AimsTo assess physical health in patients under the Early Intervention Service, whom are prescribed antipsychotics.To consider whether further intervention needs to be provided or promoted to improve physical health in this group.MethodAssessment of carenotes database for all 63 patients on EIS caseload prescribed antipsychotics.ResultOut of 47 patients studied, 20 were non-smokers at baseline. 25% of them ended up becoming smokers by the end of the study time.Out of 47 patients studied 28 were non-drinkers at baseline. 32% of them ended up engaging in alcohol by the end of the study time.Out of 47 patients studied, 38 patients had data available to record weight changes per year. Out of the 38 patients, 27 of them had positive weight change; average weight change was + 6.38 kg per year. The highest weight gain was 38.4 kg, the highest weight lost was 47.3 kg.Out of 47 patients studied, 35 patients had data available to record BMI changes. Out of the 35 patients, 27 of them had positive BMI increases, average BMI change was + 2.68. The highest BMI increase was 12.84. The highest BMI decrease was 8.24.Out of 47 patients studied, 11 patients had data available to record random glucose level changes. Out of the 11 patients, 7 of them had increased glucose levels, average glucose change were + 0.5mmol/l. The highest increase in glucose was 3.9mmol/l and the highest drop in glucose was 2.6mmol/l.Out of 47 patients studied, 19 patients had data available to record HbA1c levels. Out of the 19 patients, 10 of them had increased HbA1c levels, with the average change being + 0.31 mmol/mol. The highest increase in HbA1c levels was 5 mmol/mol and the highest drop in HbA1c levels was 3 mmol/mol.Out of 47 patients studied, 30 patients had data available to record cholesterol changes. Out of the 30 patients, 21 of them had increased cholesterol levels, with the average change being + 0.09mmol/l. The highest increase in cholesterol was 1.7mmol/l and the highest drop in cholesterol levels was 2.6.Taken together, we show that anti-psychotic use has a negative effect on physical health parameters such as weight gain, BMI increase, HbA1c levels and cholesterol levels. This increases the patient's risk of developing diabetes/metabolic syndrome in the future.ConclusionRe-audit.
This article describes an evaluation of a collaborative project with Worcestershire Health and Care NHS Trust, Adult and Community Services and Voluntary agencies to provide an evidence-based psychological therapy. This joint working venture is influenced by the National Dementia Strategy (2009) to improve intervention and quality of care in dementia services. This article contributes to the recent, limited evidence base reporting client and carer feedback, service provision and implementation of cognitive stimulation therapy.
AimsTo review available standards for physical health monitoring in people taking clozapine To audit current practice against standards To identify changes in practice and facilitate a re-audit to assess impact of any changesMethodStandard: CG178 Psychosis and Schizophrenia in Adults: Prevention and Management – NICE, February 2014Target:100%Exceptions: NoneSample: The original audit included all 58 patients from the Worcester clozapine clinic, as per October 2018. The re-audit reviewed a random sample of all patients attending the clozapine clinics in Worcester, Kidderminster and Redditch, as part of Worcestershire Health and Care NHS Trust, as per October 2019. A total of 66 patients were selected.Data Source: Carenotes and ICEResultAreas of good practice:Monitoring of HbA1c and FBC remains goodThere has been an improvement in monitoring alcohol use, substance misuse and side effectsAreas requiring improvement:There continues to be limited recording of respiratory rateThere has been a decline in recording temperature, BMI and concomitant therapiesPotential reasoning for missing data includes:Staff not knowing the monitoring requirements, which is more likely to be an issue when staff members running the clinics change frequentlyMonitoring being completed but not documentedPatients’ refusal of monitoringData being recorded in alternative locations including general practice, without communication between servicesPatients moving between teams or having inpatient stays may disrupt monitoring regimeConclusionLIMITATIONSThis audit assumes all patients involved to be on a stable dose of clozapine with routine monitoringSome patients may have been transferred between teams or inpatients during the period of data collectionThere is no scope to record when patients refuse monitoringWe may not have access to all notes such as those from general practice for data collectionRECOMMENDATIONSInduction programme for junior doctors to include education on clozapine monitoringTraining for staff involved in clozapine clinics to ensure better understanding of monitoring requirementsProcurement of ECG machines for each site and relevant training for nursing and medical staffCollaboration with GPs for shared dataRe-audit in 1 year
Purpose “Social recovery” is a long-cited aim within the UK early intervention in psychosis (EIP) services; however, there is a lack of evidence regarding existing social recovery provisions and how these can be improved. This paper aims to evaluate an existing social drop-in facility within an EIP team, ran within the Birmingham and Solihull Mental Health NHS Foundation Trust, and highlight the potential benefits of delivering such services for people diagnosed with first episode psychosis. Design/methodology/approach Attendance and basic demographic statistics (age, gender and ethnicity of attendees) were collected over a period of 13 weeks. In addition, two semi-structured focus groups were conducted: one with EIP staff members (community psychiatric nurses and support workers) and the other with current service users, with both groups describing their satisfaction and experience of the drop-in facility and how it can be improved. Findings Inductive thematic analysis was used to analyse data from both focus groups, with six overarching meta-themes being identified: reflection, environment, emotional experience, recovery, activities and interactions. Service users and staff reflected that the drop-in facility was an asset to the service, although work could be done to improve overall attendance. Originality/value This paper explores how a social drop-in facility can provide a supportive, positive environment that aids recovery from psychosis for service users and improves working conditions for the EIP staff.
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