Northern & Yorkshire

Medical Student and Trainee

Presentations

Spring 2016

2

Contents

Medical Student/FY1 Poster Presentations

MSP1 Ms Alana Ahmet

This history of Child and Adolescent Psychiatry: Why Childhood

matters

MSP2 Mr Ragu Prakash Ratnakumaran Sarah Costantino, Arnaldo Silva,

Sabrina Leigh-Hunt, Sumir Punnoose

Documentation and performance of ECGs and pregnancy tests in

acute women services

MSP3 Ms Rhiannon Davison Elizabeth Romer

Awareness of and experiences with mental support services in

medical students

MSP4 Mr Sverrir Kristinsson Niall Robinson

Documentation and performance of ECGs and pregnancy tests in

acute women services

FY2/Trainee Oral Presentations

TO1 Dr Claire Pocklington Dean McMillan, Simon Gilbody,

Laura Manea

The diagnostic accuracy of brief versions of the Geriatric Depression Scale: A systematic review and meta-analysis

TO2 Dr Helen Singhateh Yasmin Ahmed

Yorkshire and Humber Psychiatry Recruitment Survey

3

TO3 Dr Joanne Georgina Parry Trevor Gedeon, Mary-Jane Tacchi

Are all Forensic Psychiatrists arrogant? A survey of specialty stereotypes held within Psychiatry

TO4 Dr Kanmani Balaji Sarah Talari, Amanda Spencer,

Oliver Duprez, Dominik Klinikowski

Citalopram Monitoring Audit in Community Learning Disability Team

FY2/Trainee Poster Presentations

TP1 Dr Alexandros Chatziagorakis Mark Knights, Surendra Buggineni

HIV infection and the neuropsychiatric manifestations. A literature

review.

TP2 Dr Oliver James Fenton Anna Kilsby, Fiona Lacey

Clinical Audit – Junior Doctor On-Call Handover

TP3 Dr Helen Henfrey Helen Singhateh, Alison Burrows

Clinical Audit of the Initial Assessment and Ongoing Monitoring of

Physical Health in the Psychiatric Rehabilitation Setting

TP4 Dr Sabrina Leigh-Hunt Viji Saravanan, Stephen Curran,

Shabir Musa

Environmental audit of older peoples inpatient facilities

TP5 Dr Soumaya Nasser El Din Alistair Cardno, Tariq Mahmood,

David Yeomans, Mahmood Khan,

Shona McLlrae, Niki Taylor,

Hannele Variend, Rano Bhadoria,

Deline Du Toit, Sandip Deshpande

4

Clinical Variation in Psychosis: The relationships between diagnoses,

symptom dimensions, potential risk/protective factors and outcomes

in psychotic disorders.

TP6 Dr Rosalind Oliphant

Audit of Memantine Prescribing and Follow Up in an Older Persons CMHT

TP7 Dr Mary Parker Jane Leigh

Audit of clinic letters from MHSOP Consultants to GPs: Improving quality of communication to enhance patient safety.

TP8 Dr Joanne Georgina Parry Bruce Owen

Establishing Simulation Training in Health Education North East- STEP

Project

TP9 Dr Joanne Georgina Parry Patrick Keown, Iain McKinnon,

Paul Brown, Steve Cull,

Joanne French

The impact of Street Triage in Northumberland, Tyne and Wear NHS Foundation Trust

TP10 Dr Christopher Wood Hannah Arnstein, Prathibha Rao

Staff and Service User Perception of New Smoking Legislation in a Single NHS Mental Health Institution in the North East of England

5

Medical Student/

FY1 Poster

Presentations

6

MSP1 Ms Alana Ahmet

This history of Child and Adolescent Psychiatry: Why Childhood matters

Introduction

Throughout history, children have always had behavioural and psychological difficulties. These have been recognised and dealt in numerous ways throughout

the centuries. Personality disorders have been seen as the work of the devil,

behavioural disorders have been thought to be a manifestation of brain matter disease and children with mental health problems have been regarded as small

adults and thus treated or punished as such.

In most branches of medicine, positive advances have been so rapid that historical aspects have had relatively little application in modern practice,

however psychiatry is polar to this trend as obtaining a historical sense is key. One must have a perception of the past to unlock reasons in the present.

Method

Over a 6-week period I researched the Internet and attended many of the psychiatric historical museums in London. Using the knowledge I obtained this

work explores the birth and development of child and adolescent psychiatry from the medieval to the modern world using many sources for information. It aims to

be the most comprehensive piece of work available to date.

Conclusion

Child and adolescent psychiatry in Britain is now a well-established sub-specialty

of general psychiatry. As specialties increasingly compete for a place on the therapeutic spectrum and at a time when funding and the cost of health care are

crucial political issues, the challenge is to develop more effective ways of using the skills of the child psychiatrist.

MSP2 Mr Ragu Prakash Ratnakumaran Sarah Costantino, Arnaldo Silva,

Sabrina Leigh-Hunt, Sumir Punnoose

Documentation and performance of ECGs and pregnancy tests in acute women services

Background

Many service users (SU) are started on psychotropic medications, which can be teratogenic or cause metabolic, labour and perinatal complications or electrical

cardiac abnormalities. Therefore all SUs should have Electrocardiograms (ECG) on admission and pregnancy tests (PT) where appropriate, the results of which

should be clearly documented.

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Standards

We audited the documentation of PTs and ECGs in an inpatient women psychiatric department against the standards:

All women of reproductive age should be offered a pregnancy test on admission.

Before starting antipsychotic medication, an ECG should be offered

Methods A total of 47 female SUs admitted during a one month period were included in

the study. We analysed each SU’s electronic notes (PARIS), and assessed whether PTs and ECGs were performed and documented under the ‘test results’

section.

Results No PTs were performed or documented in the correct location in PARIS. 87% of

service users had ECGs performed, though only 10% of all SU had ECGs

documented under ‘test results’.

Impact PTs are rarely done and documented in inpatient services, which we believe is

due to the lack of awareness of the relevant standards. ECGs are done for the majority of services users though the results for most were documented in the

incorrect location. In order to improve awareness of the requirement to undertake and correctly document these tests, we have implemented a

communication system known as (Purposeful In-patient admission) PIPA, which displays all the daily tasks required (including PTs and ECGs) for each SU.

References Royal College of Psychiatrists (2009) Physical health in mental health, London:

Royal College of Psychiatrists.

NICE (2014) Psychosis and Schizophrenia in Adults, London: National Collaborating Centre for Mental Health.

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MSP3 Ms Rhiannon Davison Elizabeth Romer

Awareness of and experiences with mental support services in medical

students

Background Mental health problems are more common among medical students compared to

the general population. Limited research exists in this area especially within the UK but literature broadly suggests that students often feel inadequately

supported.

Objectives This research aims to evaluate the awareness of and experiences with mental

health support in medical students at Leeds University and to identify what improvements could be made.

Methods This cross-sectional observational study collected quantitative and qualitative

data between January and October 2015 via an anonymous electronic questionnaire sent to years 1, 3 and 5 of the MBChB programme.

Results

N=156. Almost half of respondents reported personal experience of mental health problems, with 20.5% starting whilst at medical school. Most respondents

(73.1%) knew where to access support but were not confident to seek help (55%). Personal tutors and GP were the most widely known sources of support.

Students were most likely to access the GP and student counselling centre. They were least likely to access the academic subdean and disability support. The main

barriers to support were academic threat and lack of time. Free text responses revealed a variety of positive and negative experiences. Respondents felt they

received the right amount or too little information and wanted to receive more

information via a website.

Conclusions Students favour sources of support which are confidential, easy to access,

independent from the medical school, involved someone they had rapport with and without threat to academic progress. Recommendations for change are

made based on the conclusions.

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MSP4 Mr Sverrir Kristinsson Niall Robinson

Documentation and performance of ECGs and pregnancy tests in acute women services

Background The Calderdale Flexible Assertive Community Treatment (FACT) model of care

comprises a multi-disciplinary team to provide a flexible period of intensive contact and support to service users, within the enhanced pathway, who are

suffering from severe mental illness. FACT is a new service that is replacing the assertive outreach team (AOT) in Calderdale due to its more beneficial effect of

reducing hospital admissions, bed use and hence overall cost. The aim of this project is to develop an informative patient information leaflet in the style of an

NHS leaflet (with adherence to trust policies) explaining the Calderdale FACT.

Method

This project is an example of descriptive/inductive research whereby qualitative data was obtained via focus group discussions to assist in the development of a

leaflet. Data was collected during the meetings via recording the group focus discussions. The focus group was ‘Dual Moderated’ meaning one moderator

encouraged group discussion through open questions whilst the other moderator ensured that discussions remained relevant, that all topics were addressed and in

time. Data was analysed using recursive abstraction. This involved typing up the

transcript of the meeting, and then summarizing the content into main themes which formed the basis of headings for the leaflet.

Impact

The leaflet will be available to all service users, carers, and anyone else involved with the Calderdale FACT team. It will be a useful tool for practitioners to use to

help engage people with the service, promoting patient education.

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FY2/Trainee Oral

Presentations

11

TO1 Dr Claire Pocklington Dean McMillan, Simon Gilbody, Laura Manea

The diagnostic accuracy of brief versions of the Geriatric

Depression Scale: A systematic review and meta-analysis

Background

Depression in older adults is under recognised. It poses diagnostic difficulties and is associated with worse outcomes in comparison to younger adults. Depression

in older adults is likely to become a more pressing issue in the future due to increasing life expectancy and population size. The GDS is the most well used

depression rating scale in older adults. Brief versions have become more popular due to their suitability for busy clinical practice.

Objective

To establish the diagnostic accuracy of brief GDS versions

Methods Twelve electronic databases were searched. Study selection was in accordance

with predefined criteria. The population of interest was older adults. Intervention

referred to a brief GDS version. Comparator was a recognised gold-standard diagnostic instrument. Outcome was data pertaining to diagnostic accuracy.

Quality assessment was performed using the QUADAS-II. Narrative analysis and, where possible, meta-analysis and meta-regression were performed.

Results

32 studies providing diagnostic data were identified providing diagnostic data for seven brief versions of the GDS; 1-item, 4-item, 5-item, 7-item, 8-item, 10-item

and 15-item. Meta-analysis was only possible for the GDS-15; a sensitivity of 0.77 and a specificity of 0.89 were found for the recommended cut-off score of 5.

Meta-analysis was not possible for other brief versions due to insufficient study numbers.

Conclusion

Results suggest the possibility of selective reporting of cut-off scores post-hoc,

therefore findings should be approached cautiously. Studies should report all cut-off scores and all brief versions should have standardised items. Further

diagnostic accuracy studies of brief versions of the GDS are required.

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TO2 Dr Helen Singhateh Yasmin Ahmed

Yorkshire and Humber Psychiatry Recruitment Survey

Background • Recruitment to Psychiatry in Yorkshire & Humber deanery identified as poor

• Fill rate of 46.7% after 2 rounds in 2014 • Senior Management Committee – suggested focus group to address this

problem • Focus group – TPDs, Higher trainees, Core trainees

Research

F2 Career Destination Report 2014 Questionnaire - CT1 trainees in deanery

Quantitative Data Yorkshire Medical Schools psychiatry uptake:

• Hull & York 2.5% • Leeds 1.9%

• Sheffield 3.4% • UK Total average: 3.0%

Foundation Schools psychiatry uptake

• NYEC 3.2% • South Yorkshire 3.1%

• West Yorkshire 2.2% • UK Total average: 3.3%

Qualitative Date Themes

Why Psychiatry?

• Inspirational Consultants / Positive Placement • Personal / Family history of mental health issues

• Future planning /work/life balance • Transfer from other specialties due to lack of job satisfaction

Why Yorkshire? • Outdoor pursuits

• Local to the area (e.g family/friends locally) • Cheaper than training down South

Why Yorkshire training schemes? • TPDs very helpful / enthusiastic

• Size of schools • Word of mouth

• Academic Fellow Job

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Results

Positives

• 80% straight from F2 • 95% of UK graduates undertook foundation placement and chose

psychiatry Negatives

• Only 23% local graduates • West Yorkshire – poor uptake from both medical and foundation schools

Reflections

• Lack of professional (rather than personal) reasons to choose Yorkshire • Those already interested in Psychiatry would have chosen an FY track that

included this. • What are other deaneries doing that we are not?

Recommendations

• Liaise with more successful medical and foundation schools for feedback

and suggestions • Improve awareness of trainees success in Yorkshire (MRCPsych pass rates)

• Improve awareness of training quality • Address quality of medical student/foundation placements

TO3 Dr Joanne Georgina Parry Trevor Gedeon, Mary-Jane Tacchi Are all Forensic Psychiatrists arrogant? A survey of specialty stereotypes

held within Psychiatry

Aims

To explore potential stereotypes, held by trainees, of psychiatric specialty

members and if these are in keeping with the views of consultants within these fields.

Background

Stereotypes continue to be portrayed throughout the medical profession with psychiatrists often being viewed negatively which has been proposed as a barrier

to recruitment. Do we however continue to express stereotypes, be it positive or negative, within the specialties of psychiatry and what impact do these have

upon future employment decisions?

Method An anonymous survey was constructed using character trait descriptive

adjectives to explore the stereotypes held by trainees on members of the different specialties. Nationally psychiatry trainees were asked to anonymously

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identify the 10 most appropriate adjectives to describe psychiatrists in the field of

CAMHS, general adult, older persons, psychiatry of learning disabilities, forensics

and psychotherapy.

Results The survey commenced in November 2015 and will close in January 2016.

Preliminary results are certainly interesting and there are strong patterns of stereotyped characteristics within each specialty. The results will be fully

available by the Conference and results displayed for each specialty via a word cloud, where the size of the word is proportional to the popularity of the word in

the list.

Conclusions Whilst the surveys data continues to populate it is apparent that stereotypes and

stigma have now become endemic within psychiatry. Whilst light-hearted the survey results will bring into question the need to unite as a profession to fight

the wider stigma that Psychiatry continues to face.

TO4 Dr Kanmani Balaji Sarah Talari, Amanda Spencer,

Oliver Duprez, Dominik Klinikowski

Citalopram Monitoring Audit in Community Learning Disability Team

Background Following FDA recommendations in August 2011 with regards to safety of

Citalopram, an audit was conducted in March 2014 by the CLDT to establish how well the guidelines were adhered to. A re-audit was conducted in October 2015 to

measure the performance.

Standards The standards were taken from the CISSG meeting in November 2011.

Maximum dose should be 40 mg or 20mg if elderly or abnormal liver

function. Should have ECG in their notes with the QTc documented or an

explanation, if not done.

If doses greater than 20mg, they should have documented LFTs. If QTc prolonged, dose to be reduced or discontinued or referred to

cardiology. If on other QTc prolonging medication , should have an ECG

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Method

Those on citalopram were identified from the caseload (August 2015). Those

previously on Citalopram but have discontinued it presently have been excluded. Clinical notes were reviewed for age, dose, other medication that prolongs QTc,

whether there was an ECG, QTc & LFT. Data was analysed using Microsoft Excel.

Results On comparing the audit and re-audit, the results are as follows:

Audit Re-audit

Sample 23/137 10/114

Age over 65 3 0

Dose over 20 10 2

ECG documentation 55% 89%

Other QTc prolonging medications 35% 50%

LFT 50% 0%

QTc documentation 45% 89%

Impact

Significant increase in adherence to guidelines thereby ensuring patient safety.

Where appropriate, the dose was reduced or switched to other antidepressants

Pro-active at investigations by liaising with GPs.

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FY2/Trainee Poster

Presentations

17

TP1 Dr Alexandros Chatziagorakis Mark Knights, Surendra Buggineni

HIV infection and the neuropsychiatric manifestations. A literature

review.

Highly Active Antiretroviral Therapy (HARRT) has led to a reduction in HIV-related morbidity and mortality and the life expectancy of HIV-positive individuals

has improved significantly. It is therefore becoming even more likely that

clinicians will encounter patients with neuropsychiatric manifestations of the disease.

Our objective was to summarise the evidence on prevalence, pathophysiology,

manifestations and treatment of neuropsychiatric conditions in HIV-positive individuals, with particular emphasis on HIV associated neurocognitive disorders

(HAND).

We searched multiple healthcare databases for English-language publications. Titles and abstracts were screened and potentially relevant papers were acquired

and evaluated for eligibility. References from eligible papers were also searched by hand. Heterogeneity allowed only for narrative synthesis.

We found 92 eligible articles. The most prevalent neuropsychiatric condition in

HIV-positive individuals is depression (35.6%), followed by substance misuse,

anxiety, psychosis, adjustment disorder and bipolar disorder. Neurocognitive impairment is also frequent. The spectrum of neurocognitive deficiency is

delineated into three categories of severity: 1. HIV-associated asymptomatic neurocognitive impairment (ANI), the least severe but most frequent, 2. HIV-1

associated mild neurocognitive disorder (MND) and 3. HIV-1 associated dementia (HAD), the most severe but least frequent.

In conclusion, HARRT has made a substantial impact on suppressing HIV; despite

this, neuropsychiatric complications persist and are likely to impose a significant burden on affected individuals. Although the degree of direct impact the virus has

on these complications remains uncertain, it is clear that effective treatment of both HIV and neuropsychiatric complications is critically important in order to

maximize life expectancy and quality of life.

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TP2 Dr Oliver James Fenton Anna Kilsby, Fiona Lacey

Clinical Audit – Junior Doctor On-Call Handover

Background Concerns were raised regarding identifying junior doctors recording handover and

clinical work acknowledged for resident on-call rota.

Baseline audit identified current levels of record keeping showing concern

identifying handover taking place and junior doctor identification. Action plan recommendation of development of handover proforma and protocol.

Completed audit cycle with re-audit showing improvement following period of

implementation of handover proforma.

Standards Following discussion standards developed based on Trust Clinical Handover of

Care Procedure principles as well as BMA, NPSA and GMC recommendations.

Standards based audit of recording date, time, doctor, shift, transfer of information and if information required acting on and acknowledged as well as

relevance of information were agreed on.

Re-audit standards as above corresponding to sections of newly developed

handover proforma.

Method For baseline audit one month’s records from previous handover book were

analysed and recorded using data collection tool and manually calculated totals. For re-audit two weeks’ data collected from new audit proformas analysed.

Results

Baseline audit showed only 86% handovers recorded and re-audit showed increase to 100% handovers recorded. Similar improvement in record of junior

doctors being identifiable, date, shift and relevance of information recorded.

Impact

The impact of the initial audit was to highlight areas of concern in recording of junior doctor handover. This led to developing a new handover proforma and

protocol. Re-audit showed improvement using new proforma. Also, new proforma received positive feedback from junior doctors and audit team and it continues to

be in use.

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TP3 Dr Helen Henfrey Helen Singhateh, Alison Burrows

Clinical Audit of the Initial Assessment and Ongoing Monitoring of

Physical Health in the Psychiatric Rehabilitation Setting

Background People with mental health problems live shorter lives than the general

population, mainly due to physical illness [1]. The RCPsych has produced pragmatic advice about improving the physical health of people with mental

health problems [2] and local guidelines have been generated [3]. The authors are concerned that these guidelines are not being implemented.

Standards

The criteria are taken from local policies, all are 100% standards. 1. Physical examination within 12 hours of admission

2. If the patient refuses examination this must be recorded and a review date set 3. Symptoms or signs identified and investigations recommended should be

followed up, and a management plan recorded on PARIS.

Methods

The audit was conducted in The Orchards rehabilitation unit in Ripon. All patients admitted to the unit 1st June 2014 - 31st May 2015 were included. The

information was collected from PARIS (electronic records system) using a designated audit tool.

Results

A total of 18 records were assessed.

Criteria Yes No N/A

22% (4)

78% (14)

-

Standard 2 0% (0)

100% (2)

16

Standard 3 0%

(0)

100%

(3) 15

Impact Induction for new doctors to include requirements regarding physical health.

Clarification to be sought from the trust Physical Healthcare Team regarding

the need for physical examinations for transferred patients. Implementation of proforma that will help the medical team accurately record

and monitor physical health parameters during admission. Re-audit in 6 months’ time.

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References

[1] - Marc De Hert et al. Physical illness in patients with severe mental disorders.

I. Prevalence, impact of medications and disparities in health care. WPA EDUCATIONAL MODULE. World Psychiatry. 2011 Feb;10(1):52-77.

[2] - RCPsych: Improving physical health for people with mental illness: what can

be done? Published 2013. Accessed online 15/10/15 [http://www.rcpsych.ac.uk/pdf/FR%20GAP%2001-%20final2013.pdf]

[3] – Guidance CLIN / 0052 / v3: Physical healthcare assessment of patients

(admission, annual and ongoing). Tees, Esk and Wear Valleys NHS Foundation Trust. Published 2013. Accessed onling 15/10/15

[http://intouch/Docs/Documents/Policies/TEWV/Clinical/Physical%20Healthcare%20Assessment%20of%20Patient.pdf]

TP4 Dr Sabrina Leigh-Hunt Viji Saravanan, Stephen Curran,

Shabir Musa

Environmental audit of older peoples inpatient facilities

Background

The National Audit of Dementia report provide recommendations on how to make the acute inpatient environment conducive to the care of dementia patients. This

audit was undertaken to gain an understanding of the environment for patients with dementia in two psychiatric inpatient facilities.

Standards Inpatient facilities were assessed against the National Audit of Dementia 2011

Report recommendations.

Methods Site visits were undertaken on the same day to the two inpatient psychiatric

wards (total 31 beds) and assessed against the National Audit of Dementia Environmental checklist. Two assessors were assigned to each site to ensure

validity of findings.

Results The wards were clearly signed with words and pictures, adapted for safety and

for individuals with mobility difficulties, as well as providing safe space for walking. While both wards provided hearing aids, only one was fitted with a

hearing loop. Toilets and bathing facilities were segregated by gender and

adapted for those with mobility difficulties, with clearly visible alarm buttons, though not fully signed with pictures. All patients had individual rooms with space

for personal belongings, and access to a quiet room, though most patients could not see a clock or calendar from their bed area.

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Impact

Both wards were broadly compliant with national recommendations. Recommendations based on findings are that every room should have a clock and

calendar to help with orientation, a hearing loop should be fitted and toilet and washing facilities need to be labelled clearly.

TP5 Dr Soumaya Nasser El Din Alistair Cardno, Tariq Mahmood,

David Yeomans, Mahmood Khan,

Shona McLlrae, Niki Taylor,

Hannele Variend, Rano Bhadoria,

Deline Du Toit, Sandip Deshpande

Clinical Variation in Psychosis: The relationships between diagnoses,

symptom dimensions, potential risk/protective factors and outcomes in

psychotic disorders.

Background

Over the last few decades, there has been much debate regarding the categorical and dimensional approaches and their use in clinical settings. Few studies

concluded that one is better than the other and few more were of the opinion that both strategies complement each other in providing valuable information

about pre-morbid risk factors and clinical outcomes.

Methods Formal clinical research interviews (SCAN version 2.1), questionnaires about risk

factors and psychosis-related experiences, and medical records were reviewed and analysed for 76 patients. Descriptive and non-descriptive analyses were

used. This research worked on previously used dimensions and mixed them

together to be able to come up with useful conclusions.

Results Seven dimensions of BADDS and SANS/SAPS items were analysed (mania,

depression, psychosis, mood incongruence, negative, positive and disorganised); all were tested against categorical diagnoses and risk factors. Mania seemed to

be the best discriminator for affective disorders, and both psychosis and mood incongruence for schizophrenia. The negative symptoms dimension correlated

strongly with poorer premorbid functioning, younger age of abusing cannabis and worse outcomes. The positive symptom dimension linked more to a better

response to neuroleptics.

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Conclusions

Both categorical and dimensional approaches seemed to complement each other

and neither on its own was sufficient to clarify the associations with all variables or risk factors. The categorical model seemed to be more instructive for age of

onset, poor social adjustment, cannabis use, and course of disorder. The dimensions used, on the other hand, were more associated with education level,

being anxious before onset, life traumas and course of disorder.

TP6 Dr Rosalind Oliphant

Audit of Memantine Prescribing and Follow Up in an Older Persons CMHT

Background NICE recommends that memantine is used only in severe Alzheimer’s disease &

moderate Alzheimer’s disease with an intolerance of or contra-indication to

acetylcholinesterase inhibitors (AChEIs). It was noted there was significant variation in reasons for prescribing memantine & subsequent follow up of

patients prescribed memantine in clinic. An audit of NICE Technology Appraisal 217 guidance for prescription & follow up of patients taking memantine was

carried out on all patients prescribed memantine under CMHT care.

Standards Patients prescribed memantine should have:

- severe Alzheimer’s or; moderate Alzheimer’s with a contraindication to or intolerance of AChEIs – 100%

- treatment initiated by a specialist – 100% - their carer’s views sought at baseline & follow up – 100%

- treatment continued only if considered to have worthwhile effect on cognitive, global, functional or behavioural symptoms – 100%

- regular cognitive, global, functional & behavioural assessment – 100%

- treatment reviewed by specialist team – 100%

Method Data was collected from online records using NICE TA 217 audit support data

collection tool.

Results 10 patients (32%) met prescribing criteria. 31 patients (100%) had treatement

initiated by a specialist.. 24 patients (77%) had their carers’ views sought at baseline & at follow up. At follow up, 21 patients (68%) had cognition assessed,

26 (84%) had a functional assessment & 28 (90%) had a behavioural assessment. All patients had a brief global assessment.

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Impact

Suggestions for intervention include: extension of the audit, institution of a

standardised monitoring service, standardized review protocols & more robust usage of off-licence prescribing procedures.

TP7 Dr Mary Parker Jane Leigh

Audit of clinic letters from MHSOP Consultants to GPs: Improving quality

of communication to enhance patient safety

Background

The audit aimed to ascertain if clinic letters provided easily accessible information needed by GPs for the care of their patients; and to identify areas for

improvement.

TEWV trust had identified a need to improve the quality of GPs letters under its CQUIN Target for safe care transfer.

Standards

The criteria for the audit were based on the SBAR communication system

adopted by the NHS improving quality initiative. A set of 12 criteria was developed including a highlighted section for:

Diagnosis Psychotropic Medication (including no change)

Plan

Standards were set at 100% as an aspirational level for quality of communication and to optimise patient safety but, with recognition that initially this may not be

achieved.

Method 50 consecutive clinic letters were analysed against the agreed criteria using an

excel spreadsheet, with 10% rechecked for data validation. Results were presented to consultants, MDT and Trust GP advisor and model letter template

devised. Re-audit performed after 3 months: re-presented to team and at trust-

wide audit event.

Results Good performance (compliance in brackets) in key clinical areas re management

plans (100%), follow up (98%) and accessibility of key information (90%). Improvement needed in timely communication (64%) and use of abbreviations

(14%).

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Impact

Good practice was demonstrated in vital areas of clinical care; however improvement needed in other key areas leading to adoption of a model template

for clinical letters.

Re-audit demonstrated improved achievement of communication standards. The Audit is currently being repeated in another area of the trust disseminating good

practice.

TP8 Dr Joanne Georgina Parry Bruce Owen

Establishing Simulation Training in Health Education North East- STEP Project

Aims and Background

In line with other medical specialities Psychiatry has begun to embrace to power

of simulation. However within HENE this has not been embraced as actively as around the country. Funded by HENE Patient safety fund a bespoke simulation

training package has been developed.

Method

Simulation Training in Emergency Psychiatry (STEP) is an interactive simulation based training session for Core Psychiatry Trainees which allows the experience

of a number of “typical emergencies” faced by Psychiatric Trainees. These include examples such as managing medical problems such as an elderly patient with a

fractured neck of femur to managing an attempted ligature on the ward and Psychiatric scenarios such as managing an acutely agitated patient with rapid

tranquilisation or assessing a patient’s capacity following overdose.

The scenarios have been written in collaboration with multi-disciplinary experts.

They are as realistic as possible, as simulation must be valid or it is unlikely to produce effective learning, and follow a real-time approach. There are actors

playing the roles of the patient and members of the wider MDT including support workers and nursing staff also contributing to the role play.

There is a Consultant Psychiatrist facilitator who will ensure space for reflective

practise which is also a crucial element post Simulation.

Conclusions

The STEP project aims to improve patient safety through exposing trainees to challenging scenarios they may face in their careers in a controlled manner and

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also through experiencing a variety of scenarios reinforcing parity of esteem

between mental and physical health emergencies.

TP9 Dr Joanne Georgina Parry Patrick Keown, Iain McKinnon,

Paul Brown, Steve Cull,

Joanne French

The impact of Street Triage in Northumberland, Tyne and Wear NHS Foundation

Trust

Background In 2014 NTW Trust committed to the principles and aims of the Crisis Care

Concordat. One central commitment was the development of “Street Triage” of people coming to the attention of the police, either through a jointly shared

telephone triage service or through the implementation of mobile Street Triage

Teams.

The impact of Street triage has been evaluated within NTW focusing on the number and rate of section 136 detentions before and after the introduction of

street triage. Rates were calculated prior to street triage operating, for the ten months when the first street team was operating, and for four months when both

street triage teams were was operating.

Method Data were obtained from three sources involved in section 136 detentions and

street triage; 1. Northumbria Police;

2. The mental health service provider (NTW NHS Foundation Trust); 3. The social work department of the local authority (Sunderland).

Results and conclusion

Our opinion is that there is strong evidence to support the hypothesis that Street Triage causes a reduction in the rate of section 136 detentions. Certainly the idea

is plausible and coherent as street triage was specifically introduced to address the dramatic increase in the use of section 136 in recent years.

There was a clear temporal relationship between the introduction of street triage

and the reduction in section 136 detentions. The greatest reduction was seen in the first few months of street triage, but there were further reductions through

the course of the first year as the service embedded.

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TP10 Dr Christopher Wood Hannah Arnstein, Prathibha Rao

Staff and Service User Perception of New Smoking Legislation in a Single NHS Mental Health Institution in the North East of England

The prevalence of tobacco use within an inpatient setting can reach 80%.

Government legislation is enforcing trusts to adhere to smoke free polices. The study design included (1) Survey of sixty-three members of staff and thirty-five

inpatient service users; and (2) a semi-structured focus group of inpatients. Questionnaires covered a range of areas encompassing quantitative and

qualitative data, which assessed smoking behaviour, opinions surrounding smoking ban and smoking cessation interventions. A third of staff disagreed with

the ban with concerns of increased violence, agitation and negative impact on mental health. Majority of staff felt their workload and stress level would increase

and smoking restrictions would contribute to increased admissions under detention. 80% of staff perceived smoking cessation interventions as an

important role. 52% of service users strongly opposed the smoking ban with

perceptions that these were violation of human rights despite 68% reporting that nicotine addiction had a negative effect on their mental health. Many patients

predicted increased violence towards staff with concerns that this would lead to covert behaviours and resumption of smoking once discharged. Despite this, they

welcomed offer of medical interventions; but indicating importance of will power over interventions. Although similar themes, staff anxieties were higher than

service users. More work needs to be done in changing staff attitudes and knowledge and dedicated staff training offered for successful implementation of

the ban. Inpatient programmes need to be tailored to patient preference and integrated with community programmes for longer term abstinence.