Adult Inpatient Wards Research Articles

Cross-sectional survey of disturbed behaviour in patients in general hospitals in Leeds

Aim:To describe the prevalence and nature of disturbed behaviour, in the general hospital setting.Method:A cross-sectional survey was conducted, from July to October 2006, in all adult inpatient wards within the...

High-dose and combination antipsychotic prescribing in acute adult wards in the UK: The challenges posed by p.r.n. prescribing

Clinical guidelines recommend the routine use of a single antipsychotic drug in a standard dose, but prescriptions for high-dose and combined antipsychotics are common in clinical practice. To evaluate the effectiveness of a quality improvement programme in reducing the prevalence of high-dose and combined antipsychotic prescribing in acute adult in-patient wards in the UK. Baseline audit was followed by feedback of benchmarked data and delivery of a range of bespoke change interventions, and then by a further audit 1 year later. Thirty-two services participated, submitting data for 3,942 patients at baseline and 3,271 patients at the 1-year audit. There was little change in the prevalence of high-dose (baseline 36%; re-audit 34%) or combined antipsychotic prescribing (baseline 43%; re-audit 39%). As required ('p.r.n.') prescriptions were the principal cause of both high-dose and combined antipsychotic prescribing on both occasions. The quality improvement programme did not have a demonstrable impact on prescribing practice in the majority of services. Future efforts to align practice with clinical guidelines need to specifically target the culture and practice of p.r.n. prescribing.

An ethnographic study of tobacco control in hospital settings

Background: Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to...

A determination of healthcare worker exposure to Mycobacterium tuberculosis in two Californian hospitals

The US Centers for Disease Control and Prevention (CDC) recommends the prompt and sustained placement of potentially infectious tuberculosis patients in to negative-pressure isolation rooms, to help prevent other patients and workers, who remain outside of the room, from exposure to potential aerosols of Mycobacterium tuberculosis. The purpose of this study was to assess the potential for healthcare worker exposure to such aerosols and, to study compliance with the CDC guidelines. All room locations of culture-positive pulmonary TB patients were identified retrospectively for a one-year period at two hospitals. Placement in a negative-pressure isolation room was delayed for >24h after admission in 30% of 54 patients at hospital 1, and for 56% of nine patients at hospital 2. The median delay in isolation was three days at hospital 1, and five days at hospital 2. At hospital 1, of the 16 patients with delayed or no isolation, 14 (88%) were AFB smear-positive, and 12 (75%) were admitted to the hospital during the winter months. At hospital 2, of five patients with delayed or no isolation, two (40%) were AFB smear-positive, and four (80%) were admitted to the hospital during the winter months. The main reason for non-isolation was failure to initiate and sustain isolation for all suspect tuberculosis patients during the winter. These delays may reflect an insufficient number of isolation rooms to accommodate an increased usage of isolation rooms during the winter months. Delays in suspecting tuberculosis also contributed to non isolation. For 33% of the non-isolated patients, recognition of the diagnosis was delayed for three or more days. Patients were hospitalized on most adult inpatient wards, and virtually every hospital location that had these patients also had, non-isolated sources of mycobacterial aerosol. All workers were at risk of exposure, although the risk varied by hospital location, and should be tuberculosis skin-tested, at least annually. Suspect and known tuberculosis patients should be isolated until they are demonstrated to be non-infectious.

One day survey by the Mental Health Act Commission of acute adult psychiatric inpatient wards in England and Wales

Objectives : To provide (via the Mental Health Act Commission's “national visit”) empirical evidence on ward occupancy levels, use of the Mental Health Act 1983, nurse staffing, and care of...

Physician-Ordered Respiratory Care vs Physician-Ordered Use of a Respiratory Therapy Consult Service: Results of a Prospective Observational Study

To assess the impact of a respiratory therapy consult service (RTCS) on practices and appropriateness of ordering respiratory care services. Nonrandomized prospective observational cohort study with concurrent controls. Adult non-ICU inpatient wards of an academic medical center. A convenience sample of 98 adult non-ICU inpatients at the Cleveland Clinic Hospital, representing 20 inpatient clinical services. Patients whose respiratory care plans were determined by respiratory care practitioners using sign and symptom-based algorithms to specify treatment comprised the treatment group (n = 51, respiratory therapy consult group). The nonconsult group (n = 47) were patients whose respiratory care plans were specified by their own physicians. Specification of the respiratory care plan by the RTCS vs by the physicians themselves. Use of the RTCS was at the discretion of the managing physician. Types and number of respiratory care treatments, length of hospital stay, costs of the respiratory therapy provided, appropriateness of respiratory care orders (based on comparison of the actual respiratory care orders with a reference respiratory care plan generated by a study investigator who was kept blind to the actual respiratory care plan), and adverse respiratory events. Patients for whom the RTCS was requested by their physicians had a greater severity of respiratory illness based on having a lower triage score, but were otherwise similar at baseline. Fewer initial orders for respiratory care were discordant with the reference algorithms in RTCS patients (15% +/- 26% [SD]) than in nonconsult patients (43% +/- 36%; p < 0.001), and a smaller fraction of RTCS patients received at least one discordant initial respiratory care order (37% vs 72%; p < 0.001). Though provided to sicker patients with longer lengths of hospital stay, RTCS-directed care incurred similar respiratory care costs per patient ($335.63 +/- $272.69 [RTCS] vs $349.06 +/- $273.27; p = 0.72). These results suggest that the RTCS can be an effective strategy to allocate respiratory care strategies appropriately while conserving the costs of providing respiratory care.

In-patient groups: Setting up, running and evaluating ‘stand alone’ groups on adult acute in-patient wards

This article describes setting up, running and evaluating open ‘stand alone’ psychoeducational and cognitive behavioural therapeutic groups in an adult acute in-patient setting.

Use of the MMPI with multiple personality patients.

The MMPI was administered to the primary personality of each of the 18 multiple personality patients who had been hospitalized on an adult inpatient psychiatric ward at the UCLA Neuropsychiatric Institute over the 10-yr. period from January 1972 to January 1982. Three MMPI profiles were 4-8 codetypes, three profiles were 2-8/8-2 codetypes, three profiles were various other codetypes, and six of the profiles were invalid due to extremely high F scales. The remaining three patients refused to cooperate with the administration of the MMPI. This study helped clarify issues in using the MMPI in patients with dissociative disorders.

Reducing the use of full-leather restraints on an acute adult inpatient ward.

The authors describe a program to reduce the use of full-leather restraints on an acute adult inpatient psychiatric ward of a large community mental health center. It included the introduction of a multipurpose pipe-frame bed, which can be used for seclusion only or seclusion with restraints. Use of the bed, coupled with a seclusion-first policy and rapid tranquilization programs, reduced the time the patients spent in full-leather restraints from 360 hours in the month before the program was introduced to 30 hours two months later.