A lack of integration between internal processes and failure to use the full potential of information technology (IT) systems is common in psychiatric hospitals. We aimed to reduce the number of out-of-hours medical errors by ensuring that there is consistent and transparent weekend medical handover by creating an electronic handover system that is easy to use, robust and embedded into the existing trust IT systems. We employed quality improvement (QI) methodology to address this issue.After trialling in a single site followed by six cycles of improvement, the weekend medical handover system is now in use across four boroughs and has been integrated into trust policy. It has received qualitative and quantitative evidence of improvement, with 100% of doctors reporting the system improved patient care and a 64% (from 11 to 4 events/year) reduction in moderate, severe and catastrophic adverse incidents occurring out-of-hours within the older adult service (p=0.29, χ2 1.117).The increasing number of complex patients with comorbid medical illness in psychiatric inpatient services demands robust handover systems similar to that of an acute trust. This QI work offers a template for achieving this across other psychiatric trusts and demonstrates the positive change that can be achieved.
It is widely acknowledged in hospitals that the quality of design and environment can influence the quality of patient care, the sense of therapeutic security and the experience of staff. This women's PICU collaborated with the charity Hospital Rooms to realise the valuable role of
art within the clinical environment. Experienced artists were commissioned to work in genuine partnership with patients and staff to re-envision the physical environment with the installation of eight imaginative, inventive and PICU compliant art works.<br/> The implementation, and both
patient and staff perspectives were evaluated. There was no disruption to clinical care and engagement and participation was enthusiastic. There were 35 patient encounters and 32 staff encounters, including creative workshops and an exhibition.<br/> Patient Experience Data Intelligence
Centre (PEDIC) reports showed an improvement following artwork installation. Patients were more likely to recommend the ward, felt more involved in their care and that the ward was comfortable. The art transformed clinical spaces creating opportunity for patients to have exceptional experiences:
'being here feels like sitting in the park'.<br/> Staff evaluation through a 'visual matrix' method that explores shared experience, revealed that the art has introduced further possibility of 'respite and escape' for both patients and staff. There is a sense that 'you feel like it is
leading you to somewhere, you feel like there is something more'. It has also engendered 'ownership and pride': it 'feels like pushing boundaries, things you thought could never be considered at all, are now being considered'.
Summary
The COVID-19 pandemic has put the UK's National Health Service under extreme pressure, and acute psychiatric services have had to rapidly adapt to a new way of working. This editorial describes the experience of a London psychiatric intensive care unit (PICU) where all nine in-patients ultimately tested COVID-19 positive.
Purpose of reviewThere is a high prevalence of delirium in palliative care patients. This review aims to evaluate the effects of the pharmacological and nonpharmacological interventions used to manage delirium symptoms in this patient group.
Recent findingsA recent study has suggested there is no role for antipsychotic medication in the management of delirium in palliative care patients, which is a move away from previous expert opinion. In addition, recent findings suggest there may be a role for the use of antipsychotics in combination with benzodiazepines in the management of agitated delirium.
This is the second of five brief reports which document the experience of a London psychiatric intensive care unit (PICU) which faced an outbreak of COVID-19 infection relatively early in the pandemic. The aim is to share what was learnt and examine the challenges which lie ahead for psychiatric intensive care services. This article will present how the PICU adapted to the changing landscape with consideration of the COVID-19 infectious window, infection prevention and control protocols and the unique challenges faced by PICU services.
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