@ncepod #MH 1 Chapter 1 Background & Method Hannah Shotton - - PowerPoint PPT Presentation

▶
ncepod mh
SMART_READER_LITE
LIVE PREVIEW

@ncepod #MH 1 Chapter 1 Background & Method Hannah Shotton - - PowerPoint PPT Presentation

Dec 09, 2022 231 likes •1.36k views

@ncepod #MH 1 Chapter 1 Background & Method Hannah Shotton 2 Background A large proportion of people are affected by poor mental health Link between physical and mental health in general hospitals Lack of integration between

slide-1
SLIDE 1

@ncepod #MH

1

slide-2
SLIDE 2

Chapter 1 Background & Method Hannah Shotton

2

slide-3
SLIDE 3

Background

  • A large proportion of people are affected by

poor mental health

  • Link between physical and mental health in

general hospitals

  • Lack of integration between delivery of mental

and physical healthcare

  • Liaison psychiatry services

3

slide-4
SLIDE 4

Definitions

  • General hospitals
  • Mental health conditions
  • Liaison psychiatry team
  • Mental health legislation

4

slide-5
SLIDE 5

Aim

To explore the overall quality of mental and physical healthcare provided to patients with significant mental health conditions who are admitted to a general hospital.

5

slide-6
SLIDE 6

Objectives

To explore the provision of organisational structures and policies:

1) Communication and sharing of relevant information 2) Systems, Services and facilities to deliver care to

patients with mental health conditions

3) Training

slide-7
SLIDE 7

Objectives

To explore remediable factors in the overall quality of care provided to this group of patients particularly focusing on the following areas:

1) Referral /review by liaison psychiatry and appropriate

management by liaison psychiatry and general hospital staff

2) Communication and record sharing

7

slide-8
SLIDE 8

Objectives

3)

The assessment of mental capacity and deployment of mental health legislation

4)

The management of medications, reconciliation and possible interactions

5)

Discharge planning

6)

The standard of care and treatment provided

7)

Evidence of missed opportunities for intervention

8

slide-9
SLIDE 9

Study population

Patients aged 18 + admitted to a general hospital for physical healthcare during the study period:

– Detained under mental health legislation during their admission to hospital and/or – Coded by ICD10 coding for a diagnosis of a listed mental health condition

9

slide-10
SLIDE 10

Method

Patients identified

  • Spreadsheet from each hospital participating
  • Key information on patients who fit the study criteria

5 patients selected per hospital

  • 1 who was admitted to critical care or who died
  • 1 who was admitted from/discharged to a MH hospital
  • 1 who was admitted due to self-harm
  • 2 patients admitted for a stay longer than 72 hours

10

slide-11
SLIDE 11

Method

  • Clinician questionnaire
  • Liaison psychiatry questionnaire where accessible
  • Case notes/Case reviewer assessment form
  • Organisational questionnaire
  • On-line survey of training

11

slide-12
SLIDE 12

12

Chapter 2 Sample population

slide-13
SLIDE 13

Data returns

13 305 Organisational questionnaires disseminated 231 Organisational questionnaires returned 1340 responses to the online survey of training

slide-14
SLIDE 14

Population

14

slide-15
SLIDE 15

Primary medical reason for admission

15

slide-16
SLIDE 16

Physical health co-morbidities

16

slide-17
SLIDE 17

Mental health conditions in the sample population

17

slide-18
SLIDE 18

Chapter 3 Presentation to hospital Vivek Srivastava

18

slide-19
SLIDE 19

Presentation to hospital

  • 351/552 (63.6%) via the emergency department
  • 80/552 (14.5%) via a GP referral

19

slide-20
SLIDE 20

Mental health conditions recorded in the ED

  • MH condition recorded at triage in 67.6% (200/296) of

patients and at senior review in 84.9% (265/312) of patients

20

slide-21
SLIDE 21

Referral made to the liaison psychiatry team

21

slide-22
SLIDE 22

Referral to liaison psychiatry

  • Quality of care affected in 20 patients
  • Referral made to liaison psychiatry in 55/327 (15.8%) patients

22

slide-23
SLIDE 23

Reason patient was not referred to liaison psychiatry

23

slide-24
SLIDE 24

Arrival of liaison psychiatry in the ED

24

slide-25
SLIDE 25

Chapter 4 Admission & initial management

25

slide-26
SLIDE 26

Listed medications

26

slide-27
SLIDE 27

Medicines reconciliation

27

slide-28
SLIDE 28

28

slide-29
SLIDE 29

Physical health recorded at initial assessment

29

slide-30
SLIDE 30

Mental health recorded at initial assessment

30

slide-31
SLIDE 31

Physical health recorded at consultant review

31

slide-32
SLIDE 32

Mental health recorded at consultant review

32

slide-33
SLIDE 33

Clerking proforma – organisational data

33

slide-34
SLIDE 34

Adequate history in nursing notes

34

slide-35
SLIDE 35

Impact of consultant review

35

slide-36
SLIDE 36

Adequate assessment of complex needs

  • Complex needs assessment undertaken in 171 patients
  • Inadequate in 34 patients

36

slide-37
SLIDE 37

Multidisciplinary care

37

slide-38
SLIDE 38

Liaison psychiatry review Sean Cross

38

slide-39
SLIDE 39

Components of the liaison psychiatry review

39

slide-40
SLIDE 40

Delay in liaison psychiatry review

40

slide-41
SLIDE 41

Reason for delay in liaison psychiatry review

  • Delay in liaison psychiatry review in 74/199 (37.2%) patients

41

slide-42
SLIDE 42

Sufficient input from liaison psychiatry

  • Delay impacted on the quality of care of 22 patients
  • Patients seen only once by liaison psychiatry in 135/225 (60%)

42

slide-43
SLIDE 43

Patients who were not reviewed by liaison psychiatry but should have been

43

slide-44
SLIDE 44

44

slide-45
SLIDE 45

Legal frameworks

45

slide-46
SLIDE 46

Patient was detained under mental health legislation

  • 34 patients were detained at admission with details documented

in 24 cases

46

slide-47
SLIDE 47

47

slide-48
SLIDE 48

Personnel assessing mental capacity

48

slide-49
SLIDE 49

Reason for assessing mental capacity

49

slide-50
SLIDE 50

Room for improvement in mental capacity assessments

50

slide-51
SLIDE 51

51

slide-52
SLIDE 52

Communication

52

slide-53
SLIDE 53

MDT inclusion

53

slide-54
SLIDE 54

Liaison psychiatry in the MDT

54

slide-55
SLIDE 55

MDT changed the management plan

55

slide-56
SLIDE 56

Chapter 5 Ongoing patient care

56

slide-57
SLIDE 57

Care refused by the patient

  • Mental health was a contributing factor in 136/149 (91.3%) patients

57

slide-58
SLIDE 58

Could have been prevented

58

slide-59
SLIDE 59

Multiple incidents in the same patients

Room for improvement

59

slide-60
SLIDE 60

Chapter 5 Surgery & other interventions Vivek Srivastava

60

slide-61
SLIDE 61

Surgery/intervention as a result of a mental health condition

  • Room for improvement in consent in 24/109 (22.0%) cases

reviewed

61

slide-62
SLIDE 62

62

slide-63
SLIDE 63

Continuity of essential drugs

63

slide-64
SLIDE 64

Clinical deterioration

  • 1 patient not admitted to critical care due to their mental

health condition

64

slide-65
SLIDE 65

Chapter 6 Outcomes

65

slide-66
SLIDE 66

Discharge destination

66

slide-67
SLIDE 67

Delay in discharging patients

  • Delay in discharge in 65/443 (14.7%) patients

67

slide-68
SLIDE 68

Appropriate risk assessment at discharge

68

slide-69
SLIDE 69

Plan for review appointment

69

slide-70
SLIDE 70

Information included in the discharge summary

70

slide-71
SLIDE 71

71

slide-72
SLIDE 72

End of life care

  • Sepsis/infection was the most common cause of death (29/50)

72

slide-73
SLIDE 73

Chapter 7 Organisational data Sean Cross

73

slide-74
SLIDE 74

Type of hospital

74

slide-75
SLIDE 75

Liaison psychiatry service

75

slide-76
SLIDE 76

Liaison psychiatry service

76

slide-77
SLIDE 77

Liaison psychiatry service

  • 24/7 liaison psychiatry in 94/184 (51.1%) general hospitals

77

slide-78
SLIDE 78

Liaison psychiatry service

78

slide-79
SLIDE 79

Triggers for referral to the liaison psychiatry service

  • 102/185 hospitals had a policy for who should be referred to

liaison psychiatry

79

slide-80
SLIDE 80

Non-clinical activities of the liaison psychiatry service

80

slide-81
SLIDE 81

PLAN accreditation

81

slide-82
SLIDE 82

Protocols and policies

82

slide-83
SLIDE 83

Protocols for physical health and mental health

  • 123/211 (58.3%) hospitals had protocols covering the

treatment of patients with mental health conditions who are admitted for physical health conditions

83

slide-84
SLIDE 84

Protocol covering mental capacity

84

slide-85
SLIDE 85

Observation and supervision of patients

85

slide-86
SLIDE 86

Policy for addictive substance replacement

86

slide-87
SLIDE 87

History of smoking status

87

slide-88
SLIDE 88

Record keeping

88

slide-89
SLIDE 89

Records management

89

slide-90
SLIDE 90

Clinical record sharing

90

slide-91
SLIDE 91

Discharge summaries copied to community

91

slide-92
SLIDE 92

Improvements being made in record sharing

92

slide-93
SLIDE 93

Central database for MH legislation requirements

93

slide-94
SLIDE 94

Clinical governance

Hospitals reported:

  • No joint governance in 124/201 (61.7%)
  • No shared learning with primary care in 119/194 (61.3%)
  • No rolling mental healthcare audits in 124/204 (60.8%)
  • No monitoring of readmissions/outcomes in 131/195 (67.2%)
  • No monitoring of adverse/ serious incidents in 102/201 (50.7%)

94

slide-95
SLIDE 95

Education and training

95

slide-96
SLIDE 96

Mental health training

96

slide-97
SLIDE 97

Mental health training

97

slide-98
SLIDE 98

Mental health training

98

slide-99
SLIDE 99

Mental health training

99

slide-100
SLIDE 100

Mental health training

100

slide-101
SLIDE 101

Chapter 8 Overall quality of care Vivek Srivastava

101

slide-102
SLIDE 102

Overall quality of care

102

slide-103
SLIDE 103

Overall quality of care by PLAN accreditation

103

slide-104
SLIDE 104

Recommendations

104

slide-105
SLIDE 105

Recommendation

Patients who present with known co-existing mental health conditions should have them documented and assessed along with any other clinical conditions that have brought them to hospital. These should be documented:

  • a. In referral letters to hospital
  • b. In any emergency department assessment
  • c. In the documentation on admission to the hospital

105

slide-106
SLIDE 106

Recommendation

National guidelines should be developed outlining the expectations of general hospital staff in the management of mental health conditions. These should include:

  • a. The point at which a referral to liaison psychiatry

should be made

  • b. What should trigger a referral to liaison psychiatry
  • c. What relevant information a referral should contain

106

slide-107
SLIDE 107

Recommendation

Liaison psychiatry review should provide clear and concise documented plans in the general hospital notes at the time of assessment. As a minimum the review should cover:

  • a. What the problem is (diagnosis or formulation)
  • b. The legal status of the patient and their mental

capacity for any decision needing to be made if relevant

107

slide-108
SLIDE 108

Recommendation

  • c. A clear documentation of the mental health risk

assessment immediate and medium term

  • d. Whether the patient requires any further risk

management e.g. observation level

  • e. A management plan including medication or

therapeutic intervention

  • f. Advice regarding contingencies e.g. if the patient

wishes to self-discharge please do this ‘…’

  • g. A clear discharge plan in terms of mental health

follow-up

108

slide-109
SLIDE 109

Recommendation

All hospital staff who have interaction with patients, including clinical, clerical and security staff, should receive training in mental health conditions in general hospitals. Training should be developed and offered across the entire career pathway from undergraduate to workplace based continued professional development.

109

slide-110
SLIDE 110

Recommendation

In order to overcome the divide between mental and physical healthcare, liaison psychiatry services should be fully integrated into general hospitals. The structure and staffing of the liaison psychiatry service should be based on the clinical demand both within working hours and out-of-hours so that they can participate as part of the multidisciplinary team.

110

slide-111
SLIDE 111

Recommendation

Record sharing (paper or electronic) between mental health hospitals and general hospitals needs to be improved. As a minimum patients should not be transferred between the different hospitals without copies of all relevant notes accompanying the patient.

111

slide-112
SLIDE 112

www.ncepod.org.uk @ncepod #MH

112