Clinical Team Meetings Research Articles

IRAMP: Investigation of Risk Assessment and Management Processes Using Datix Report Analysis and Observation of Clinical Team Meetings

IRAMP: Investigation of Risk Assessment and Management Processes Using Datix Report Analysis and Observation of Clinical Team Meetings

Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Quality Improvement Project to Improve Patient Satisfaction and Opportunity to Attend Clinical Team Meetings

AimsClinical Team Meetings (CTM) are weekly multidisciplinary (MDT) meetings to review and discuss patients’ clinical care at Reaside Clinic, a medium secure inpatient forensic unit. Last year, there were significant difficulties in releasing nurses from ward duties to attend CTM, with effects on CTM efficiency and patients’ involvement and satisfaction in care. Furthermore, a hospital ‘protected mealtimes’ deadline commencing at 1230 meant additional pressure and further impacted patient attendance when meetings overran. The MDT (comprising doctors, nurses, psychologists, occupational therapists, pharmacists and admin staff) worked together to generate solutions, formulating a QI project to try to make improvements. Three primer drivers were: increasing patient satisfaction, increasing staff participation and increasing CTM efficiency.MethodsThe MDT generated multiple change ideas to test to improve CTM experience and outcomes. Actions implemented included review of timetabling of patients to ensure adequate timekeeping and ensuring availability of attending ward staff, defining patient expectations from CTM through increased communication, and seeking patient feedback on satisfaction or engagement after each CTM through anonymous questionnaires. Data were collected at CTMs from February to April 2022, retrospectively compared to reference data collected before QI actions were implemented. A Microsoft OneDrive document was shared between the MDT to ensure accurate data collection, with information collected on CTM finish time, number of patients offered to attend, number of patients who did attend and anonymous patient satisfaction feedback from questionnaires.ResultsEarly indications show improvement in meeting timelines and increased staff satisfaction with the CTM process, with data collection ongoing. Baseline results from September 2021 show an average of only 2 of between 13–15 patients attending weekly, in addition to finishing beyond the 1230 target on almost all occasions. Anecdotal evidence from the MDT showed poor patient satisfaction and engagement with the process before QI changes were implemented. Full results will be available by the time of presentation; currently, an average of 4 patients have attended CTM each week with all sessions finishing on time since implementation of changes.ConclusionPatient involvement in care and person-centred care are key to improving engagement and satisfaction with inpatient psychiatric management in forensic settings. Targeted multiple change ideas implemented by the MDT through this QI aim to improve patient satisfaction through enabling increased opportunity to attend weekly CTM, with modifications to the CTM process from key staff. Preliminary results show increased opportunity of patients to attend CTM, increased staff and patient satisfaction, and increased CTM efficiency.

Random case analysis in general practice clinical team meetings

The Medical Board of Australia intends to mandate that at least 25% of continuing professional development (CPD) is focused on performance review. The aim of this article is to describe howrandom case analysis (RCA) can beused for performance review in general practice clinical team meetings, and outline its benefits and challenges. RCA is a powerful learning method for CPD. Involving peers in case review allows practice quality improvement and safety issues to be explored. Planning is required to overcome logistic and legal barriers and to ensure accreditation of the activity by The Royal Australian College of General Practitioners. Vital to the success of RCA is a supportive educational environment and the provision of learner-centred and specific feedback.

Effectiveness of Pharmacist-convened Multidisciplinary Clinical Team Meetings in Promoting Appropriate Benzodiazepine Receptor Agonist Use

Benzodiazepine receptor agonists (BZRAs) are used in the treatment of a wide variety of clinical conditions. Although clinical practice guidelines discourage high dosage or long-term use of BZRAs, they are prescribed in clinical settings. This study aimed to investigate whether the pharmacists at multidisciplinary clinical team meetings can help reduce BZRA use and promote appropriate use of these drugs. The psychiatric unit of the Tokyo Women's Medical University Hospital occupies two floors, with 31 beds on Floor A and 34 beds on Floor B. The multidisciplinary clinical team meetings were held once a week in each ward. During the meetings, the pharmacists comprehensively assessed the number of BZRA doses administered and the equivalent diazepam doses, presented their prescription recommendations aimed at dosage reduction, and shared their views with the entire clinical team. This intervention was commenced on Floor A in 2014 and on Floor B in 2015. The average number of BZRAs in each period and equivalent diazepam doses were assessed for 273 psychiatric inpatients hospitalized from April to June in 2013, 2014, and 2015. Changes in the number of BZRA doses administered were assessed per floor per year. The results showed a statistically significant decrease between years with and without interventions. The intervention of pharmacists allowed multidisciplinary clinical team members to gain the same understanding about BZRA use and formulation of drug therapy plans. The results suggest that the intervention of pharmacists at clinical team meetings can strategically lead to decreased BZRA dosages and their proper use.

Huddle up!: The adoption and use of structured team communication for VA medical home implementation.

Daily clinical team meetings (i.e., "huddles") may be helpful in implementing new roles and responsibilities for patient care because they provide a regular opportunity for member learning and feedback. We examined how huddles were implemented in the context of the VA patient-centered medical home (PCMH) transformation, including assessing barriers and facilitators to regular huddling among small teams ("teamlets"). We assessed the extent to which teamlet members that huddled had higher self-efficacy for PCMH changes, reported better teamwork experiences, and perceived more supportive practice environments. We used a convergent mixed-methods approach to analyze 79 teamlet member interviews from six VA primary care practices and 418 clinician and staff PCMH survey responses from the six interviewed practices and 13 additional practices in the same region. Most members reported participating in teamlet huddles when asked in surveys (85%). A minority of interview participants, however, described routine huddling focused on previsit planning that included all members. When members reported routine teamlet huddling, activities included (a) previsit planning, (b) strategizing treatment plans for patients with special or complex needs, (c) addressing daily workflow and communication issues through collective problem solving, and (d) ensuring awareness of what team members do and what actions are happening on the teamlet and in the practice. Primary care providers (PCPs) were least likely to report routine huddling. PCP huddlers reported greater self-efficacy for implementing PCMH changes. All huddlers, irrespective of role, reported better teamwork and more supportive practice climates. The most common barriers to teamlet huddling were limited time and operational constraints. In order to improve the impact of huddles on patient care, practice leaders should clearly communicate the goals, requirements, and benefits of huddling and provide adequate time and resources to ensure that frontline teams use huddle time to improve patient care.

A multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series

ProblemAntibiotic administration to inpatients developing sepsis in general hospital wards was frequently delayed. We aimed to reproduce improvements in sepsis management reported in other settings.ContextNinewells Hospital, an 860-bed teaching hospital...

Usage de la contention en psychiatrie : vécu soignant et perspectives éthiques

The return of restraint in psychiatry raises many ethical issues for caregivers. However their experience is little explored in literature.Our objective was to study the feelings of caregivers facing restraint with regard to an ethical perspective and to identify areas for improvement.Between November 2011 and February 2012 a descriptive cross-sectional epidemiological study was performed in two psychiatric emergency services and two closed units in which doctors and nurses were individually interviewed using semi-structured questionnaires. Five topics were explored: indications and contexts, impact on the patient, caregiver-patient relationship, perspective on the practice and feelings of caregivers on which we insist particularly. Results were presented in tables with percentages and possibly diagrams. The notable responses of caregivers were also cited.Twenty nurses and nine psychiatrists, mostly female, were recruited. They all had participated in experiments of restraint. The self-aggressiveness, the aggressiveness against other persons and agitation were the most frequent indications. In the patients, caregivers identified misunderstanding (79.3%) and anger (75.9%). The majority of nurses (75%) felt that there was an improvement in the caregiver-patient relationship after the episode of restraint compared to what it had been in the moments preceding this measure. The emotional experience of caregivers was rich, intense and predominantly negative type of frustration (35% of nurses; 66.7% of doctors), anger (30 and 33.3%) and lack of feeling (35 and 44.4%). The feelings of doctors and nurses were not completely similar. For caregivers it was "a difficult but necessary experience" (82.75%), "an act of care and safety" (68.9%). All psychiatrists and almost half of the nurses (45%) said they did not feel the same when they used seclusion. In their opinion, seclusion entailed a less painful experience because of its therapeutic properties. More than half of the caregivers thought that there were alternatives to restraint: the strengthening of containing function in the hours before the use of restraint; the use of seclusion at the time of the decision to restrain. They identified contexts (80%) encouraging the use of restraints, not only related to the patient, the lack of resources but also institutional contexts, in particular conflicts or divisions in the health care team.The misunderstanding of the patient led us to wonder about the quality of the information he/she received: it was sometimes too formal and did not take into account the uniqueness of the patient. The frustration of caregivers could concern the lack of resources but also be directed towards a patient or caregiver. In addition, there were often cleavages between doctors and nurses that stemmed from a misunderstanding, also with rivalries and power struggles. From the literature and caregivers' reflections we identified three prospects to reduce the use of restraint and modify feelings of caregivers: 1) develop better crisis management upstream through increasing resources and improving training; 2) promote patients support in using ethical principles of autonomy and beneficence by showing them solicitude, inviting them to tell themselves and helping them to regain their own experience; 3) develop an afterthought in setting up institutional reflection time by restoring a central role in clinical team meetings in psychiatry, possibly supplemented by supervision, but also through regional ethical spaces.In our investigation, we found that caregivers had a predominantly negative experience with frustration, anger and a lack of feeling. Among caregivers we also identified awareness of ethical issues that may be for the first time for a change.

Questions for pharmacist providers in clozapine clinics: Ott and Williams

HOW LONG HAVE YOU BEEN PRACTICING IN YOUR CLINIC? WAS IT YOUR IDEA, OR SOMEONE ELSE'S? Dr. Ott: My clinic has been in operation since May 2009. I was invited by the attending psychiatrists to be a part of the launch, as well as a continuing team member for the clinic with a collaborative practice agreement. My role continues to grow as our research program expands, studies often include me as a co-investigator with similar study responsibilities to our physicians, including research and clinical visits and rating scales.

How do centres begin the process to prevent contrast-induced acute kidney injury: a report from a new regional collaborative

ObjectivesThis study evaluates the variation in practice patterns associated with contrast-induced acute kidney injury (CI-AKI) and identifies clinical practices that have been associated with a reduction in CI-AKI.BackgroundCI-AKI is recognised...

A clinical librarian pilot project in psychiatry

Aims and methodA 4-month pilot was conducted to assess whether the clinical librarian model, which has been successfully used within acute hospitals, would work in a mental health setting. A librarian attended weekly clinical team meetings in two community mental health teams to help generate clinical questions. A summary of the evidence on each topic was then presented the following week. An evaluation of the pilot was carried out using a questionnaire survey, focus groups and interviews.ResultsResults suggest that the project had produced a positive impact within the teams and begun the process of embedding evidence-based information within clinical practice.Clinical implicationsWith some adaptations, the clinical librarian model can be an effective method of implementing evidence-based practice and addressing continuing professional development needs within mental health clinical teams.

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

Implementation of Integrated Dual Disorders Treatment: A Qualitative Analysis of Facilitators and Barriers

Developing the role of pharmacists as members of community mental health teams: Perspectives of pharmacists and mental health professionals

Background People living with bipolar mood disorder and psychotic illnesses in Australia primarily access public-sector mental health care through community mental health teams (CMHTs). Adverse drug events are common among clients of CMHTs taking psychotropic medications. Objective The study aimed to investigate and describe a potential role for pharmacists as members of CMHTs. Methods Five study pharmacists were employed 1 day per week to work with 5 mental health teams over a 24-week period. The pharmacists conducted both client and team specific activities designed to optimize the use of medications. The pharmacists recorded their professional activities in diaries. Audiotaped focus groups were conducted with the pharmacists (n = 1) and mental health team staff (n = 3) at the conclusion of the study. Pharmacists' diaries and the transcripts of focus groups were thematically content analyzed. Results Study pharmacists were perceived as valuable sources of unbiased and evidence-based drug information for both mental health team staff and their clients and caregivers. Mental health team staff particularly appreciated the provision of information about nonpsychotropic medications. Pharmacists' participation in clinical team meetings was used as an opportunity to present medication review findings and recommendations. Liaising between medication prescribers and dispensers working in primary and secondary care settings was deemed an important additional role; however, participating only 1 day per week was considered to delay rapport building and the establishment of collaborative working relationships with mental health team staff. Conclusions Including pharmacists as members of CMHTs addressed an unmet need for pharmaceutical services among clients and staff of CMHTs. Pharmacists' contributions were welcomed by mental health team staff. The study raised the issue of whether pharmacists should be considered as essential and legitimate members of interdisciplinary CMHTs.

EuropASI: A standard in de Sleutel, Belgium

Aims. The introduction of the EuropASI (European version of the Addiction Severity Index) as a standard intake instrument was inspired by four different viewpoints—clinical, registration, research and management—and aimed at implementation in these four areas.Setting. De Sleutel includes five ambulatory centres and four residential centres in different parts of Flanders in Belgium. In 1998, the EuropASI interview was introduced in de Sleutel as a diagnostic standard admission for residential as well as ambulatory drug‐treatment settings. Today there is a database of about 2500 EuropASIs of unique clients.Findings and conclusion. Clinically, the introduction of the EuropASI gave a basic guideline for clinical workers to act, measure and orient the client after his first treatment demand. It provided a uniform procedure that guarantees a well‐balanced focus for all life areas traditionally linked with addiction problems. It also became a useful instrument for structuring the clinical team meetings and led to better planning and treatment. The EuropASI could deliver the minimal data set needed for regional, national and European epidemiological data. The extra time spent in making up special data sets for monitoring or registers could be saved. Uniformity in the way data are gathered could guarantee a better quality of the data for registration, and redundancy eliminated. Instead the basics are set for a treatment‐supporting documentation system. The research concentrated around a more scientifically founded understanding of addiction problems, more specificity in client profiles, an ability to compare groups, research in matching treatment to client profiles, and more insight in to necessary knowledge and skills for the clinical teams. From a management perspective, the introduction of a European standard for basic assessment of our clients could start the process of total quality management, in providing an accepted basis in documenting the core business of the treatment centres.

Managed care: Strengthening the consumer voice in managed care: VII. The Georgia peer specialist program.

The Surgeon General’s landmark 1999 Mental Health Report gives consumers and their families a prominent place in the mental health system as advocates, participants in overseeing policy, and providers of services (1). Managed care programs, when adequately funded and wisely managed, can, should, and sometimes do promote all three objectives (2). The rationale for a more consumercentric approach to managed care derives from a clinical prediction that services provided in this manner will lead to improved outcomes (3) and a view of democratic process that calls for robust citizen involvement beyond that provided by representative government alone (4). The state of Georgia has pioneered a certified peer specialist program that combines consumer-provided services, consumer advocacy, and consumer influence on policy in a highly innovative manner. In this column, the seventh in a series on strengthening the consumer voice in managed care (5–10), we present lessons about enhancing the consumer role derived from Georgia’s unique program. Although Georgia’s program is currently one of a kind, the values and strategy that inform the program could have wide application. Since 1999, the Georgia Division of Mental Health, Developmental Disabilities, and Addictive Diseases has placed a strong emphasis on recoveryoriented programming and peer support in its approach to providing services for clients who have serious and persistent mental illness (11). Publicsector officials and consumer leaders concluded that in order to achieve stable funding for peer-support services, the services would have to be developed in a way that made them eligible for Medicaid funding under Medicaid’s psychiatric rehabilitation option (12). Accomplishing this objective required melding two cultures: the consumer recovery movement—with its informality, vision, and energy—and Medicaid, with its complex bureaucratic requirements. The certified peer specialist role is

Power in Work Groups: Team Member's Perspectives

Power and restrictive participation are often identified as primary issues which can retard the productivity of work groups. The study describes team member responses to a questionnaire regarding bases of social power used within 19 interdisciplinary clinical team meetings and their relationship with team decision-making style, participation in team decisions, and team meeting productivity. Physicians were found to effect almost all treatment decisions, and autocratic decision making was found to be more prevalent than consensual decision making. It is suggested that the generally held belief that the interdisciplinary team approach is equivalent with shared decision making and broad-based participation needs careful re-examination. Implications of the findings for shared decision making in health care teams and work groups in general are discussed. The importance for managers and team leaders to understand and appropriately facilitate the dynamics of power in work groups is emphasized.