Abstract

AimsAudit carried out to assess whether or not patients had been asked about their smoking status during admission onto an acute adult mental health ward, as well as if they had received any smoking cessation advice or offered nicotine replacement therapy.Background•Physical health outcomes in patients with serious mental illness (SMI) are consisitently worse than the general public This is due to multiple factors; adverse effects of medication (including metabolic syndromes with psychotropics) as well as poor lifestyle factors such as smoking status•Patients with an SMI are 3–6 times more likely to die due to coronary artery disease. 70% of patients in inpatient psychiatric units are smokers, a strong independent risk factor for cardiovascular disease.•Smoking cessation is a potent modifiable risk factor that can prevent mortality and reduce morbidity.MethodA cross-sectional review of all 34 inpatients across four general adult acute psychiatric wards.Patient records were explored using the Aneuran Bevan Health Board admission proformas to identify evidence of smoking status and whether advice was offered.ResultSmoker but not given cessation advice n = 13 (38%)Not asked about smoking n = 11 (32%)Smoker and given cessation advice n = 4 (12%)Non-smoker n = 6 (18%)ConclusionPatients were asked about their smoking status the majority of the time (68%) but provision of advice or nicotine replacement therapy was only done in 14% of potential smokers (identified smokers and patients not asked about smoking status).A consideration to be taken into account is that on admission, a patient's physical health status may be unknown, with the additional difficulty of a patient's acute distress complicating the physical examination, smoking status and modification of patient's smoking status may not be the highest priory in that context.Data regarding asking about smoking were different amongst wards, potentially signifying differences between assessors willingness to ask about smoking status.There is a lack of smoking cessation literature available on the wards and patients are often unaware of what options are available to quit smoking.The audit simply determined whether or not assessors were documenting smoking status, it does not measure the quantity or quality of smoking cessation advice provided.Further quality improvement projects should be launched, with focus groups as the intial step at further investigating inpatient smoking rates, as well as attempting to reduce them in a more systemic way.

Highlights

  • Out of all the incidences where PRN medication was administered, only 64% of monitoring charts were completed

  • This study aimed to assess whether compliance with baseline physical health monitoring had improved in line with the previous audit’s recommendations

  • It is proposed that Glasgow Antipsychotic Side Effect Scale (GASS) questionnaires be sent to patients prior to appointments to be completed in advance to avoid further risk of GASS being incomplete

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Summary

Heena Mistry

The results were presented to ward staff and doctors to discuss the implications for patient care and ways to improve clinical practice by ensuring full monitoring of the use of PRN medication to help reduce the overmedication of people with learning disability by improving the use of the PRN charts. This study aimed to assess whether compliance with baseline physical health monitoring had improved in line with the previous audit’s recommendations. The CMHT performed better than the inpatient team at baseline monitoring This may reflect action on the previous audit’s recommendations to increase provision of community ‘Wellbeing Health Improvement Service’ (WHISe) clinics. The first recommendation is for Quality Improvement Activities to help improve compliance with the ‘Shared Care Guidelines’ This may include CQUINs and further provision of community clinics to improve compliance with both baseline and follow-up checks. It is proposed that GASS questionnaires be sent to patients prior to appointments to be completed in advance to avoid further risk of GASS being incomplete

Audit of inpatient smoking cessation advice
BJPsych Open
Findings
Eileen Moss
Full Text
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