The Impact of COVID-19 On The Quality of Admission Clerkings On An Old Age Psychiatry Ward - An Audit

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S174 Poster Presentations

overdose of illicit drugs, not with prescribed medication and one 24% (6/25) of acute trust staff were aware about checking lithium
was admitted, and one felt worse, and one did not have any levels on admission.
response. Conclusion. Ideally, a 100% compliance and positive response
However, 22 out of 50 patients were prescribed antipsychotic rate should be achieved as these relate to completion of expected
medication.11 out of 22 patients had ECG and blood done by safety checks. Lithium is a potentially high-risk drug with a nar-
the Crisis Team and 4 done by other parties (hospital and pri- row therapeutic index. Possibility of its acute and chronic side
mary care).3 had recent blood tests but no ECG.2 patients did effects, including lithium toxicity, makes it essential to follow
not have physical health monitoring and the reason was not docu- safety guidelines on lithium prescribing and hence ensure patient
mented.2 patients were started on antipsychotic by the Crisis safety.
Team, but the dose was not changed. In view of this, the clinical audit results clearly show that there
In terms of side effects, 8 out of 50 reported some side effects. is significant room for improvement to achieve a 100% positive
6 of them were prescribed antidepressants. They reported dif- response rate for awareness of safety guidelines on Lithium pre-
ficulty in sleeping and palpitations with Venlafaxine, nausea with scribing.
Fluoxetine, nonspecific side effects with Citalopram, and sedation Overall, there were an average of 57% positive responses and
with Trazadone. 2 patients felt dizziness, diarrhoea, and muscle 42% negative responses for awareness of various aspects of the
spasms with Mirtazapine. One patient had a metallic taste with safety guidelines for Lithium.
Zopiclone. For side effects with antipsychotics, only one patient A robust action plan which included teaching sessions on cre-
reported side effects with Olanzapine. ating awareness about lithium monitoring was planned because of
Conclusion. this audit.
• The Crisis Team is working at excellent standards on most areas
of psychotropic prescribing and monitoring
• The Crisis Team needs to improve physical health monitoring
of their patients.
The Impact of COVID-19 on the Quality of Admission
Clerkings on an Old Age Psychiatry Ward – an Audit
Dr Ivan Shanley*, Dr Jaweria Faheem, Dr Sandeep Bansal,
Clinical Audit of the Awareness of Safety Guidelines Dr Mahnur Khan and Dr Hana Jeetun
on Lithium Prescribing Within the Acute Hospital- Essex Partnership University NHS Foundation Trust, Chelmsford,
James Cook University Hospital United Kingdom
*Presenting author.
Dr Nayeema Shakur*, Dr Mubin Tahir,
Dr Ramanand Badanapuram and Dr Sagrika Nag doi: 10.1192/bjo.2022.486
Tees, Esk and Wear Valley NHS Foundation Trust, Teeside, United Aims. On 11th February 2020 a novel coronavirus was named
Kingdom SARS-CoV-2, with the World Health Organisation announcing
*Presenting author. that the associate disease would be known as COVID-19. As doc-
doi: 10.1192/bjo.2022.485
tors providing an inpatient psychiatric service, there were various
changes in our daily practice secondary to the pandemic. These
Aims. Lithium is a useful drug and is of particular benefit included reduced staffing levels due to illness, the need to wear
in patients with chronic mood disorders like bipolar affective dis- personal protective equipment during all patient contact and
order and recurrent depression. Lithium requires careful monitor- high levels of anxiety surrounding transmission. We hypothesised
ing and dose adjustment for safe use due to its narrow therapeutic that the resultant pressure on our service might impact the quality
index and high potential for toxicity. Monitoring must carry on of admission clerkings to our ward, (a 17 bed functional Old Age
even when mental health patients taking Lithium are admitted Psychiatry ward), and therefore resolved to audit the data. We
to acute hospital. Therefore, the main aim of this clinical audit determined that “quality” of the clerking should be equated to
was to evaluate the level of awareness of the lithium safety guid- completeness, i.e. the degree to which all desired information is
ance amongst medical staff working within the Acute Hospital, included.
James Cook University Hospital. Ideally 100% of staff should Methods. Admission clerkings to the ward are to be completed
have the appropriate knowledge. on a pro forma built within the electronic patient record system
Methods. Questionnaire consisted of 6 items which were derived (“Paris”). This pro forma is based on guidelines for the admis-
from key points within the Trust guidelines for Lithium. It was sion of patients to psychiatric inpatient units produced by the
designed to highlight the key points in the document and check the Royal College of Psychiatrists. The standard for the audit was
level of awareness of the respondents. Respondents were drawn set as 90% compliance with each individual section of the pro
from James Cook University Hospital and South Tees Liaison forma.
Psychiatry team. A total of 25 respondents were included in the study. All admissions across three periods were extracted from the
Results. 96% (24/25) of the respondents were aware that renal and electronic record using the inbuilt reporting function. The per-
thyroid function should be checked for patients on Lithium. 84% iods were 1st April to 1st July in 2019 ( pre-pandemic, n = 15),
(21/25) were aware of the potential impact of Lithium on Kidney 2020 (early pandemic, n = 29) and 2021 (late pandemic, n =
function (eGFR) and 68% (17/25) were aware of signs of Lithium 22). Data were extracted manually from each admission clerking
toxicity. and recording anonymously on an excel spreadsheet, with
60% (15/25) of acute staff were aware about referring patients either “yes” or “no” confirming or denying compliance with
with deranged Lithium levels to the Liaison Psychiatry team. 40% each domain (e.g. presenting complaint).
(10/25) were aware of the drugs that could potentially increase Results. All domains showed improved compliance from 2019 to
lithium levels like Diuretics, Non-steroidal anti-inflammatory 2021 other than recording of the mental state examination which
drugs, ACE (angiotensin converting enzyme) inhibitors. Only saw a 9.09% decrease (which is not statistically significant).
BJPsych Open S175

Comparing the pandemic years, performance was better in the to the appointment of a pharmacist working across primary and
early pandemic in 4 domains, better in the late pandemic in 10 secondary care.
domains and equal in 6 domains. 4 domains demonstrated a stat-
istically significant improvement compared to pre-pandemic,
however 9 domains still fell below the 90% standard set. Audit & Reaudit of Assessments Regarding Substance
Conclusion. Despite the challenges posed by the COVID-19 pan- Misuse in Patients Referred to Liaison Psychiatry
demic the quality of inpatient admission clerkings has not only Service
remained unharmed but in some domains significantly improved.
Admission numbers increased during the pandemic periods, so it Dr Oriyomi Shittu1*, Dr Samlan Mushtaq1 and Dr Dervis Maria2
may represent greater familiarity with the clerking process, or per- 1
Livewell Southwest, Plymouth, United Kingdom and 2Derriford
haps a desire to make more comprehensive notes during a time of Hospital, Plymouth, United Kingdom
crisis. Repetition of the study post pandemic may be of value. *Presenting author.
doi: 10.1192/bjo.2022.488
Are We Following MHRA Guidance Regarding Aims. 1- What percentages of people presenting to general hos-
Valproate Prescription in Women of Child-Bearing pital that are referred to Liaison Psychiatry service have
Potential? Substance misuse problems? 2- Are the assessments by Liaison
Psychiatry services identifying substance misuse problems? 3- If
Dr Adarsh Shetty1* and Dr Joseph Polson2 substance misuse problem is identified then are we offering any
1
Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, advice/intervention/referral
United Kingdom and 2Hywel Dda University Health Board, Methods. To look at 100 consecutive assessments by using an
Carmarthen, United Kingdom audit proforma to capture information required to answer above
*Presenting author. questions.
Results. In 78% of cases there was evidence documented that the
doi: 10.1192/bjo.2022.487 patient was asked about alcohol use. In 22% - no evidence patient
Aims. To clarify if MHRA guidance regarding valproate pre- was asked about alcohol use.
scription in women of childbearing potential is being followed – 77% documentation about drug use. 23% no evidence docu-
by psychiatrists in Cwm Taf Morgannwg University Health mented that the patient was asked.
Board. – Of those asked about their alcohol use (n = 62), a misuse prob-
Methods. Women of childbearing potential who were prescribed lem was identified by clinicians making the assessment in 6
valproate for mental health conditions were identified by contact- cases (10% of those asked).
ing GP practice pharmacists. The notes of these patients were – Of those asked about their drug use (n = 61), a misuse problem
reviewed to see if the ARAF (Annual Risk Acknowledgement was identified by clinicians making the assessment in 8 of cases
Form) had been completed. The GP records were cross-checked (13% of those asked).
to see if highly effective contraception was prescribed for Of those with a substance misuse problem identified (n =
women who were on valproate. The first audit was done in 15), 20% identified misuse of both alcohol and drugs, 40%
November 2018, while the second audit was completed in identified misuse of alcohol only, and 40% identified misuse
December 2020. The main intervention after the first audit was of drugs only.
general awareness raising amongst psychiatrists in secondary – Of those with a substance misuse problem identified (n = 15),
care about the MHRA guidance and the need for annual reviews, 73% were offered advice or an intervention, and 27% had no
through email reminders and posters. The 2020 audit gathered intervention documented.
detailed clinical information, including the reasons for prescribing Conclusion. Just over a fifth of patients assessed were not asked
valproate and the doses prescribed. about alcohol or drug use. This has improved since August
Results. 2018 – out of 53 women on valproate, 1 had a completed 2020 when nearly half of the patients assessed were not asked
ARAF, and 15 were on highly effective contraception. about alcohol or drug use.
2020 – out of 48 women on valproate, none had a completed – Since audit in August 2020, there has been a 21% increase in
ARAF, and 13 were on highly effective contraception. documentation of advice or intervention being offered to
Concerningly, only half (46%) of these women were pre- patients identified to have a substance misuse problem.
scribed valproate for bipolar disorder. The rest were prescribed
valproate for a variety of diagnoses including schizophrenia,
cyclothymia, emotionally unstable personality disorder, and Audit to Assess Melatonin Prescribing in Community
complex PTSD. CAMHS
Conclusion. Raising general awareness about MHRA guidance
Dr Chirag Shroff*
failed as an intervention in this audit. Hence, after the second
audit, specific targeted emails are being sent to each sector’s con- Alder Hey NHS Trust, Liverpool, United Kingdom
sultant psychiatrists, with a list of female patients of childbearing *Presenting author.
potential in their sector who are prescribed valproate. A valproate doi: 10.1192/bjo.2022.489
register was created for the Merthyr/Cynon and Rhondda/Taff Ely
localities – to our knowledge, this is the first time this has been Aims. Disordered sleep is common, affecting 20–30%of children
developed in Wales. The impact of these interventions is being aged 1–5 years and often continues later into childhood.
evaluated with a third audit which is being done in March Neurodevelopmental disorders and psychiatric comorbidities
2022. This audit cycle highlighted significant challenges in shar- pose a greater risk. The audit aimed to determine whether clinical
ing information across primary and secondary care. Detailed prescribing practice of melatonin in Burlington House, Sefton
information about patients on valproate, with information on pre- CAMHS reflected current NICE recommendations. NICE suggest
scribed contraception, was available only for the 2020 audit, due that first-line treatments for children with sleep problems include
Reproduced with permission of copyright owner. Further reproduction
prohibited without permission.

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