Adult Psychiatric Inpatient Unit Research Articles

143. Self-Reported Quality of Interpersonal Relationships and Its Overlap With Psychopathology in Adult Inpatient Psychiatric Units

143. Self-Reported Quality of Interpersonal Relationships and Its Overlap With Psychopathology in Adult Inpatient Psychiatric Units

Sex perspective on mandatory admission in acute psychotic patients

IntroductionPsychotic disorders are strongly linked to a higher risk of mandatory hospitalization, often affecting men more, though some studies report the opposite. Recent investigations also show a higher rate of involuntary admissions in younger individuals. Knowledge in this area is still limited despite extensive research.ObjectivesAnalyze whether there is an association between sex and age with involuntary admissions of individuals with psychotic disorders.MethodsRetrospectively, 254 people with psychotic disorders admitted between 2018-2023 to the adult psychiatric inpatient unit at Hospital Universitari Germans Trias i Pujol were selected, collecting their nature of admission, sex, age, and discharge diagnosis. Comparisons between voluntary and involuntary admissions, with respect to sex and age variables, were conducted using independent sample t-tests, Mann-Whitney U tests, Fisher’s exact test, and chi-square tests. A logistic regression model was used to identify variables significantly associated with mandatory admission.ResultsIn both the male and female groups, there were no statistically significant differences in terms of the mean age at admission (p = 0.162) or the nature of admission (p = 0.586) ( Table 1). When analyzing the voluntary nature of admission based on age and sex, statistically significant differences were only found in the female group (p = 0.01), resulting in a 9.18 year age difference among those admitted voluntarily ( Table 2). The model that best predicted the probability of involuntary admission in individuals with psychotic disorders included the sex variable (OR = 4.88) and the interaction between sex and age (OR = 0.97) ( Table 3). Table 1:Differences between sex regarding voluntariness of patients with psychotic disorders.MaleFemalep valueN (%)122 (48%)132 (52%)Age, m (SD)38.39 (16.64)44.15 (18.44)0.162Admissions, N (%)Voluntary38 (31.1%)37 (28.0%)0.586Involuntary84 (68.9%)95 (72.0%) Table 2:Analysis of voluntariness by sex and age.Age, m (SD)VoluntaryInvoluntaryp valueMale37.45 (16.38)38.81 (16.84)0.677Female50.76 (18.19)41.58 (17.98)0.01*Total44.01 (18.44)40.28 (17.46)0.127 Table 3:Predictors of involuntariness in psychotic patients: Logistic regression model (ENTER METHOD). Predictor -2log likelihood Nagelkerke R2 x2 (df*) OR* (95% CI*)p value301.220.0390.03 (1)Age1.01 (0.98; 1.03)0.674Sex4.88 (1.15; 20.72)0.032*Age x Sex Interaction0.97 (0.94; 0.99)0.046*ConclusionsYoung women with psychotic disorders face a higher risk of involuntary admissions, emphasizing the need for gender-specific strategies to improve care of these patients.Disclosure of InterestNone Declared

216. Self-Reported Psychotic Symptoms Among Patients who Screen Positive for Borderline Personality Disorder in Adult Inpatient Psychiatric Units: A Cross Sectional Study

216. Self-Reported Psychotic Symptoms Among Patients who Screen Positive for Borderline Personality Disorder in Adult Inpatient Psychiatric Units: A Cross Sectional Study

41.2 The Odd Couple: Security and Psychiatry

Although published literature exists about the use of security guards on adult psychiatric and forensic inpatient units, that is not the case for inpatient child and adolescent units. However, security officers are sometimes present on these units, particularly if there is a concern for staff and/or patient safety. The presence of a uniformed guard can be intimidating to patients, especially those with a history of trauma or negative interactions with law enforcement, but also can lend a sense of safety.

Admission Clerking- Inpatient Adult Psychiatric Unit - a Quality Improvement Project

AimsTo improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.MethodsWe started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.With the findings obtained, we went ahead to create a proforma encompassing all the details.The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming resultsResultsThe baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 yearConclusionThis QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best

Hertfordshire Partnership NHS Trust - Improving VTE Risk Assessments in an Older Adult Psychiatric Inpatient Unit

AimsVTE-related deaths are a leading cause of preventable mortality amongst all hospital inpatients. Psychiatric inpatients are at greater risk of this, due to administration of antipsychotic medication and longer inpatient stay. This is particularly significant during the COVID-19 pandemic, not least as it is a disease known to cause hypercoagulability, but also due to an increase in mental illness and extended admission, resulting from an overwhelmingly run social service. The objective is to analyse VTE risk assessments performed for the 23 patients at Lambourn Grove, a continuing care unit for old age psychiatric inpatients, diagnosed with dementia. The aims are to assess; the frequency at which VTE risk assessments are performed, the accuracy of each assessment and the subsequent management and appropriateness of preventative measures taken.MethodsA retrospective study was conducted of 23 service users. Data were collected from the VTE assessment form on the local electronic patient record system, and analysed to assess compliance with local guidance. GP records were consulted to cross check data and ensure accuracy of information inputted. Improvement measures include presenting at the local teaching session and implementing a mandatory monthly review onto the ward round proforma. A second cycle will be carried out to assess the success of these interventions in improving best medical practice.ResultsOf the 23 service users, 20 patients had their VTE risk assessment completed on admission and there was a delay of over a month with the remaining 3 patients. Of significance is that of all initial VTEs, 6 out of 23 contained inaccurate details, such as omission of comorbidities or a subjective assessment of mobility, indicating the need to use a standardized tool which allows for comparison across time. The mean admission duration for all 23 inpatients, as of February 2022 was calculated to be 16.2 months, with a range of 2 and 59 months. 15 patients did not have their VTE risk assessment repeated during admission, and of these 2 did have a change in their risk profile, indicating non-adherence with NICE guidelines.ConclusionThis study has identified significant areas for improvement, specifically the need for clear timing for repeated VTE assessments, consistent sources of patient's medical history and documentation of mobility status. The project has highlighted the need for a more robust VTE assessment protocol which is currently being developed, to improve patient mortality and outcomes.

P281. The Relationship Between Sleep Disturbance and Suicidal Thoughts on Inpatient Psychiatric Units

Sleep disturbance and acute suicidal thinking are primary targets for inpatient psychiatric treatment. The present analysis investigates the relationship of self-reported suicidal thinking and sleep disturbance in patients on adult psychiatric inpatient units.

P282. Precision Psychiatry on Adult Inpatient Psychiatric Units: Utilizing Patient Reported Measures and Actigraphy Data to Characterize Patient Symptomology and Outcomes

Self-report measures can assist in personalizing patient care and monitoring patient outcomes. The present work aims to characterize the symptom severity, comorbidity prevalence, and symptom improvement of patients on a short-term, adult psychiatric inpatient unit who completed a battery of self-reports during their admission.

The mental distress of our youth in the context of the COVID-19 pandemic.

Epidemiological evidence from population-based surveys suggest that the psychological well-being of adolescents has been severely affected by the COVID-19 pandemic itself, as well as by the safety measures implemented. The rationale of the study was to investigate the influence of the pandemic on psychiatric emergency service use, psychiatric admissions rates, emotional well-being, suicidality and self-harm behaviour in help-seeking children and adolescents. Retrospective cohort study of electronic patient records before and during the COVID-19 pandemic from the emergency out-patient facility of the department of child and adolescent psychiatry and psychotherapy of the Psychiatric University Hospital Zürich. The frequency of all emergency service contacts from 1 January 2019 to 31 June 2021 were described and the frequency of records compared in half-year intervals. Emotional well-being, behavioural problems, suicidality and self-harm were estimated based on the mental state examination notes of electronic patient records from the 1 March to the 30 April for the years 2019, 2020 and 2021. After an initial decline in emergency contacts at the beginning of the first lockdown, the use of the centralised emergency service increased during the subsequent months and has since stabilised at a significantly higher level than before the pandemic. Comparison of emergency contacts in the first half of 2019 with the first half of 2021 shows that the number of emergency phone contacts nearly doubled, emergency outpatient assessments increased by 40%, emergency bridging interventions increased by 230%, and inpatient admissions of minors to adult psychiatric inpatient units more than doubled because of lack of service capacity in child and adolescent psychiatry. The proportion of adolescents who reported suicidal ideation increased significantly by 15%, from 69% to 84%, and the proportion of adolescents who reported self-harm behaviour increased by 17%, from 31% to 48%. We found a significant increase in psychiatric service use, as well as in reported serious mental health symptoms such as suicidality and self-harm behaviour in help-seeking children and adolescents in the course of the pandemic. The child and adolescent psychiatric healthcare system is overburdened and down-referral of adolescents in need of ongoing therapy is becoming increasingly difficult. We recommend prioritising preventive and therapeutic measures to support the mental health of our children and adolescents alongside the somatic management of the COVID-19 pandemic.

Seclusion Reduction on an Adult Inpatient Psychiatric Unit: A Quality Improvement Project.

Seclusion practices have traditionally been used in psychiatry to maintain patient and staff safety. Despite negative emotional consequences for all involved parties and the movement toward patient-centered care, these practices continue in in-patient psychiatric units across the United States. The purpose of the current quality improvement project was to decrease the rate of seclusion events on an adult inpatient psychiatric unit through the implementation of a standard debriefing process based on the National Association of State Mental Health Program Directors' Six Core Strategies for Reducing Seclusion and Restraint Use. In 2020, the seclusion rates at the project site were above state and national benchmarks. Post-intervention, the seclusion hours per 1,000 patient care hours increased by 16% (0.38 to 0.44); however, the mean duration of each seclusion episode decreased by 10% (158 minutes to 142 minutes). Intervention compliance was low, including interprofessional participation. These findings demonstrate the need to address seclusion practices with an evidence-based solution, such as debriefing, coupled with adequate support from interprofessional leadership. [Journal of Psychosocial Nursing and Mental Health Services, 60(6), 27-32.].

Neuroimaging in an older adult inpatient psychiatric unit

AimsThis audit aimed to analyse the use of neuroimaging and its effect on treatment in an older adult inpatient psychiatry unit over the period of one year.BackgroundBrain imaging can be used as a diagnostic tool in psychiatry. According to NICE guidelines, structural imaging, such as magnetic resonance imaging (MRI) or computed topography (CT), can be used in the workup for dementia diagnosis in order to exclude non-dementia pathology and identify dementia subtype. This is important in the geriatric population where evidence of small vessel disease has an impact on treatment options and management of polypharmacy.MethodA list of patients from the past year (January to December 2019) was accessed. Patient records were then analysed to see if neuroimaging had been accessed during their admission at The Meadows Hospital, Surrey and Borders Partnership. This included imaging from prior to admission. Analysis was divided into type of imaging, comments and impact on diagnosis.ResultOverall numbers for the audit were small. A total of 74 patients were admitted onto the unit, of which 3 were readmissions. There was missing information for 8 patients, giving a total of 63 patients. CT scans were accessed for 35 patients (56% of total); 3 of these were done during the admission. MRI scans were completed for 21 patients (33%), with one requested during admission. A total of 9 patients (14%) had both CT and MRI scans. Neuroimaging results led to a change in diagnosis for 6 patients (10%). In all cases this reflected the finding of small vessel disease and a change of diagnosis to either vascular dementia or mixed dementia.Diagnoses were also analysed. The Meadows Hospital has 2 dementia wards (male and female) and 1 functional ward (for females). A total of 36 patients (57%) were diagnosed with dementia, of which the biggest groups were: Alzheimer's dementia (13 patients, 36%) and Vascular dementia (11 patients, 31%).ConclusionThe majority of the patients were admitted with established diagnoses and so only a small number had changes made following review of imaging. Good imaging results and reports help to differentiate types of dementia. Although neuroimaging is not gold standard in diagnosing dementia syndromes, it is now an important aspect in the diagnostic pathway. Getting the diagnosis correct will help with treating individuals appropriately and avoid unnecessary prescribing.

Improving Patient Flow and Access to Care at an Academically Affiliated Urban Safety-Net Hospital.

Access to inpatient psychiatric beds remains a significant barrier to care for patients having a mental health crisis. A quality improvement initiative described here was designed to increase access to care by increasing efficiency of health care delivery on an adult and adolescent inpatient psychiatric unit. Design and implementation centered on collaborative relationships among hospital administration, physician leadership, frontline physicians, and members of the multidisciplinary treatment team. Initial 5 months of data indicated significant improvements in care access as measured by number of encounters on both units. Reductions in length of stay were made possible by optimizing internal work flows and standardizing goals of hospitalization.

Measuring therapeutic engagement in finnish adult acute psychiatric in-patient care units using the finnish version of therapeutic engagement questionnaire (TEQ)

IntroductionThe Therapeutic Engagement Questionnaire (TEQ) has been developed and validated in partnership with service users (SUs), registered mental health nurses (RMHNs) and nurse academics in the UK in accordance with psychometric theory. The TEQ is highly relevant and useful to clinical practice. The TEQ measures therapeutic engagement (TE) in two contexts - 1-1 interactions between SUs and RMHNs, as well as the overall environment and atmosphere of the units - from the perspective of both SUs and RMHNs. The TEQ has been translated into Finnish by two expert panels and was pre-tested and validated in ten adult acute psychiatric in-patient units in two hospitals in Finland.ObjectivesTo measure TE in Finnish adult acute in-patient psychiatric settings from the perspectives of both SUs and RMHNs.MethodsThe Finnish version of the TEQ (Hoidollinen yhteistyö) will be completed by RMHNs and SUs in 15 adult acute psychiatric in-patient units. Nine of the units are within the University Hospital and six in a municipal psychiatric hospital. The data will be collected within a 3-month period (October - December 2020). The coordinating nurse of each unit will organise the operational side of the study including obtaining consent from SUs. The nurses will participate in the survey via Webropol which includes nurses’ consent. Sociodemographic information will be collected from the SUs and nurses.ResultsThe results of the measurement study will be reported at the 29th European Congress of Psychiatry.ConclusionsThe conclusions of the measurement study will be reported at the 29th European Congress of Psychiatry.Conflict of interestThis study is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London).

Sociodemographic and clinical variables associated with discharge under compulsory treatment orders.

To document the sociodemographic and clinical variables associated with discharge under compulsory treatment orders in patients with schizophrenia or related disorders. Information on various sociodemographic and clinical variables were extracted from the clinical files of 349 patients discharged from an adult (age 18-65) inpatient psychiatric unit with diagnoses of schizophrenia or related disorders. Univariate and multiple logistic regression analyses with legal compulsion (compulsory versus voluntary) as outcomes were applied. Two hundred of the 349 discharged patients were placed under compulsory treatment orders. In the univariate logistic regression analysis, unemployment, diagnosis of schizophrenia, forensic history, dosage of antipsychotics, prescription and frequency of injectable antipsychotics, polypharmacy and a hospital stay of more than 28 days were associated with compulsory status. Being married or in partnership and living with partner was associated with voluntary status. Multiple regression models respectively confirmed most of these relationships observed in the univariate analyses. Clarification of the apparent drivers for compulsory treatment may help thoughtful reductions in the use of compulsion.

Bir Erişkin Psikiyatri Servisinde Yatan Ergen Hastaların Değerlendirilmesi: 2015-2018 Yılı Verileri

Amaç: Bu çalışmanın amacı bir erişkin psikiyatrisi servisinde yatan ergen hastaların sosyodemografik değişkenlerinin ve hastalık ile ilişkili karakteristiklerinin değerlendirilmesi ve cinsiyetlere göre karşılaştırılmasıdır.Yöntem: Hastanemizin erişkin psikiyatrisi servisinde 1 Ocak 2015-31 Aralık 2018 tarihleri arasında yatan 18 yaş altı tüm hastalar çalışmaya dâhil edildi. Sosyodemografik veriler ve hastalık değişkenleri kaydedildi.Bulgular: Çalışmada, 27 kız (%51,9), 25 erkek (%48,1) vardı (p=0,782). Ortalama yaş 16,50±0,70 yıldı. Alkol-madde kullanımı erkeklerde anlamlı olarak daha yüksekti (p=0,01). En sık yatış nedenleri intihar girişimi, psikotik alevlenme, madde ile ilişkili durumlar, disosiyatif durumlar ve davranış sorunlarıydı. En sık psikiyatrik tanılar konversiyon bozukluğu, davranım bozukluğu ve madde kullanım bozukluğuydu. Mevcut yatış süresi ortalama 10,53±14,95 gündü. Kızların %51,85’i, erkeklerin %72’si şifa veya kısmi şifa ile taburcu edilirken geriye kalan hastalar kendi ve/veya ailelerinin istekleri ile taburcu edildi (p=0,13). Hastaların 29 (%55,8)’i antipsikotik (AP)+antidepresan (AD) kombinasyonuyla, 8 (%15,4)’ü sadece AP’le, 5 (%9,6)’sı AP+duygudurum düzenleyici (DDD) kombinasyonuyla, 5 (%9,6)’sı AP+AD+DDD kombinasyonuyla, 4 (%7,7)’si sadece AD ile 1 (%1,9)’u ilaçsız olarak taburcu edildi.Sonuç: Bu çalışma, ilimizdeki bir erişkin psikiyatri servisinde yatarak tedavi gören ergen hastalarla ilgili ilk çalışma olması açısından önemlidir. Bu bulguların, çocuk ve ergen psikiyatrisi alanındaki müdahalelere yol gösterebileceği düşünülmektedir.

Reflection of a 2-year journey since the introduction of psychiatric behaviour of concern (Psy-BOC) call, a medical emergency team (MET) call equivalent for the deteriorating mental health of patients.

To reflect on the challenges encountered and the resultant cultural changes that occurred during the implementation of psychiatric behaviour of concern (Psy-BOC), a medical emergency team (MET) equivalent for the deteriorating mental health of patients within an adult psychiatric inpatient unit. Implementing Psy-BOC on an adult psychiatric inpatient unit has been challenging, but it has successfully embedded a systematic approach to early escalation and capacity building to prevent and manage harmful behaviours.

The effect of limited English proficiency and interpreter service use on clinical outcomes in psychiatric inpatient units.

The effects of limited English and interpreter use on clinical outcomes in mental health are poorly understood. This paper describes an exploratory study examining those effects across three adult inpatient psychiatric units, predicting it would lead to increased length of stay. Forty-seven patients with limited English proficiency (LEP) were retrospectively identified and compared with 47 patients with proficient English. Length of stay, number of consultant reviews and discharge diagnosis were recorded and compared. An increased length of stay for those with LEP was not statistically significant (p=0.155). The LEP group did undergo more consultant reviews (p=0.036), however, and attracted different discharge diagnoses, with no primary discharge diagnoses of personality disorder made (p=0.018). This study provides evidence of significant effects of limited English on both service burden and outcome.

Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit.

Despite their widespread use, typical visual observation practices are not evidence-based and adverse events - such as self-harm and absconding - still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement-focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self-harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement-focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror-image design, rates of violence/aggression, self-harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement-based model was introduced, and 1087 admissions before implementation (24months) were compared with 965 admissions post-implementation (18months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P<0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P<0.0001). Rates of aggression, deliberate self-harm, and sexually inappropriate behaviour were non-significantly decreased. Findings suggest that this engagement-focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well-tolerated risk management model.

Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review.

The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.

East meets west in psychiatry: Yoga as an adjunct therapy for management of anxiety

PurposeProvide yoga for coping and symptom management in a locked, adult inpatient psychiatric unit. DesignHatha yoga was offered to inpatients with mood disorders and/or psychosis 3 times per week in this evidence-based practice change project. Impact on sleep was examined using recorded sleep hours. Anxiety symptoms were assessed using 6 of the 7 symptoms recorded on the Generalized Anxiety Disorders (GAD) 7. Sustainability of benefits was examined. A self-assessment was conducted at discharge to determine acquisition of new coping skills. ResultsNo difference in sleep hours or interruptions was noted. A statistically significant increase in the total anxiety scores (z = −1.9815, p = 0.02385) and sustainability of benefits (z = −2.0894, p = 0.03662) between the first and second yoga class were observed. A positive change from baseline in sustainability of symptoms for “less anxiety” (k = 0.108) and “more relaxed” (k = 0.083) was found. There was a significant increase in utilization of yoga (p = 0.0015) and meditation (p = 0.013) as coping mechanisms at discharge. ConclusionsAdults in an acute inpatient psychiatric unit who participated in yoga practice identified yoga and meditation as newly-acquired coping mechanisms and reported significant improvement in anxiety symptoms with sustained benefits ranging from half day to full day.