changes on to in-patient units:Structural and cultural adaptation to create a sleep friendly ward environmentA “Protected Sleep Time” between midnight and 6amRoutine screening for sleep disorders, including obstructive sleep apnoea and restless leg syndromeBackgroundInsomnia and other sleep disturbances are cause, correlate and consequence of psychiatric disorders. Routine hourly night time observations, ward noise, bright lights at night time, sleep disorders, insufficient exercise, insufficient day light exposure, too much caffeine and inappropriate psychotropic use are all causes of disturbed sleep (Horne 2018).MethodSeven wards participated in a pilot (SleepWell). These consisted of one male and two female Acute Wards (General Adult), a High Dependency Unit, a Neurorehabilitation ward, an in-patient dementia service and one rehabilitation ward. These wards were supported via an existing trust management structure and the pilot was specifically supported by two trust managers (RW and RB) and by a clinical director (PK). The expectation was that each ward would identify a sleep champion from existing staff to facilitate the changes. A “product” was developed which identified core sleep management features but, in addition, wards were not confined to these. The existing policy that all inpatients should be checked each hour over night was suspended for the pilot wards and the patients had protected sleep time (PST) if the MDT agreed that it was clinically appropriate.Quantitative and qualitative techniques were used to identify facilitators of change, impact on sleep and, outcome.ResultProtected sleep was viewed positively by all staff and approximately 50% of patients on the pilot wards were able to have PST at some point in their admission. Routine sleep disorder assessments were harder to implement and 33% of patients were screened. There were no deaths or significant events on patients due to PST. Hypnotic use on the pilot wards reduced. It is anticipated that PST where it is safe will be rolled out across all adult and old age wards in the trust.ConclusionWith support, it has been feasible to change many aspects of sleep management across a breadth of inpatient units in a large NHS trust.
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Budihardjo, Vidia Sabrina. "FAKTOR PERAWAT TERHADAP KEJADIAN MEDICATION ADMINISTRATION ERROR DI INSTALASI RAWAT INAP." Jurnal Administrasi Kesehatan Indonesia 5, no. 1 (December 20, 2017): 52. http://dx.doi.org/10.20473/jaki.v5i1.2017.52-61.
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Medication administration error is one of medication error that happened due to unfulfillment of drug instruction or drug administration that is different with the recipe. From the initial survey conducted in 2015, there were 13 events medication errors known in 2014-2015 in RSU Haji Surabaya. Based on Kepmenkes RI nomor 129/Menkes/SK/II/2008 about Minimum Service Standards, medication incident should not be any error occurred in the Hospital.This study was an observational descriptive study aimed to identify factors that contribute to the incidence of medication errors. Respondents were 56 nurses that worked on 7 inpatient wards. Variablesi n this research are: the skills of nurses, nurse's knowledge, and communication between nurse and patients. The result showed that the incidence of medication error in 2014-2016 amounted to 14 events that occurred in most of the inpatient ward (57.1%). Most of inpatient ward (57.41%) had good skill of nurses, most of the inpatient wards (57.1%) had a sufficient knowledge and communication of nurses.From this study it can be concluded that the skills of nurses, nurse's knowledge, communication between nurse and patients are contributing to the incidence of medication errors in RSU Haji Surabaya. Keywords: inpatient ward, medication errors, nurses
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Hyland, Declan, Millie Prime, and Rabia Khaliq. "An evaluation of the prevalence of weight-related comorbidities in patients following admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust." BJPsych Open 7, S1 (June 2021): S83—S84. http://dx.doi.org/10.1192/bjo.2021.259.
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AimsThis audit aims to evaluate the prevalence of any weight-related comorbidities in patients following their admission to the general adult inpatient wards in Mersey Care NHS Foundation Trust.BackgroundObesity has an increased prevalence in those with mental disorder. There are many factors that influence this, e.g. sedentary lifestyle and poor dietary intake. Medication prescribed to treat mental disorders may increase risk of weight gain, particularly most of the second generation antipsychotics. Patients with severe mental illness are at increased likelihood of developing weight-related comorbidities - essential hypertension, ischaemic heart disease, hyperlipidaemia and type II diabetes mellitus.Many patients with severe and enduring mental illness do not readily or regularly access primary care services. Admission to the psychiatric ward therefore provides an ideal opportunity to address, not only the patient's mental health issues, but also any physical health issues.MethodA list of all inpatients on the eight general adult wards was obtained on 3rd of December 2020. Inpatients on the Psychiatric Intensive Care Unit were also incorporated, providing a final sample of 148 inpatients.An audit tool was designed, to collect demographic data for each inpatient – gender, age, ethnicity, psychiatric diagnosis, as well as the presence of any cardiovascular comorbidities and, if so, what were they and how many were present.ResultOf the 148 inpatients, 91 were male, 57 female. Patient age ranged from 19 to 71 years. The majority were of “white British” ethnicity. The most common mental disorder diagnosis was schizophrenia (35 inpatients), followed by schizoaffective disorder (22 inpatients). Twenty-one of the 148 patients had at least one weight-related comorbidity recorded. Only 2 of the 21 inpatients with a diagnosis of one or more weight-related comorbidity had a recorded BMI in the “healthy” range. The gender split for the presence of weight-related comorbidities was almost equal. The most common comorbidity recorded was type II diabetes mellitus. Most patients with a weight-related comorbidity had only one recorded, but three patients had two comorbidities recorded, and one patient had three recorded.ConclusionA significant proportion of patients admitted to the general adult inpatient wards in the trust have a weight-related comorbidity. Admission to hospital provides an ideal opportunity to review the management of any such comorbidity and optimise this as required. There is a need to ensure there is a strong focus on, not only the patient's mental health issues, but also his / her physical health status.
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Mellsop, Graham W., George W. Blair-West, and Vasanthi Duraiappah. "The Effect of a New Integrated Mental Health Service on Hospitalisation." Australian & New Zealand Journal of Psychiatry 31, no. 4 (August 1997): 480–83. http://dx.doi.org/10.3109/00048679709065068.
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Objective: The purpose of the present study was to partially evaluate a new integrated mental health service by monitoring inpatient lengths of stay. We hypothesised that the median cumulated length of stay for inpatients would decrease, and that the frequency of readmissions would not increase. Method: Data was collected for two 6-month periods before and after the introduction of an integrated mental health service (IMHS). Two functionally identical wards (G and E) were studied. Ward G was then integrated with the regional community psychiatry service, while Ward E remained non-integrated. Results: Following integration, the median cumulative length of stay in the IMHS's Ward G was more than halved in comparison with both its own baseline and with the non-integrated ward. The average length of stay of overdose patients at the regional general hospital that was serviced by the IMHS was also reduced from 2.6 days to 1.5 days. The non-IMHS ward had a non-significant increase in admissions and no change in cumulative length of stay. Conclusion: The hypotheses of this study were supported by the results. Twelve beds were subsequently closed as a result of the efficiencies generated by integration. These findings support the model of true integration trialled here.
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Pannick, Samuel, Stephanie Archer, Susannah Jane Long, Fran Husson, Thanos Athanasiou, and Nick Sevdalis. "What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards." BMJ Open 9, no. 3 (March 2019): e024058. http://dx.doi.org/10.1136/bmjopen-2018-024058.
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ObjectivesTo compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.MethodsMultimodal qualitative evaluation of general medical wards and semi-structured interviews.SettingUK tertiary National Health Service (public) hospital.ParticipantsFourteen patients and carers on acute medical wards and geriatric wards.ResultsQuality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.ConclusionsThere is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
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Rittmannsberger, Hans, Norman Sartorius, Mihaela Brad, Victoria Burtea, Nora Capraru, Pavel Cernak, Mojca Dernovçek, et al. "Changing aspects of psychiatric inpatient treatment." European Psychiatry 19, no. 8 (December 2004): 483–88. http://dx.doi.org/10.1016/j.eurpsy.2004.05.001.
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AbstractThis paper presents data obtained in a one-day census investigation in five European countries (Austria, Hungary, Romania, Slovakia, Slovenia). The census forms were filled in for 4191 psychiatric inpatients. Concerning legal status, 11.2% were hospitalised against their will (committed) and 21.4% were treated in a ward with locked doors. There was only a small correlation between commitment and treatment in a locked ward. More frequent than treatment of committed patients in locked wards was treatment of committed patients in open wards (Austria, Hungary) and treatment of voluntary patients in closed wards (Slovakia, Slovenia). Concerning employment, 27.7% of patients aged 18–60 held a job before admission. The vast majority of patients (84.8%) had a length of stay of less than 3 months. A comparison of these data with the results of a study performed in 1996 and using the same method shows a decrease of rates of long-stay patients. In 1996 the rates of employment were significantly higher in Romania (39.3%) and Slovakia (42.5%) compared to Austria (30.7%). These differences disappeared in 1999 due to decreasing rates of employment in Romania and Slovakia. The numbers of mental health personnel varies between types of institution (university or non-university) and countries, being highest in Austria and lowest in Romania. A considerable increase in the numbers of staff was found in Slovakia.
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Stafford, A., A. Martin, and D. Tiwari. "16 Comparison of Characteristics and Outcomes for Older Adults Admitted to Specialty Wards Versus Outlying Wards at Royal Bournemouth and Christchurch Hospitals." Age and Ageing 49, Supplement_1 (February 2020): i1—i8. http://dx.doi.org/10.1093/ageing/afz183.16.
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Abstract Background At Royal Bournemouth and Christchurch Hospitals (RBCH) elderly patients are admitted to either the acute medical unit or the older person’s assessment unit. If the inpatient stay is likely to be longer than 72 hours, then patients are transferred to one of three elderly care wards. If these wards are at capacity, then patients must be outlied to other wards. Introduction GMC guidance June 2014, states hospital inpatients should have a named consultant. Studies have shown that length of stay and outcomes can be affected when the patient is on an outlying ward. This issue affects many hospitals and specialties, and also impacts older frail patients at RBCH. During winter elderly care admission rates increase, and more patients are outlied. Our aim was to improve the care and outcomes for elderly care patients treated on outlying wards. Methods The notes of 50 specialty ward patients and 50 outlying patients were compared from the first two weeks of January and February 2019 using scanned electronic records where elderly care was responsible for their treatment. We studied demographic characteristics, length of stay, mortality, readmission within 30 days of discharge, frequency of consultant review, escalation plans, discharge destination and ward moves. Interventions A dedicated outlying team was created for the 2018/2019 winter to attempt to improve outcomes for outlying elderly care patients. This team consisted of a geriatrician, registrar, SHO and allied health care professionals including a physiotherapist and discharge coordinator. Results Our results showed that outlying patients had a significantly longer average length of stay compared to patients on specialty ward (13.8 days vs 8.2 days, p=0.01). A significantly higher proportion of patients in outlying wards did not have a consultant review every 72 hours (66% vs 8.3% specialty ward patients, p=0.001). However the specialty ward patients had a significantly higher number of readmissions within 30 days (30.6% vs 16%, p=0.04). Conclusions We found that despite a dedicated team, outlying patients had a significantly longer length of stay and were seen by a consultant less often than patients on a specialty ward. Further work is needed to ensure equality of care for these patients. Patients with complex medical needs are generally triaged to specialty wards, which may account for their higher readmission rate.
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Hyland, Declan, and Mohammed Uddin. "A survey of the level of knowledge and understanding of members of the inpatient team on the role of the physician associate on the general adult psychiatric wards." BJPsych Open 7, S1 (June 2021): S140. http://dx.doi.org/10.1192/bjo.2021.398.
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AimsPhysician Associates (PAs) are healthcare professionals with a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This survey aims to establish what level of understanding different members of the inpatient teams across the inpatient wards have of the tasks PAs are permitted to undertake and those they are not.MethodA survey was designed, listing 37 tasks, e.g. completing an admission clerking. For each task, the participant was asked whether a PA is allowed to complete it or not, with three options provided – “can carry out the task”, “cannot carry out the task” and “do not know.” A score of + 1 was awarded if the correct answer was provided, –1 for an incorrect answer and 0 if the respondent didn't know. The highest possible score for a completed survey was + 37 points; the lowest possible score was –37 points.A sample of survey respondents was identified from the three general adult inpatient wards at Clock View Hospital and the Psychiatric Intensive Care Unit (PICU), comprising: senior doctors, junior trainees, Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner.ResultTwenty-four members of staff completed the survey – 3 senior doctors, 4 junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 5 Band 5 nurses and 4 Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. The highest survey score was 36 out of 37 (a Consultant); the lowest was 18 (a junior trainee). The lowest mean score was variable across the different grades of staff, with Consultants scoring highest at 29 and Assistant Practitioners and Ward Managers both scoring lowest at 25. There was little variability in mean score (only 2 points) across the three wards and PICU.ConclusionThe results from this survey demonstrate that different members of the inpatient team have a good understanding of what tasks PAs are and are not permitted to. There is still a need to provide further education to inpatient staff to ensure they utilise the PA at Clock View Hospital appropriately and that the PA is able to develop his skill set.
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Fernandes, J., B. Barahona Corrêa, and M. Talina. "Characterization of an Inpatient Ward in Portugal: What’s Different from a Decade Ago?" European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71023-5.
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Inpatient wards have been changing over the last years because of a shift emphasizing community care. However, characterization of inpatient wards remains mandatory for evaluating the effectiveness of care.Demographics, diagnosis classification, length of stay and destination after discharge were obtained for inpatients discharged during 2007 and compared with patients discharged in 1997.Main results are as follows:Variable199720072007 vs 1997Number of patients (beds)346 (30)403 (42)+16.5%Mean age, years (SD)38.97 ± 14.3338.97 ± 14.33 Female sex51.7%49.1% Length of stay, days (SD)22.17 ± 21.9924.57 ± 17.66+1.1%Diagnosis: Schizophrenia, Personality Disorders, Afective Disorders, Drug Psychosis, Alcohol/Substance Dependence/Abuse26.3%, 19.4%, 15.6%, 0.6%, 13.6%30.1%, 8.7%, 31.1%, 2.9%, 1.6%+14.4%, -55%, +99.4%, +483.3%, -88.4%Follow up in community team72.5%65%-10.3%Discharge against medical advice/Abandonment7.8%2.5%-68.2%Differences in diagnosis appear to follow a trend, as depicted:Affective disorders are currently the main diagnosis in our ward. Drug induced psychosis excess diagnoses may reveal increased substance abuse. Fewer admissions for substance abuse/dependence and personality disorders may reflect new specialized services for these patients. Introduction of the Mental Health Act in 1998, may explain the fewer patients discharged against medical advice/abandonments.
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White, L., A. Tyler, and A. Samji. "92 Clinical Frailty Scoring Is Crucial For the COVID-19 Era and Beyond." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.53.
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Abstract Introduction The COVID-19 pandemic placed a new focus on provision of clinical resources. With high mortality and limited capacity; appropriate decisions to escalate to critical care were vital for just resource allocation but also to prevent harm where interventions would not change outcomes. NICE guidance highlighted Clinical frailty scoring (CFS) as central to the decision-making process. 1, Despite initial criticism, recent evidence has confirmed increasing CFS as an independent risk factor to inpatient mortality in COVID-19.2 We conducted a quality improvement project with the aim of improving CFS documentation at the Royal Free Hospital. Methods We reviewed the notes of 71 inpatients over the age of 65 years from 6 wards on 08/05/20–12/05/20 for both a CFS score documentation and clear treatment escalation plan at time points of initial clerking, post-take and following ward admission with an audit standard of 100%. We developed teaching sessions, promoted the CFS mobile application, developed a post-take sticker and an elderly medicine ward admission proforma. We re-audited 66 inpatient notes from the same 6 wards from 25/06/20–07/07/20. Results Documentation.of CFS improved from 7% to 17% for clerking and post-take and from 13% to 24% on the ward admission. The number of patients with treatment escalation plans was 50%. Conclusion CFS is crucial for the COVID-19 era and beyond. We have demonstrated that increased awareness improves use of CFS, though it is not yet being widely used in escalation decisions. 1. Covid-19 Rapid guideline: Critical Care in adults. NICE guideline [NG159]: https://www.nice.org.uk/guidance/ng159 Accessed July 2020 2. Hewitt J et al (2020): The effect of frailty on survival in patients with COVID -19 (COPE): a multicentre, European, observational cohort study; The Lancet: https://doi.org/10.1016/ S2468–2667(20)30146–8.
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Lelliott, Paul. "Acute inpatient psychiatry in England: an old problem and a new priority." Epidemiologia e Psichiatria Sociale 15, no. 2 (June 2006): 91–94. http://dx.doi.org/10.1017/s1121189x00004267.
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AbstractWith the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.
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Hyland, Declan, and Mohammed Uddin. "An analysis of the views of different members of the inpatient team on the role of the physician associate on the general adult psychiatric wards." BJPsych Open 7, S1 (June 2021): S140—S141. http://dx.doi.org/10.1192/bjo.2021.399.
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AimsPhysician Associates (PAs) are healthcare professionals who have a general medical education background, having completed a two-year postgraduate degree. Whilst the number of PAs employed in healthcare trusts continues to increase, the number working in mental health settings remains small.Mersey Care NHS Foundation Trust employed two PAs two years ago. In August 2019, a third PA was recruited to work at Clock View Hospital, a general adult inpatient unit.This analysis aimed to establish the views of different members of the team across the three general adult wards and the Psychiatric Care Unit (PICU) at Clock View Hospital on the role of the PA.MethodA sample of members of staff was identified from across the three general adult inpatient wards at and the PICU, comprising: senior doctors (Consultants and Specialty Doctor), junior trainees (Core Trainee and Foundation Trainees), Ward Manager, Deputy Ward Manager, Band 5 nurse and Assistant Practitioner. Each member of staff was asked to answer the question “On a scale of 1 to 10 (with “1” being completely unhappy, “10” being completely happy), how happy are you to have a PA working on your ward?” Each staff member was then asked to provide comments on their views on the role of the PA.ResultTwenty-three members of staff participated – 3 x senior doctors, 4 x junior trainees, 4 Ward Managers, 4 Deputy Ward Managers, 4 x Band 5 nurses and 4 x Assistant Practitioners. The respondents were distributed equally across the three general adult wards and the PICU. All 23 members of staff provided a score of 10 out 10 to the question about how happy they were to have a PA working on the ward. Many of the staff members provided some very positive comments on their respective views about the role of the PA at Clock View Hospital. No negative comments were provided by any members of staff.ConclusionIt is clear from the large sample of members of staff of different grade at Clock View Hospital that were surveyed that the PA has been a warmly received and welcome addition to the inpatient team and that the PA is viewed as having become an important and valued member of the inpatient team. This provides a strong argument for both Mersey Care NHS Foundation Trust, and other mental health trusts across the U.K., to consider employing more PAs to work in their inpatient units.
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Thew, Graham R., Jackie MacCallam, Paul M. Salkovskis, and Jay Suntharalingam. "Anxiety and depression on an acute respiratory ward." SAGE Open Medicine 4 (January 1, 2016): 205031211665960. http://dx.doi.org/10.1177/2050312116659604.
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Objectives: Psychological difficulties are a common complication among patients with respiratory disease, and are associated with poorer health outcomes and increased use of healthcare. As prevalence studies typically sample patients from community settings, this study aimed to explore the extent and nature of psychological difficulties during acute hospital admission. Methods: A case example of an acute respiratory ward is presented. In total, 41 acute respiratory inpatients completed standardised measures of depression, anxiety, and health anxiety. Results: Rates of clinically significant depression, anxiety, and health anxiety were 71%, 40%, and 21%, respectively, with 76% of participants showing clinically significant scores on at least one measure. Comparison to existing literature suggests depression rates may be elevated in the acute inpatient context. The difficulties experienced encompassed both contextual factors related to being in hospital and broader health concerns. Conclusion: We suggest that psychological distress may be particularly prevalent in inpatient settings and that larger-scale studies are warranted.
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Coyle, Christina M., and Brian P. Currie. "Improving the Rates of Inpatient Pneumococcal Vaccination: Impact of Standing Orders Versus Computerized Reminders to Physicians." Infection Control & Hospital Epidemiology 25, no. 11 (November 2004): 904–7. http://dx.doi.org/10.1086/502317.
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AbstractObjective:To determine the impact of interventions using standing orders and computerized reminders to physicians on inpatient pneumococcal vaccination rates relative to a control group.Design:Open trial of the following approaches, each on a different ward: (1) standing orders for vaccination of eligible consenting patients, (2) computerized reminders to physicians, and (3) usual practice.Setting And Patients:Four hundred twenty-four patients were admitted to three 30-bed inpatient medical wards during a 4-month period in 1999 at one hospital. Unvaccinated patients 65 years or older and competent to give oral consent were included.Intervention:A pharmacist activated a standing orders protocol for vaccination of all eligible consenting patients on one ward and computerized reminders to physicians on a second ward. A third ward served as a control group.Results:Forty-two patients met inclusion criteria and accepted vaccination in the standing orders arm versus 35 patients in the computerized reminder arm. Vaccination rates on the standing orders ward included 98% of those eligible and accepting vaccination, 73% of eligible patients, and 28% of all patients admitted. Rates on the computerized reminder ward were 23%, 15%, and 7%, respectively. All of the rates from the standing orders ward were significantly greater than those from the computerized reminder ward (P < .0001). Only 0.6% of all patients on the control arm were vaccinated.Conclusion:Although both interventions were effective in increasing inpatient pneumococcal vaccination rates relative to baseline practice, physician independent initiation of standing orders was clearly more effective.
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Alotaibi, Badr S., and Stephen Lo. "Thermal Environment Perceptions from a Longitudinal Study of Indoor Temperature Profiles in Inpatient Wards." Buildings 10, no. 8 (July 25, 2020): 136. http://dx.doi.org/10.3390/buildings10080136.
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Inpatient wards in general have cooling systems with a “one-size-fits-all” approach, driven by a fixed set-point temperature (21–24 °C) that is flexible to lower limits down to 18 °C or less. This approach does not consider patients’ temperature demands, which vary due to thermo-physiology caused by medical conditions, and mixed demographics. It also causes additional cooling demands in hot climates that are infrequently utilized by patients, who tend to adopt warmer internal set temperatures. Thus, this research examined the indoor temperature profiles (distribution of shape) in patient rooms in fully air-conditioned inpatient wards over an extended period of time. During four months of summer, longitudinal monitoring of internal temperature and relative humidity was carried out in 18 patient rooms in the surgical, medical, cardiology, and oncology wards of two hospitals in Saudi Arabia. In parallel, 522 patients were surveyed to capture common subjective thermal indices. The findings revealed that the most frequently preferred temperature (peaks) varied significantly between wards; peaks (modes) were 20.1–21.8 °C in cardiology; 22.2–23.9 °C in the surgical ward; warmer 24.8–25.3 °C in medical ward; and 25.3–26.8 °C in oncology. Surveys also showed that patients were not satisfied with the indoor environment in both hospitals. Given the significant variance in temperature profiles between wards and patient dissatisfaction with the indoor environment, these results suggest that more appropriately designed zoned cooling strategies are needed in hospitals as per the nature of each ward. Besides its implications for benchmarking the HVAC system, this approach will substantially reduce energy loads and operational costs in hot-climate hospitals if patients desire warmer conditions than the set conditions provided by system.
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Mardiani, Mardiani. "PEMENUHAN KEBUTUHAN SPIRITUAL CARE PASIEN RAWAT INAP." JURNAL MEDIA KESEHATAN 10, no. 1 (November 15, 2018): 001–6. http://dx.doi.org/10.33088/jmk.v10i1.316.
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Nurses who have the ability to identify and understand the spiritual aspects of thepatient, will be able to carry out spiritual fulfillment and knowing how spiritual beliefs can affectthe life of every individual. The purpose of this research is the perception of nurses correlationwith the fulfillment of the spiritual care of patients in inpatient hospitals Dr.M. YunusBengkulu. The type of this research is analityc with cross sectional design. The Researchsample is nurses inpatient ward of RSUD Dr. M. Yunus Bengkulu who numbered 83 nursestaken with total sampling technique. Research done at eight wards hospitals Dr. M YunusBengkulu for two months. Collecting data using a questionnaire. Quantitative data analysis isunivariate and bivariate with uji chi-square at α 5%. The results showed that there was a significantrelationship between the perception of nurses and spiritual fulfillment of inpatientcare in hospitals Dr.M.Yunus Bengkulu (p : 0.022) with OR 3.107 (95% CI : 1.265 to 7.630),which means nurses have perceptionless chance three times to apply the spiritual care that isless favorable than that good perception. To the Hospital Dr. M. Yunus Bengkulu expectedfor the provision of facilities and additional skills for nurses in the inpatient room about theimportance of spiritual fulfillment as well as the necessary care program to improve the perceptionof nursing care, especially for spiritual fulfillment inpatients.
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Hyland, Declan, Millie Prime, and Ellen Carter. "An evaluation of the prevalence of physical health comorbidities in patients with severe and enduring mental illness following admission to the general adult psychiatric inpatient wards in Mersey Care NHS Foundation Trust." BJPsych Open 7, S1 (June 2021): S84—S85. http://dx.doi.org/10.1192/bjo.2021.261.
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AimsThis evaluation aimed to establish the prevalence of physical health comorbidities in SMI patients admitted to the general adult wards in Mersey Care NHS Foundation Trust.BackgroundMean life expectancy in individuals with severe and enduring mental illness (SMI) is 15-20 years shorter than that of the general population. A significant proportion of excess mortality in patients with SMI is due to natural causes, e.g. cardiovascular disease and type II diabetes mellitus. Although SMI patients are at greater risk of developing chronic physical health problems, they often receive worse health care than the general population. SMI patients more likely to engage in unhealthy lifestyle behaviours, such as poor dietary choices, smoking and physical inactivity; Antipsychotic medication prescribed to these patients can cause adverse metabolic side effects.MethodA list of all inpatients on the eight general adult wards in the Trust was obtained in September 2020, producing a sample of 135 inpatients.An audit tool was designed, capturing demographic data – gender, age, ethnicity, and also recording whether the patient had a diagnosis of an SMI (e.g. schizophrenia, bipolar affective disorder). The presence of any physical health comorbidities and whether the inpatient was a smoker was also recorded.ResultOf the 135 inpatients, 10 didn't have any physical health monitoring completed and were excluded from the sample, making the final sample 125 inpatients. 68 of the inpatients were male, 57 were female. 98 had a diagnosis of an SMI, 27 did not. Most inpatients were of “white British” ethnicity. Of the 98 SMI patients, 14 had type II diabetes mellitus, 11 had essential hypertension, 12 had chronic obstructive pulmonary disease and 22 were obese (i.e. a BMI > 30 kg/m2). 70 of the 98 patients with an SMI were smokers.ConclusionAs expected, a significant proportion of patients with SMI admitted to the general adult inpatient wards are smokers. Whilst admission to hospital may not be considered an ideal time to get patients to consider quitting smoking, admission does at least provide an opportunity to educate patients on the negative effects on physical health that smoking has. This evaluation has highlighted that physical health comorbidities are common in this patient group. Admission to the psychiatric ward provides a golden opportunity to provide education to patients on the importance of making healthy lifestyle choices and also to assess any physical health comorbidities and ensure the management of any such comorbidities is optimised prior to discharge.
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Brooker-Thompson, Chad, Yasmin Sultana, and Adeela Ashraf. "Oppurtunistic completion of the 9 diabetic care processes during inpatient admission to a mental health hospital: an audit of local practice." BJPsych Open 7, S1 (June 2021): S67. http://dx.doi.org/10.1192/bjo.2021.221.
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AimsDiabetes is more prevalent in people with mental illness than in the general population. Those with both mental illness and diabetes are more likely to have poor glycaemic control. Clients with mental illness and diabetes are less likely to receive the 9 NICE recommended annual diabetic care processes than the general population. In 2017, the Joint British Diabetes Societies for Inpatient Care (JBDS-IP) and the Royal College of Psychiatrists released guidance recommending that inpatient psychiatric admissions should be used as an opportunity to complete diabetic care processes, and a named staff member should be responsible for this.We aimed to review local compliance with this JBDS-IP guidance, increase knowledge and improve local care for clients living with both mental illness and diabetes.MethodWe reviewed the notes of all current inpatients to general, forensic or learning disability wards at our centre and identified all patients with a known diagnosis of Diabetes. We identified which of the 9 care processes had been completed (or had the most recent result documented, or had a plan made for completion) during this admission. We identified if a named staff member was responsible for completing processes on each ward, and whether the care processes were documented in the patients’ notes.ResultWe identified 18 current diabetic inpatients at our centre (14% of inpatients). We found that none of these patients had a diabetic care processes review documented and none of these patients had had a foot check and urinary albumin performed during admission, or had the last community result identified and documented. We found that less than 15% of patients had a documented plan concerning the completion of retinal screening. One ward had a named staff member responsible for reviewing their diabetic patients’ screening. However, 6/9 care processes had been completed in the significant majority of patients (>75%).ConclusionOur centre is not compliant with the guideline audited. We have implemented a plan to increase awareness of care processes through posters, teaching (at junior and consultant level), creating documentation templates and ensuring wards nominate a staff member to review care processes. We have organised a re-audit. Organising foot examination, renal function testing and retinal screening during admission for clients who may have complicated social situations and may not be aware of (or be non adherent with) the long term management of their diabetes has the potential to significantly reduce morbidity in this client subgroup.
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Martland, Rebecca, Juliana Onwumere, Fiona Gaughran, and Brendon Stubbs. "Perspectives on implementing HIIT interventions for service users in inpatient mental health settings: a qualitative study investigating patient, carer and staff attitudes." BJPsych Open 7, S1 (June 2021): S269. http://dx.doi.org/10.1192/bjo.2021.716.
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AimsHigh intensity interval training (HIIT) may improve a range of physical and mental health outcomes among people with severe mental illnesses (SMI). However, there is limited data on patients’ reported attitudes towards HIIT and its implementation within inpatient settings, and there remains an absence of data on attitudes towards HIIT from informal family carers of service users and healthcare professionals, who both have key roles to play in facilitating recovery outcomes in service users. This study sought to qualitatively investigate, in inpatients with SMI, carer and staff groups, perspectives on implementing HIIT interventions for patient groups in inpatient settings.MethodSeven focus groups and one individual interview were conducted. These included three focus groups held with inpatients with SMI (n = 12), two held with informal carers (n = 15), and two held with healthcare professionals working in inpatient settings (n = 11). An additional individual interview was conducted with one patient participant. The focus group schedule comprised open- ended questions designed to generate discussion and elicit opinions surrounding the introduction of HIIT on inpatient mental health wards. Data were subject to a thematic analysis.ResultTwo key themes emerged from the data, across all participants, that reflected the ‘Positivity’ in the application of HIIT interventions in psychiatric inpatient settings with beliefs that it would help patients feel more relaxed, build their fitness, and provide a break from the monotony of ward environment. Moreover, the short length of HIIT sessions was deemed appealing to mitigate against difficulties that many inpatients can experience with motivation, interest and attention, and was considered to be more appealing than more lengthy forms of exercise, which may require greater physical exertion. The second theme related to ‘Implementation concerns’, that reflected subthemes about i) low patient motivation, particularly with older participants, those administered many medications, and for those with less positive memories of exercise ii) patient safety, including concerns surrounding the intensity of HIIT and inclusion of patients with physical health comorbidities and iii) practical logistical factors, including having access to the right sports clothing and staff availability to supervise HIIT.ConclusionHIIT for inpatients with SMI was actively endorsed by patients, carers and healthcare professionals. Patient safety and baseline motivation levels, and practical service considerations were all noted as potential barriers to successful implementation and are worth considering in preparation for trialing a new intervention.
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Paleri, Vigneshwar, Samantha Perera, Shivani Dudha, Robert Harland, and David Codling. "Evaluating the huddle as a method of improving staff communication and process efficiency on a psychiatric inpatient ward." British Journal of Healthcare Management 27, no. 4 (April 2, 2021): 1–10. http://dx.doi.org/10.12968/bjhc.2020.0146.
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Background/Aims Variation in healthcare processes is widespread in mental health care and can lead to inefficient processes and unnecessarily long inpatient stays. This study aimed to identify sources of variation and implement a huddle intervention to increase system efficiency on a psychiatric inpatient ward in London. Methods Using a Lean Six Sigma approach, areas for improvement on the authors' ward and processes working well on other wards were identified through process mapping and stakeholder interviews. The huddle intervention was implemented, then evaluated and improved through four Plan Do Study Act cycles based on feedback from staff and green-to-red methodology. Results Inconsistencies in multidisciplinary team communication was identified as the most prominent area of concern and inefficiency. The huddles were found to improve staff communication and increase ward activity. Concerns regarding the huddles' duration and focus on tasks were identified and addressed. Conclusions Huddles are a useful means of improving staff communication and increasing ward efficiency without taking up a significant amount of clinicians' time to care for patients. This could increase ward efficiency and reduce lengths of stay, although further research is required to establish this.
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Paul, N., and A. Xyrichis. "114 Tackling Noise Pollution in Hospitals: A Pre-Feasibility Study." Age and Ageing 50, Supplement_1 (March 2021): i12—i42. http://dx.doi.org/10.1093/ageing/afab030.75.
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Abstract This study aimed to better understand appropriate interventions aimed at reducing hospital ward noise and the subsequent impact this would have on inpatient experience. Service users consistently reported that noise pollution was the most detrimental factor in their recovery in hospital, principally due to its effects on sleep. Methods To aid usability and data collection the Richards- Campbell Sleep Questionnaire (RCSQ) was adapted into an electronic format with a sliding Likert scale using QuestionPro Software3. Qualitative patient interviews, the RCSQ and ward decibel measurements were recorded on Henry and Anne wards at St. Thomas’ Hospital, London. 20 patients were interviewed (12F, 8 M), with 3 being ultimately discounted due to severe cognitive impairment. Results were collated and will be presented as part of a pre-feasibility evaluation of the tools to measure patient sleep and experience of ward noise. Results: The mean of the responses from the 17 patients interviewed were calculated and graphically displayed. Of interest, 87.5% found the questionnaire straightforward to understand, but only 18.75% found it easy to complete (due to technological unfamiliarity). Conclusion and discussion Patients reported a consistently reported a less than optimal night’s sleep on the ward, with light sleep and increased time to fall asleep being key factors. Although visits were restricted to the “quietest” times on the ward, noise measurements consistently exceeded WHO recommendations of 40 dB. Subsequently excessive night-time noise created by other patients as well as staff was cited as the principal causes of poor sleep, with ward lighting being another cause. Results from this study have provided the justification for sound-masking technology to be trialled on inpatient wards, with the view of decreasing unpleasant ward noise and improving patient rest and recovery.
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Lekka, Nikoletta, Samantha Nunns, and Robert Verity. "Staff's perspectives on physical activity in acute mental health general adult wards." BJPsych Open 7, S1 (June 2021): S203—S204. http://dx.doi.org/10.1192/bjo.2021.545.
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AimsPhysical activity (PA) has multiple health benefits for people with severe mental illness (SMI). Nevertheless, people with SMI engage in less exercise and more sedentary behaviour than the general population. Additionally, inpatient settings can exacerbate barriers to PA and facilitate sedentary behaviour. Staff's attitudes towards PA promotion may influence patient engagement. The aim of this study was to explore staff's views on PA for acute psychiatric inpatients, including enablers and barriers.MethodAn online anonymous survey with free text was sent to all 85 multidisciplinary team (MDT) members of two acute general adult wards, including nurses, doctors and allied health professionals. A qualitative approach was used to gain deeper understanding of the participants' perspectives. Manual thematic analysis was completed to identify discrete themes.ResultResponse rate was 64%, with 54 professionals responding. Notably, 100% agreed or strongly agreed that exercise is beneficial to physical and mental health. Nevertheless, 72% felt it was not easy to do PA with patients during their shift, while many reported they were able to encourage exercise but were unable to accompany patients to sessions. Specifically, participants reported lack of time (40%), high level of clinical activity (32%), lack of staff (30%), lack of PA resources inside the wards (20%) and conflicting priorities (18%), stopping them from helping patients to do more exercise. However, they felt more staff (28%), time dedicated to PA (26%), on-ward resources (18%), access to the gym and gardens (18%), staff dedicated to PA (16%) and staff trained in facilitating PA (10%), would help participants promote PA on the ward. Other suggestions to enable PA included a change in ward culture, valuing and promoting PA, daily patient encouragement by all MDT members instead of only occupational therapists, and PA promotion as part of mental health treatment and as physical health strategy. Finally, 70% of participants said they exercised regularly, although some reported lack of time or motivation, work commitments and workload-related exhaustion reducing their ability to exercise.ConclusionParticipants acknowledged the importance of PA for physical and mental health. Furthermore, they described multiple enablers and barriers. Prioritising PA during admission, providing on-ward activities, educating/training staff, reiterating that PA promotion is within all MDT members' job roles, and offering organisational support can contribute to improved PA provision and regular involvement of patients.An integrative approach to mental health and wellbeing, promoting PA in inpatient psychiatric settings is required.
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Abd El Sayed, Sarah, and Sudhir Salujha. "Psychiatric staff training in managing medical emergencies: re-audit." BJPsych Open 7, S1 (June 2021): S63. http://dx.doi.org/10.1192/bjo.2021.211.
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AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.
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Septiani, Vina, Pudjiastuti Kartidjo, and Fenny Asri Nurdiani. "The Rationality of Antibiotics Use on Inpatient Department of Pediatric in One of the Hospital in Cimahi." Borneo Journal of Pharmacy 2, no. 2 (November 14, 2019): 125–32. http://dx.doi.org/10.33084/bjop.v2i2.1044.
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The purpose of this study is to assess the rationality of the use of antibiotics from inpatients in one hospital in Cimahi, West Java. The research about rationality analysis of antibiotics at pediatric inpatient in one of the hospitals in Cimahi was done retrospectively use descriptive analysis design. The data source was the medical record of a patient who treated at the children's inpatient ward from January through March 2017. The result shows that 39% of infected patients were children under one-year-old. Three significant cases of diseases that occurred in the period were bronchopneumonia, typhoid fever, and typhoid fever+bronchopneumonia. Antibiotics therapy was given as single therapy as well as combination, where cefotaxime (51%) and ceftriaxone (42%) were the most antibiotics widely used as single therapy. Antibiotic use at children inpatient ward during the period January � March 2017 on bronchopneumonia, typhoid fever, and typhoid fever + bronchopneumonia patients was not 100% rational referring to criteria: correct diagnosis, correct indication, the correct drug of choice, correct dosage, correct method, and correct time interval of drug administration.
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Blennerhassett, Jannette Maree, Karen Nancy Borschmann, Ruby Adelaide Lipson-Smith, and Julie Bernhardt. "Behavioral Mapping of Patient Activity to Explore the Built Environment During Rehabilitation." HERD: Health Environments Research & Design Journal 11, no. 3 (March 22, 2018): 109–23. http://dx.doi.org/10.1177/1937586718758444.
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Aim: To explore the use of a rehabilitation-focused behavioral mapping method to identify changes in patient physical activity, location, and social interaction following the relocation of a rehabilitation ward. Background: Rehabilitation wards are unique healthcare environments where patient activity is encouraged to improve recovery. Little is known about the impact of building design on patient behavior within a rehabilitation setting. We examined this issue when a rehabilitation ward was relocated without altering other aspects of the healthcare service. Method: The setting was a publicly funded inpatient general rehabilitation ward with a separate therapy area. Before and after ward relocation, patient behavior (location, physical, and social activities) was observed at 10-min intervals between 8:00 a.m. and 5:00 p.m. Patients and staff performed their usual activities during data collection. Results: Twenty-three patients participated in the old ward and 24 in the new ward, resulting in 1,150 and 1,200 observation time points, respectively. Patient location and behaviors were similar between wards ( p > .05). Participants were in bedrooms for more than half of the observations (67% old ward, 58% new ward), sitting down (62.8% old ward, 59.0% new ward), and alone (42.0% old ward, 38.0% new ward). Design features, such as separation of the therapy area and ward, may have impacted on patient behavior. Conclusions: The rehabilitation-focused behavioral mapping method provided a rich description of relevant patient behaviors, indicating that it is a feasible and useful method for exploring the impact of the built environment in rehabilitation settings.
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Hunt, Isabelle M., Kirsten Windfuhr, Jenny Shaw, Louis Appleby, and Nav Kapur. "Ligature Points and Ligature Types Used by Psychiatric Inpatients Who Die by Hanging." Crisis 33, no. 2 (March 1, 2012): 87–94. http://dx.doi.org/10.1027/0227-5910/a000117.
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Background: Approximately three-quarters of patients who die by suicide on psychiatric wards do so by hanging/strangulation. Increased awareness of the methods used by these patients may benefit prevention strategies in mental health services. Aims: To describe the ligature points and ligatures used in ward hangings; to identify any trends over time in ligature points and ligatures used; and to compare these patient characteristics with other inpatient suicides. Methods: A national clinical survey of suicide cases in recent (< 1 year) contact with mental health services in England and Wales (1999–2007). Results: Of the 448 suicides that occured on psychiatric wards, 77% were by hanging. The number of hanging cases, however, has fallen by 74% since 1999. The most common ligature points and ligatures were doors, hooks/handles, windows, and belts or sheets/towels, respectively. Use of shoelaces, doors, and windows increased over time. These patient suicides had had high rates of self-harm, alcohol/drug misuse, and were more likely than other cases to have died early in admission and been formally detained for treatment. Conclusions: Despite the decrease in inpatient suicides by hanging, regular reviews of ward structures are needed, particularly as ligatures and ligature points change over time. Improving the ward environment to engage patients, especially early in admission, may also contribute to reducing risk.
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Hughes, Joshua, Rhianne Thomas, Jonathan Macklin, and Jonathan Owen. "Investigating sleep quality on an inpatient psychiatry ward." BJPsych Open 7, S1 (June 2021): S195. http://dx.doi.org/10.1192/bjo.2021.525.
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AimsSleep is essential for optimal physiological functioning, but often interrupted in hospital settings. Disturbed sleep is associated with relapse of mood disorders and multiple comorbidities including impaired immunological function and increased cardiovascular risk. There are unique environmental challenges on psychiatry wards, such as overnight monitoring. Recent studies highlight the importance of evaluating and managing inpatient sleep disturbance. Aims include exploring the extent to which patients’ sleep is impacted by inpatient admission, elucidating causes of sleep disturbance and determining ways to improve sleep during admission.MethodPatients aged 18–65 years, who consented and were expected to be inpatients for a week, were approached after 72 hours of admission (n = 35). Quantitative and qualitative data, including on pre-hospital and hospital sleep quantity and quality, were gathered, as part of a cohort characterisation. Questionnaires using Pittsburgh Sleep Quality Index elements were used to gather data. Offering earplugs as a sleep-aid intervention was implemented, with sleep quantity and quality reassessed 72 hours post-intervention. In response to feedback, sound monitoring at regular intervals overnight was undertaken using a decibel-metre to determine noise baseline and variation.ResultAll patients approached agreed to participate. Pre-hospital average sleep quantity was 5.2 hours, with restedness score of 4.3, and 71% patients rating their sleep as ‘bad’. After 72 hours post-admission, average sleep length was 6.5 hours and restedness 5.3. Of patients who accepted earplugs (59%), there were improvements to mean sleep quality and quantity (7.6 hours), with 86% patients rating earplugs helpful. All patients surveyed thought that earplugs should be offered routinely on admission. 70% of patients were prescribed benzodiazepines or z-drugs as required. Self-reported factors affecting sleep included noise, psychiatric symptoms and medication side effects, with 13 patients mentioning the former. Sound monitoring recorded an average decibel level with a range of 35–75 dB, with peaks reaching 95 dB.ConclusionPoor sleep in hospital is widespread. There is a need to understand and address modifiable environmental and ward factors implicated in sleep disturbance within inpatient settings. Pharmacological options for sedation are common, but it is important to focus on alternative options of low-cost, non-pharmacological interventions which promote sleep optimisation and enhance inpatient care.
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Young, John, Claire Hulme, Andrew Smith, John Buckell, Mary Godfrey, Claire Holditch, Jessica Grantham, et al. "Measuring and optimising the efficiency of community hospital inpatient care for older people: the MoCHA mixed-methods study." Health Services and Delivery Research 8, no. 1 (January 2020): 1–100. http://dx.doi.org/10.3310/hsdr08010.
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Background Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance. Objectives (1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5). Methods Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of < 24 hours) and the National Audit of Intermediate Care. Results Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions. Limitations The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample. Conclusions The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale. Future work How less efficient hospitals might reduce costs and sustain quality requires further research. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
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Gill, Neeraj S., Stephen Parker, Andrew Amos, Richard Lakeman, Mary Emeleus, Lisa Brophy, and Steve Kisely. "Opening the doors: Critically examining the locked wards policy for public mental health inpatient units in Queensland Australia." Australian & New Zealand Journal of Psychiatry 55, no. 9 (June 23, 2021): 844–48. http://dx.doi.org/10.1177/00048674211025619.
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The Queensland Government issued a policy directive to lock all acute adult public mental health inpatient wards in 2013. Despite criticism from professional bodies and advocacy for an alternative, the policy has been retained to this day. A blanket directive to treat all psychiatric inpatients in a locked environment without individualised consideration of safety is inconsistent with least restrictive recovery-oriented care. It is against the principles of the United Nations Convention on the Rights of Persons with Disabilities, to which Australia is a signatory. It is also contrary to the main objects of the Mental Health Act 2016 (Qld). Queensland Health has reported a reduction in ‘absences without permission’ from psychiatric inpatient wards after the introduction of the locked wards policy; however, no in-depth analysis of the consequences of this policy has been conducted. It has been argued that patients returning late or not returning from approved leave is a more common event than patients ‘escaping’ from mental health wards, yet all may be counted as ‘absent without permission’ events. A review of the international literature found little evidence of reduced absconding from locked wards. Disadvantages for inpatients of locked wards include lowered self-esteem and autonomy, and a sense of exclusion, confinement and stigma. Locked wards are also associated with lower satisfaction with services and higher rates of medication refusal. On the contrary, there is significant international evidence that models of care like Safewards and having open door policies can improve the environment on inpatient units and may lead to less need for containment and restrictive practices. We recommend a review of the locked wards policy in light of human rights principles and international evidence.
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Beaglehole, Ben, John Beveridge, Warren Campbell-Trotter, and Chris Frampton. "Unlocking an acute psychiatric ward: The impact on unauthorised absences, assaults and seclusions." BJPsych Bulletin 41, no. 2 (April 2017): 92–96. http://dx.doi.org/10.1192/pb.bp.115.052944.
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Aims and methodThe acute psychiatric inpatient service in Christchurch, New Zealand, recently changed from two locked and two unlocked wards to four open wards. This provided the opportunity to evaluate whether shifting to an unlocked environment was associated with higher rates of adverse events, including unauthorised absences, violent incidents and seclusion. We compared long-term adverse event data before and after ward configuration change.ResultsRates of unauthorised absences increased by 58% after the change in ward configuration (P = 0.005), but seclusion hours dropped by 53% (P = 0.001). A small increase in violent incidents was recorded but this was not statistically significant.Clinical implicationsAlthough unauthorised absences increased, the absence of statistically significant changes for violent incidents and a reduction in seclusion hours suggest that the change to a less restrictive environment may have some positive effects.
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Lyons, Patrick G., Jeff Klaus, Colleen A. McEvoy, Peter Westervelt, Brian F. Gage, and Marin H. Kollef. "Factors Associated With Clinical Deterioration Among Patients Hospitalized on the Wards at a Tertiary Cancer Hospital." Journal of Oncology Practice 15, no. 8 (August 2019): e652-e665. http://dx.doi.org/10.1200/jop.18.00765.
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PURPOSE: Patients hospitalized outside the intensive care unit (ICU) frequently experience clinical deterioration. Little has been done to describe the landscape of clinical deterioration among inpatients with cancer. We aimed to describe the frequency of clinical deterioration among patients with cancer hospitalized on the wards at a major academic hospital and to identify independent risk factors for clinical deterioration among these patients. METHODS: This was a retrospective cohort study at a 1,300-bed urban academic hospital with a 138-bed inpatient cancer center. We included consecutive admissions to the oncology wards between January 1, 2014, and June 30, 2017. We defined clinical deterioration as the composite of ward death and transfer to the ICU. RESULTS: We evaluated 21,219 admissions from 9,058 patients. The composite outcome occurred during 1,945 admissions (9.2%): 1,365 (6.4%) had at least one ICU transfer, and 580 (2.7%) involved ward death. Logistic regression identified several independent risk factors for clinical deterioration, including the following: age (odds ratio [OR], 1.33 per decade; 95% CI, 1.07 to 1.67), male sex (OR, 1.15; 95% CI, 1.05 to 1.33), comorbidities, illness severity (OR, 1.11; 95% CI, 1.10 to 1.13), emergency admission (OR, 1.45; 95% CI, 1.26 to 1.67), hospitalization on particular wards (OR, 1.525; 95% CI, 1.326 to 1.67), bacteremia (OR, 1.24; 95% CI, 1.01 to 1.52), fungemia (OR, 3.76; 95% CI, 1.90 to 7.41), tumor lysis syndrome (OR, 3.01; 95% CI, 2.41 to 3.76), and receipt of antimicrobials (OR, 2.04; 95% CI, 1.72 to 2.42) and transfusions (OR, 1.65; 95% CI, 1.42 to 1.92). CONCLUSION: Clinical deterioration was common; it occurred in more than 9% of admissions. Factors independently associated with deterioration included comorbidities, admission source, infections, and blood product transfusion.
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Adamidou, I., and I. Udo. "The challenge of Vitamin D deficiency in an inpatient ward." European Psychiatry 33, S1 (March 2016): S563. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2085.
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Aims and hypothesisWe set out to determine standards that would enable the identification of persons at risk of Vitamin D (VitD) deficiency in our ward; the prevalence of deficiency in at risk patient group on a 25-bedded ward (Brunswick). Deficiencies were identified, managed according to local guidelines and care plans were updated to reflect this change.BackgroundLow VitD levels have been associated with depression, psychosis, schizophrenia, suicidality, treatment resistance and poor coping. However, serum VitD levels is not a routine investigation on inpatient psychiatric admissions. Factors associated with VitD deficiency include prolonged stay in inpatient units with limited exposure to sun; Inpatients’ diet; Self-neglect and social isolation.MethodsCriteria for identifying patents who may be at increased risk was agreed.These patients were approached, and consented to screening. Results of the investigation were discussed with patients and actioned according to need. Study period May 2015–July 2015.ResultsWe were unable to identify any criteria in use for identifying persons at risk in psychiatric services. The following criteria were agreed: Hospital stay for > 2 months and limited opportunities of leaving the ward (Detention); Transfer from another unit with a total of hospital stay > 2 months; Admission from the community with severe depression or history of social isolation.7 patients (28%) were identified to be at increased risk. Of this, 6 patients (85.7%) were deficient and another 1 (14.3%) had insufficient level. Management was instituted.ConclusionsIf indicated, psychiatrists ought to consider monitoring VitD levels during inpatient stays and managing as appropriate.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Riyadi, Muskhab Eko, Ahmad Ikhwan Hanafi, and Ni Ketut Arningsih. "Kemampuan mobilitas dan derajat luka tekan pasien rawat inap." Health Sciences and Pharmacy Journal 4, no. 1 (April 30, 2020): 28. http://dx.doi.org/10.32504/hspj.v4i1.177.
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The occurrence of pressure ulcer is directly related to the duration of immobility. If the suppression continues for a long time, small vascular thrombosis and tissue necrosis will occur. In bone protrusions that hold weight are more susceptible to pressure sores and are often found in people with limited movement because they are unable to change positions to remove pressure. Objective is to determine the relationship of mobility ability with the degree of pressure ulcer on inpatients at Wonosari Hospital in Gunungkidul Regency. This research was non-experimental research with cross-sectional design. The samples in this study were patients treated in the surgical, internal and neurological ward of Wonosari Hospital in Gunungkidul Regency. The sampling technique used the simple random sampling technique. While the statistical test used the Pearson test. Results showed that the average scale of mobility ability of inpatients was 3 scale (mean 2,70), while the average value of the degree of pressure ulcer in the inpatient ward of Wonosari Hospital was degree I (mean 1,32). Conclusion of this research was there was a significant correlation between mobility ability and the degree of pressure ulcer of the patient in the inpatient room at Wonosari Hospital in Gunungkidul Regency with a significance value of 0.000 (ρ < 0,05).
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Risal, Ajay, and Pushpa Prasad Sharma. "Psychiatric Morbidity Patterns in Referred Inpatients of Other Specialties." Journal of Nepal Medical Association 52, no. 189 (March 31, 2013): 238–44. http://dx.doi.org/10.31729/jnma.563.
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Introduction: Consultation-liaison psychiatry is an upcoming field dealing with interdepartmental collaboration heading into multidisciplinary and holistic care. In general hospital setting, psychiatrists need to be involved in evaluation of patients referred from other specialties. This study analyzed the psychiatric morbidity among the inpatients referred to Psychiatry Department from different wards in a Tertiary care University Teaching Hospital.
Methods: Total 385 subjects were referred to the Department of Psychiatry from different wards during a period of one year. Each of them underwent a detailed psychiatric evaluation by a consultant psychiatrist once they were medically stable. Psychiatric diagnosis was considered as per International Classification of Disease-10 criteria.
Results: The mean age of the subjects evaluated was 37.26 (±1.86); most of them were females 216 (56.4%), married 287 (74.5%), and homemaker 159 (41.3%). Maximum 271 (70.4%) referral was from Medical ward, and most of them 292 (75.8%) were admitted in general bed. The most common medical diagnosis was self-poisoning 115 (30.6%) followed by alcoholic liver disease 49 (12.7%); while the commonest 123 (31.9%) psychiatric diagnosis was depression (including Dysthymia and Adjustment disorder). Depression remained the commonest diagnosis among those referred from medical ward 131 (34.7%); while anxiety was mostly found in the emergency referral 94 (24.5%). Significant Correlation (P <0.05) was seen between the source of referral and Psychiatric diagnosis.
Conclusions: Psychiatric consultation was sought mostly by medical ward that had maximum number of patients presenting with self-poisoning. The commonest diagnosis seen in the referred in-patients was depression and anxiety disorder.
Keywords: consultation-liaison psychiatry; in-patient referral; psychiatric morbidity.
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Dietlein, M., C. Reiners, and R. Lorenz. "Nuclear medical inpatient treatment in Germany." Nuklearmedizin 49, no. 02 (2010): 49–57. http://dx.doi.org/10.3413/nukmed-0296.
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SummaryAll public licensed hospitals of Germany are obligated since 2004 to establish and to publish a structured biennial quality report. The aim of this study was to analyse the quality reports from 2008 of clinics with nuclear-medicine therapy ward and to investigate developments for the inpatient nuclear-medicine therapy by comparing the results with the quality reports of the years 2004 and 2006. Methods: All available structured quality reports of clinics with a nuclear-medicine therapy ward of the years 2004, 2006 and 2008 were evaluated. Results: The total number of inpatient treatment cases in 2008 amounted to 54 190 (2006: 54 884; 2004: 57 366). This corresponds to a decrease of 5.5% in comparison to 2004. The number of the therapy wards decreased at the same time to currently 117 (2006: 120; 2004: 124). Remarkable changes were found in the spectrum of the main diagnosis. Thus, the most frequent diagnosis with the ICD-code E05 (hyperthyroidism) decreased continuously from 37 747 treatments in 2004 and 34 764 in 2006 to 31 756 in the year 2008. In contrast, the ICD-diagnoses for thyroid cancer (C73, Z08) with 14 761 cases in 2008 increased with time (2006: 13 426; 2004: 12 581). Conclusions: In analogy to the observations from Europe after introduction of an iodine prophylaxis the improved iodine supply in Germany has led to a decline of the radioiodine therapy due to hyperthyroidism.
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Kang, Kuldip Kaur, and Nicola Moran. "Experiences of inpatient staff meeting the religious and cultural needs of BAME informal patients and patients detained under the Mental Health Act 1983." Mental Health Review Journal 25, no. 2 (June 17, 2020): 113–25. http://dx.doi.org/10.1108/mhrj-11-2019-0041.
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Purpose This paper aims to explore inpatient staff experiences of seeking to meet the religious and cultural needs of Black, Asian and Minority Ethnic (BAME) inpatients on mental health wards. Design/methodology/approach Nine semi-structured interviews were undertaken with inpatient staff in one NHS Trust in England to explore their views and experiences of supporting BAME inpatients to meet their religious and cultural needs. Anonymised transcripts were analysed thematically. Findings Inpatient staff reported lacking the confidence and knowledge to identify and meet BAME inpatients’ religious and cultural needs, especially inpatients from smaller ethnic groups and newly emerging communities. There was no specific assessment used to identify religious and cultural needs and not all inpatient staff received training on meeting these needs. Concerns were raised about difficulties for staff in differentiating whether unusual beliefs and practices were expressions of religiosity or delusions. Staff identified the potential role of inpatients’ family members in identifying and meeting needs, explaining religious and cultural beliefs and practices, and psychoeducation to encourage treatment or medication adherence. Practical implications Potential ways to address this gap in the knowledge and confidence of inpatient staff to meet the religious and cultural needs of BAME patients include training for inpatient staff; the production and updating of a directory of common religious and cultural practices and needs; local resources which can help to support those needs; and religious and cultural practices and needs being documented by mental health practitioners in community teams such that this information is readily available for inpatient staff if a service user is admitted. Originality/value This is the first study to consider inpatient staff views on meeting the religious and cultural needs of BAME informal patients and patients detained under the Mental Health Act 1983.
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Grobler, Christoffel, Johanita Strumpher, and Ruwayda Jacobs. "Overcrowding as a possible risk factor for inpatient suicide in a South African psychiatric hospital." South African Journal of Psychiatry 21, no. 3 (August 1, 2015): 1. http://dx.doi.org/10.4102/sajpsychiatry.v21i3.759.
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<p>About 4% of all suicides are estimated to occur while being an inpatient in a psychiatric facility. Staff generally assume that an inpatient suicide reflects a failure on their part to recognise the patient’s suicidal intent and whether it could have been prevented in any way.</p><p>Inpatients who commit suicide do not seem to be a homogenous group, but some risk factors have been identified, including being young, single, male, unemployed, abusing substances, schizophrenia and personality- and affective disorders. Number of admissions in the previous month also appears to be a risk factor.</p><p>When the numbers of inpatients are high, more violent incidents occu. Although literature presently do not suggest an association, overcrowding in psychiatric inpatient wards should be considered a risk factor for inpatient suicide.</p>
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Goss, Grace Lydia, Priya Gowda, and Danika Rafferty. "Advanced nurse practitioners- the missing link on old age pyschiatry inpatient wards?" BJPsych Open 7, S1 (June 2021): S331. http://dx.doi.org/10.1192/bjo.2021.869.
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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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Propper, Carol, Michael Damiani, George Leckie, and Jennifer Dixon. "Impact of patients' socioeconomic status on the distance travelled for hospital admission in the English National Health Service." Journal of Health Services Research & Policy 12, no. 3 (July 1, 2007): 153–59. http://dx.doi.org/10.1258/135581907781543049.
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Objectives: To compare the distances travelled for inpatient treatment in England between electoral wards prior to the introduction of a policy to extend patient choice and to consider the impact of patients' socio-economic status. Methods: Using Hospital Episode Statistics for 2003–04, the distance from a patient's residence to a National Health Service hospital was calculated for each admission. Distances were summed to electoral ward level to give the distribution of distances travelled at ward level. These were analysed to show the distance travelled for different admission types, ages of patient, rural/urban location, and the socioeconomic deprivation of the population of the ward. Results: There is considerable variation in the distances travelled for hospital admission between electoral wards. Some of this is explained by geographical location: individuals living in more rural areas travel further for elective (median 27.2 versus 15.0 km), emergency (25.3 versus 13.9 km) and maternity (25.0 versus 13.9 km) admissions. But individuals located in highly deprived wards travel less far, and this shorter distance is not explained simply by the closer location of hospitals to these wards. Conclusions: Before the introduction of more patient choice, there were considerable differences between individuals in the distances they travelled for hospital care. An increase in patient choice may disproportionately benefit people from less deprived areas.
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Johanes, Mikhael, and Paramita Atmodiwirjo. "Visibility Analysis of Hospital Inpatient Ward." International Journal of Technology 6, no. 3 (July 29, 2015): 400. http://dx.doi.org/10.14716/ijtech.v6i3.1458.
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