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Objective:  This paper reports the effects on challenging (agitated) behaviours, such as aggression, noisiness and wandering, when persons with dementia were relocated to a special unit. Methods:  The study was a simple interrupted time series quasi‐experimental design. The dependent variable was agitated behaviour and the independent variables were residing in an old unit and in a Special Care Unit (SCU). Twenty‐two persons with dementia from a nursing home were involved in this study. Subjects were assessed weekly for 1 month prior to the move to the SCU and weekly for 1 month at 3 and 6 months after the move. Data were entered into SPSS software and analysed. Results:  The most significant results from the study were that the verbally agitated behaviour of the subjects was reduced and sustained throughout the 6 months of the study after their move into a SCU. Conclusions:  This study has shown that environmental design does impact positively in the care of persons with dementia.

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Clinical coding plays a vital role in ensuring accuracy of data used for clinical governance and statistical comparison of health outcomes. This audit looked at the quality and depth of the coding by the clinical coder compared to what is documented by the clinical staff in the patient record. Methods Retrospective review of obstetric case notes. All patients admitted under a randomly selected consultant in the month of April 2013 were included in the audit Results 42 case notes were reviewed.6 amendments were made to the original coding giving an amendment rate of 14.28%. However the primary diagnosis was right in 100% of cases and amendments effected secondary diagnosis and procedure codes. This related to the coder facing difficulty extracting relevant information from the notes with particular problem areas being poor handwriting making notes illegible at times, information in notes being in a random order and occasional entry of conflicting information. Conclusion An amendment rate of 14.28% to initial coding is high and can have significant implications with regards to clinical governance and evaluation of a patient’s clinical care and comparison of outcomes. It also adversely effects epidemiology data and can have an adverse impact on the trusts finances. Main areas contributing to coding errors were illegible writing, random order of filing information and conflicting data entry. Moving on to electronic case notes might be the way forward in effectively addressing this issue which has profound implications on patient care.

Background and aimsThere is a high burden of mental health (MH) problems among children with epilepsy. The relationship between MH problems and epilepsy is bidirectional with shared risk factors. Our key aims were:To determine the prevalence of MH difficulties among the patients of our Secondary Paediatric Epilepsy Service.To ascertain if more input from MH services is required within the Secondary Paediatric Epilepsy Service.To demonstrate the use of a standardised behavioural screening questionnaire in assessing MH difficulties.MethodsThe Strengths and Difficulites Questionnaire (SDQ) was used to screen for those at risk of, or currently experiencing MH problems. We received 86 replies and, following exclusions, 64 patients data was analysed. The patient’s electronic notes were used to determine diagnoses and medications.Results56% of patients scored high or very high risk for having or developing MH difficulties. A chi- square test indicated a significant difference (p<0.001) in the proportion of children with epilepsy with clinically significant scores versus the proportion in the community samples. Peer and pro-social subdomains scored in the ‘high’ risk category whilst the other subdomains scored in ‘close to average’ risk. Patients not on anti-epileptic drugs have close to average scores. There is trend towards those on more than 1 Antiepileptic drug having higher scores. Developmental disorder increases that risk of having a high or very high score from 43% to 68%.ConclusionsOur results reflect similar prevalence to that demonstrated in the literature; children with epilepsy have a high risk of developing MH disorders. Our data highlights the need to improve identification, diagnosis, prevention and management of MH problems in children with epilepsy on both a national and local level.

The transition from paediatric to adult neurodisability services can be a challenging time for young people and their families. This vulnerable group have complex needs encompassing healthcare, social care and education sectors. A new transition clinic for young people with complex neurodisability was established in 2015. Our aim was to ensure a patient-centred approach in developing and improving the current transition service in accordance with NICE guidelines on transition (2016) and cerebral palsy (2017).The patient cohort was derived from young people referred from the paediatric neurodisability service to the transition ‘spasticity’ clinic since its establishment in 2015. We used a two pronged apporach in the form of audit and telephone interviews. The audit criteria were derived from NICE guidelines and involved reviewing patients‘ notes and clinic letters. The structured telephone interviews with patients and parents enabled us to get qualitative feedback on the existing service.Our cohort of 8 patients were transitioned from paediatric to adult services at a mean age of 17.2 years. As well as the adult neurologist, a paediatrician was present in the transition clinic in 7 of 8 cases. An adult physiotherapist was present in 6, but a paediatric physiotherapist was only present in 2. Strengths demonstrated during the clinic included discussing communication and learning needs (7 out of 8). Weaknesses included discussing emotional health and planning future involvement of parents/carers. Communication with GPs was present in 5 out of 8 (formal transition letter with GP CC’d). 6 families gave us qualitative feedback.Based on our results and responses, we co-produced a leaflet with young people and their families on what to expect from the transition process including information about the transition clinic and possible discussion topics, practical information such as new contact details and where to seek emergency care. We also produced a matching ‘Patient Passport’ to be used as a checklist in the transition clinic to ensure that all aspects of care are covered in the discussion. We hope these interventions will encourage autonomy and informed decision making in the transition process.

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