Security Hospital Research Articles

Professional Ethics Relationship with Patient’s Rights Charter Observance among Nurses and Midwives

Introduction: Respect for patients’ rights and observance of professional ethics standards improves medical services that will have an essential role in promoting patients’ health. Objective: This study aimed to determine the relationship between awareness of patient’s rights charter and professional ethics with patient’s rights charter observance. Materials and Methods: This analytical correlational study was performed on 285 staff members (196 nurses and 85 midwives) working in 2 hospitals affiliated to Alborz University of Medical Sciences, Iran, and 2 social security hospitals. They were selected using a stratified random sampling method. The study data were collected using the sociodemographic characteristics questionnaire, awareness and observance of the patient’s rights, and professional ethics charter questionnaires. Descriptive statistics and inferential statistics, including the independent t-test, Pearson correlation, Chi-square tests, and multivariate linear regression, were used for data analysis. Results: The Mean±SD ages of nurses and midwives were 36.2±8.3 and 37.5±7.9 years, respectively. The results also showed an association of professional ethics and awareness of patient’s rights charter with patient’s rights charter observance in both nurses (P=0.0001) and midwives (P=0.0001). Based on multivariate linear regression analysis, there were relationships between gender (B=-0.3; 95%CI; -2.0, 2.0; P=0.000), work experience (B=-0.6; 95%CI; -4.0, 3.0; P=0.000), marital and employment status (B=-3.2; 95%CI; -6.0, -0.0; P=0.045), in nurses and between job position (B=9.5; 95%CI; 5.4, 13.5; P=0.000), interest to work (B=-7.9; 95%CI; -11.5, -4.3; P=0.000), and income status (B=6.3; 95%CI; 3.3, 9.2; P=0.000), in midwives with Observance of the Charter of Patient Rights. Conclusion: It is possible to improve compliance with the charter of patient’s rights and its dimensions by strengthening the knowledge of nurses and midwives in this area and their professional ethics, which results in patient satisfaction in this area.

Integration among national health information systems in Brazil: the case of e-SUS Primary Care.

ABSTRACTOBJECTIVE:To measure the degree of integration of the Electronic Citizen’s Record (PEC - Prontuário Eletrônico do Cidadão) of the e-SUS Primary Care Strategy (e-SUS AB - Estratégia e-SUS Atenção Básica) in the view of other Brazilian´s National Health Information Systems (SNIS - Sistemas Nacionais de Informação em Saúde), relating to the internal political-organizational structure of the Brazilian Ministry of Health (MH).METHODS:This is a qualitative case study. Data collection was carried out through document analysis and semi-structured interviews. In the first stage, we sought to clarify how many SNIS were in use in the Primary Care (PC) of the Unified Health System between 2013 and 2017. Then, we defined as criterion the maintenance of data collection interfaces by the Ministry of Health even after the implementation of the PEC/e-SUS Primary Care in order to measure the integration.RESULTS:31 SNIS were identified in Primary Care. We observed that 12 of them were completely integrated and 15 presented no unification of interfaces related to PEC/e-SUS Primary Care. Another 4 have partial integration. By correlating these data with the political-organizational structure of the MS, we observed a greater integration with the systems managed by the Department of Primary Care and a persisted fragmentation in SNIS, especially those under the management of the Health Surveillance Department (Secretaria de Vigilância em Saúde). The disparity between the integration of the PEC/e-SUS Primary Care with the Health Surveillance SNIS is a sign of the persistence of the division and the false dichotomy between Health Care and Health Surveillance practices and processes in the Ministry of Health – even 30 years after the foundation of the SUS and unification of the state structures of social security hospital care and federal public health in MH.CONCLUSION:Although still insufficient, the systems integration carried out by the e-SUS Primary Care Strategy, which focuses on reducing user interfaces, can be considered a new fact on the SUS information and information policy agenda.

Reasons of Missed Nursing Care From the Viewpoints of Nurses in Educational, Private, and Social Security Hospitals in Urmia-Iran in 2018

Reasons of Missed Nursing Care From the Viewpoints of Nurses in Educational, Private, and Social Security Hospitals in Urmia-Iran in 2018

Collaborative care planning in a high security hospital: A conversation about getting inclusive practice off the ground

Collaborative care planning in a high security hospital: A conversation about getting inclusive practice off the ground

Psychological and the physical health impacts of forensic workplace trauma

PurposeHealth-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting.Design/methodology/approachSemi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital.FindingsThematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes.Practical implicationsThe findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events.Originality/valueThis research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.

Morbidity patterns and provision of workplace safety among industrial workers

Background: Occupational injuries are among the ten most common reasons of illness and death. In Pakistan, the circumstances are very grave like many other developing countries. So, it was inevitable to carry a study among industrial workers. Aims: To determine the morbidity patterns, socio-demographic determinants and to provide safe workplace environment to the industrial patients admitted in the Social Security Hospital, Lahore. Method: Cross sectional survey among industrial workers was conducted at Social Security hospital, Lahore. Total size of the sample was 385 which was distributed equivalently among all the indoor units of hospital. A structured questionnaire was administered, and data was analyzed using SPSS version 23. For quantitative variables like age, mean and standard deviation and for qualitative variables frequency and percentage was calculated. Chi square was applied among qualitative variables. Data was presented in the form of tables and bar graphs. Results: Mean +/- SD age was 32 +/- 7.5 years: 118(30%) of the sample was between 26-30 years. Majority of the patients, 366(95%), were men and 258(67%) were married. Majority of the sample, 158(41%), were illiterate. 318(83%) of the sampled patients were workers/laborers, 25(7%) had administrative duties, 17(4%) were working in office and 13(4%) skillful laborers. The incidence of injuries and accidents was remarkably high among the laborers 96(25%) followed by Gastroenteritis 50(13%), fever 50(13%) and cough & respiratory tract infections 38(10%). 298(77%) stated that most of these incidences were not reported at their workplace, 309(80%) were not using any personal protective equipment. Conclusion: Majority of the industrial patients were admitted due to accidents and injuries at their workplaces. Majority of them were young adults, married males. Unskilled labor was largely uneducated. Safety practices at workplace of the respondents were very poor. Keywords: morbidity patterns, industrial workers, social security hospital, personal protective equipment.

Assessing the Feasibility of a Multicenter Transition Intervention Model Across Adolescent Secure Services in England (MOVING FORWARD): Protocol for a Feasibility Cluster Randomized Controlled Trial.

BackgroundYoung people moving from adolescent secure inpatient units to adult care in the United Kingdom have multiple and complex needs and are more likely to experience poor transition outcomes. Poorly managed transitions can lead to enduring use and dependency on mental health services. However, there is a lack of knowledge about the feasibility of transitional care models.ObjectiveThis paper presents the protocol for a study that aims to test a feasibility cluster randomized controlled trial for young people transitioning from adolescent secure services to adult-oriented settings. The overarching aim of the MOVING FORWARD study is to provide a preliminary estimate of the effectiveness and cost-effectiveness of a new transition intervention model and to inform a future full-scale cluster randomized controlled trial.MethodsThe design of the study is a 3-arm feasibility cluster randomized controlled trial comparing the MOVING FORWARD intervention against standard transition preparation conducted at 6 adolescent secure services, of which 4 units will receive the intervention and 2 will serve as controls. Eligible young people between 17-19 years, their parents/carers, and key workers will be invited to participate. Young people and parents/carers will be allocated to two conditions (young people alone and young people with a parent/carer) and will receive 4 transition preparation workshops across 6 months. Six adolescent secure hospitals will be randomly allocated, stratified by area and service type. Data will be collected at 3 time points: baseline (T0), 6-12 months postintervention (T1), and 18-24 months postbaseline (T2). Primary and secondary outcomes will be based on assessment measures and interviews conducted at T1 and T2.ResultsA total of 13 young people and 17 staff members have contributed to the intervention design through online advisory groups on the design of the study and important themes for transition. We have also consulted members of the public (a steering group) including 2 young people who have transitioned to the community and 2 parents/carers. Common identified themes included appropriateness of module content and support during delayed transitions. The content of the intervention will be finalized during the first 6 months of the study. Participants will be recruited over the course of 6 months. An intraclass correlation coefficient will be calculated to inform the power of the sample size for a further large-scale trial. With a sample size of 50, we will be able to estimate a dropout rate of 80% (95% CI –11% to 11%).ConclusionsThis research will provide practitioners and policy makers with an evidence-based framework of how training and familiarization with the prospective transitions can yield positive outcomes. This study will test whether a psychosocial intervention can be implemented in adolescent secure hospitals. The results will identify barriers and facilitators to the proposed intervention and will enable services to reflect on the quality of transitional care delivery.International Registered Report Identifier (IRRID)PRR1-10.2196/29273

Is non-completion of treatment related to security need?

Treatment completion difficulties are common in forensic mental health settings and may have a profound impact on recidivism rates. To test for associations between measures of risk and of security needs on the one hand and treatment non-completion on the other among male offender-patients in one medium security hospital. We conducted a retrospective file study in a Flemish medium security hospital. A random sample of 25 treatment non-completers was compared to a random same-size sample of completers, each rated, blind to outcome, on the DUNDRUM-1 security needs scale from data recorded at the time of admission to the unit. 'Non-completion' was defined as any failure to complete treatment, whether staff-terminated or self-terminated; in Flanders, failure to comply with the judicial conditions of placement can result in re-imprisonment. We used binary logistic regression to test relationships between treatment completion/non-completion and security need, measured with the DUNDRUM-1, together with a range of possible confounding variables. Most patients had psychosis and/or personality disorder and often substance use disorders also. Treatment non-completion was invariably staff ordered because of security breaches. DUNDRUM-1 and PCL-R Facet 4 scores at the time of admission and HCR-20 scores during admission were significantly higher among non-completers than completers, but after binary logistic regression, only the DUNDRUM-1 rating was independently associated with non-completion. Our study showed that an admission DUNDRUM-1 rating, indicating levels of security need, co-varies only to a small extent with the historical items of the HCR-20, so may be regarded as measuring complementary domains. While conditions in Flanders at the time of the study complicated it in that medium security hospital units offered the highest level of hospital security available, the finding that non-completion of treatment was particularly likely when the DUNDRUM-1 indicated a higher security need than facilities could provide may have implications for all secure hospital services.

Endoscopic and Histopathological Characteristics of Polypoid and Non-Polypoid Colorectal Lesions in Patients of a Social Security Hospital of Lambayeque, Peru

Objective: To describe the endoscopic and histopathological characteristics of polypoid and non-polypoid colorectal lesions at the Luis Heysen Inchaustegui hospital, Peru, 2017-2018. Materials and methods: Descriptive-analytical cross-sectional study. We study epidemiological, endoscopic and histopathological variables. location, Size and shape of the lesions taking into account the Paris classification. Results: Endoscopically, of a total of 81 colorectal lesions, the majority were non-polypoid (71.6%). Lesions smaller than 10mm represented 90.1% in non-polypoid lesions and 56.5 % in polypoid lesions. Histopathologically, non-adenomatous lesions predominated (53.0%). Conclusions: The most frequent lesions were non-polypoid, the main location being the rectum; while in polypoid lesions, the transverse colon. Regarding size, lesions smaller than 10mm predominated in both non-polypoid and polypoid lesions. Histopathologically, the most frequent were non-adenomatous lesions (hyperplastic polyps); for its part, the predominant adenoma subtype was tubular. Keywords: Adenomas; Polyps; Intestinal Polyps; Colon (source: DeCS BIREME).

Health Related Quality of Life among Tuberculosis Patients

Aims: To find out health related quality of life among patients being treated for tuberculosis in the hospital of Lahore, Pakistan.
 Study Design: Cross sectional survey is used as research design in this study.
 Place and Duration of Study: Farooq Hospital west wood branch Lahore, Gulab Davi Hospital Lahore, Social Security Hospital Lahore between June 2020 and July 2021.
 Methodology: Sample (N=150) was drawn through purposive sampling technique from various hospitals of Lahore with age range of 18 – 65 years of 56.7% male and 43.3% female patients of Tuberculosis.Standardized questionnaire (SF-36) was used to determine the health related quality of Life. This questionnaire determines the effect of TB on physical activities, social activities, emotional activities and limitation in routinely work. Data was analyzed through SPSS with descriptive statistic of frequency and percentages.
 Results: On the basis of total scores of general health category 53.3% patients considers their health as good when taking antituberculosis medicine. Total scores of Limitations of activities 70.7% patients considers their social activities limited a lot. On the basis of total score of physical health problem category 81.3% considered their physical health were not affected. On the basis of total score of social activities 70.0% patients considered their emotional health problems interfered with normal social activities affected.
 Conclusion: It was concluded that limitations of physical activity and compromised psychological status impacted the HRQOL in patient with pulmonary TB. Tuberculosis effect on patient’s physical, psychological and social activities of daily routine. Patient become bed bound due dyspnea and unable complete their task to fulfill the needs of life.

Access to non-violent pornography in a secure forensic hospital

PurposeThe purpose of this paper is to explore non-violent pornography within secure hospital settings.Design/methodology/approachIt includes a systematic review (n = 40 papers), followed by a qualitative study comprising semi-structured interviews (n = 24, 6 patients and 18 staff) and staff focus groups (n = 22 staff).FindingsThe systematic review identified six themes, as follows: pornography is inconsistently defined, pornography exposure can increase general aggression, pornography exposure may increase the risk for sexual aggression, pornography exposure can increase aggression supportive beliefs, pornography exposure impacts negatively on those with a violent predisposition and pornography is educational for men not identifying as heterosexual. The semi-structured interviews and focus groups revealed four themes as follows: staff members hold diverse beliefs about pornographic material, pornography is difficult to obtain and use for patients who do not identify as heterosexual, pornography is used for specific functions, and frequent exposure to pornography can have negative effects for staff members.Practical implicationsTrying to obtain consensus on the impacts of pornography on forensic patients is not possible; material access decisions should be on a case-by-case basis. Policy decisions should be based on fully represented views, including the LGBTI community. The impacts on staff of their occupational exposure to such material should be recognised and support provided. Clinical decision-making in this area should consider not only if access should be allowed but also how it can be managed safely, if at all. This includes for all those who could be exposed to such material, inadvertently or otherwise.Originality/valueIt addresses the under-researched area of patient access to pornography, capturing a poorly considered sample, namely, high secure psychiatric.

Men with intellectual disabilities and sexual offending histories: an exploration of their experiences of living within a secure hospital setting

PurposeThere is a national drive to transform services for individuals with intellectual disabilities (ID), to provide care within the community rather than hospital settings. However, there are limited community provisions for those with more complex care needs such as sexual offending. There has been limited research focussing on this client group’s experiences of inpatient services and the treatment they have received from their own perspective. This study aims to explore their experiences of living in a secure service focussing on treatment for sex offences.Design/methodology/approachIn total, 10 men with ID and sexual offending histories took part in an interview designed to explore their experiences of living within a secure hospital setting. The data were analysed using thematic analysis.FindingsThree key themes relating to the participants’ experiences within the hospital were identified. These were, namely, “hospital environment”, “personal journey through secure services” and “closeness to home”.Practical implicationsMen’s experiences at a secure hospital were generally positive in terms of a supportive staff approach. Difficulties existed around the hospital organisation affecting the support they received.Originality/valueSome participants experienced a struggle to become more independent and move to less restrictive environments due to their perceived risk levels. Some participants found being away from home to be hard and longed to be closer to their families. Around half of the participants did not want to live near their hometown due to family difficulties, negative peer influences or fears of consequences for their sexual offending. Implications for community service planning are considered.

Evaluation of the effectiveness of newborn hearing screening program in Zahedan: A cross-sectional study

Introduction: Hearing loss is one of the most common congenital disorders. The prevalence of this disorder in different communities has been reported between 3.5 to 9 percent, which can have adverse effects on language learning, communication, and education of children. Also, early diagnosis of this disorder in newborns is not possible without the use of hearing screening. Therefore, the aim of this study was to evaluate the effectiveness of newborn hearing screening programs in Zahedan. Method: In this cross-sectional observational study, all babies born in the maternity hospitals of Zahedan city (maternity hospitals of Nabi Akram, Imam Ali, and Social Security hospitals) in 2020, were examined. In order to conduct the study, TEOAE was initially performed for all neonates. Then, based on the results obtained in the ODA test and in case of unsatisfactory response, cases were referred for re-evaluation. Infants who were rejected again in the second stage were immediately subjected to the AABR test and if they failed in this test, they were also subjected to a diagnostic ABR test. Results: Based on our results, 7700 infants were first evaluated with the OAE test. Of these, 580 (8%) had no OAE response. Out of 580 infants rejected in the first stage, 76 infants were also rejected in the second stage; Among them, 8 infants were re-diagnosed with hearing impairments. Finally, out of 3 infants who were diagnosed with hearing loss, 1 (33%) had conductive hearing loss and 2 (67%) had sensorineural hearing loss. Conclusion: Based on the findings of the present study, the implementation of a comprehensive neonatal hearing screening program is necessary for the timely and early diagnosis and treatment of hearing loss. Also, screening can improve the health of children and their personal, social, and educational development in the future. Keywords: Hearing screening, hearing loss, newborns, OAE, AABR

Characteristics of patients coinfected with Severe Acute Respiratory Syndrome Coronavirus 2 and dengue virus, Lambayeque, Peru, May–August 2020: A retrospective analysis

IntroductionBefore the Coronavirus Disease 2019 (COVID-19) arrival and its pandemic, dengue was already a significant cause of epidemics in South East Asia and Latin America. In 2020 with their cocirculation, coinfections began to be observed and reported in different countries. As expected, this syndemic is evident in different areas and deserves proper characterisation and studies in Peru. MethodsWe retrospectively assessed the clinical, epidemiological, diagnostic characteristics and outcomes in a Social Security Hospital of Chiclayo, Lambayeque, Peru, of patients that were diagnosed simultaneously with COVID-19 and dengue during May–August 2020. ResultsA total of 50 patients with COVID-19/dengue coinfection were identified. Of them, 60% presented thrombocytopenia, and 52% fever, among other findings. The case fatality rate in this group was 28%, being higher in those patients initially classified as severe dengue (100%), as well as in females (55%) than males (21%) (OR = 4.65; 95%CI 1.18–18.45). DiscussionCo-occurrence of COVID-19/Dengue is growing as a consequence of the syndemic of these viral diseases in endemic areas, such as Latin America, and as both conditions may evolve to severe disease, their epidemiological but clinical interaction in terms of outcomes need further assessment in future studies in the region.

International overview of phallometric testing for sexual offending behaviour and sexual risk.

Phallometry is an objective method of assessing male sexual arousal. The main applications in forensic psychiatry concern the evaluation of men charged with or convicted of sexual offences, the evaluation of those with suspected paraphilias not subject to the criminal justice system, risk assessment and measurement of response to sex offender treatment. In some jurisdictions, phallometry is incorporated into legal decisions about release from custody or discharge from secure hospitals. This paper provides a brief overview of the international development of phallometry, considers challenges to its broader adoption and discusses future directions for research and clinical practice.

Effect of different manipulations on serum PSA in patients with benign prostatic hyperplasia.

Objectives: To evaluate the effect of different urological manipulations on the serum PSA level in patients with benign prostatic hyperplasia. Study Design: Quasi-experimental study. Setting: Department of Urology, Nawaz Sharif Social Security Hospital, Lahore. Period: January 2018 to December 2018. Material & Methods: A series of 60 patients were included in the study who fulfill the inclusion criteria. All the patients were above 50 years of age and presented with symptoms of benign prostatic hyperplasia. These patients were divided into four groups equally. In group A digital rectal examination, in group B transurethral resection of prostate, in group C Foley’s catheterization and in group D Trans rectal ultrasound guided prostatic biopsy was done. Pre-manipulation and post-manipulation blood samples for serum PSA were taken after 30 minutes, 72 hours and one week. Results: Trans urethral resection of prostate, Foley's catheterization and trans rectal ultrasound guided prostatic biopsy caused a statistically significant rise in serum PSA level (p < 0.05) while digital rectal examination did not raise serum PSA level significantly. Conclusion: Different manipulations do cause alteration in the serum PSA level which may change the management plan.

Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide.

Concerns have been raised that people detained in secure hospitals after a criminal act spend longer in a locked institution than people sent to prison for similar offending, but research evidence is scarce and conflicting. To compare the length of secure hospitalisation of people convicted of crimes for which flexible sentencing is allowed with length of time in prison for people serving a prison sentence for similar crimes who were not found mentally ill. A records-based, retrospective study was conducted comparing length of stay of all inpatients in one medium security hospital in Poland, hospitalised between 2014 and 2018, who had been convicted of any interpersonal crime other than homicide or attempted homicide, and data on all sentenced prisoners in Poland on 09.05.2018 convicted of a similar range of offences. Homicide was excluded because, in Poland, it usually attracts a fixed sentence-a life sentence until the 1970s and currently a 25-year imprisonment-so disrupting comparisons. Eighty-two patients completed their secure hospital stay within the study period or were still hospitalised at the census point 09.05.2018, only 10 of them women. Male patients convicted of stalking or similar threatening offence or 'mistreatment' spent, on average, almost twice as long confined to hospital than men sentenced to imprisonment spent in prison (28.8 months, respectively). By contrast, men hospitalised after sex offences were confined for over three years less than those sentenced to prison. Only bodily harm offences attracted comparable lengths of stay in hospital and prison. Our findings confirm significant disparities in length of time spent in a closed institution after offences of serious interpersonal violence, according to whether that institution was prison or hospital, but not all in the same direction. Next steps should explore reasons for this and relative longer-term outcomes.

Vitamin D monitoring and management within men's secure services

AimsTo audit the investigation, identification and treatment of Vitamin D deficiency within Men's Secure Services.BackgroundVitamin D and/or vitamin D deficiency has been suggested to play a role in the pathogenesis of mental illness. There is evidence that Vitamin D inadequacy is pandemic among rehabilitation patients in inpatient settings. Patients within secure hospitals are similarly considered to be at high risk, due to their limited solar exposure during often lengthy admissions. It has been suggested that these patients should be considered an ‘at-risk’ cohort, for whom Vitamin D supplementation should be routine. Men's secure services in Birmingham comprise of two medium secure units and a low secure rehabilitation unit. Here we present an audit of Vitamin D monitoring and treatment completed in 2019.MethodA three year retrospective review of electronic patient records, for all inpatients admitted within men's secure services as of 1 September 2019 (n = 188). Standards were based on the Trust accepted guidelines for management of Vitamin D deficiency.ResultKey findings included:- The majority of inpatients were Caucasian (43%) and African-Caribbean (24%). Ages ranged from 18 to 70, with a mean age of 39.Approximately two-thirds (65%) had been in hospital for over a year, of which 44% had been admitted for more than 3 years. The average length of admission was 885 days.Only 47% of patients had their Vitamin D level checked within the study period.Of those checked, 24% were tested within 1 month of admission. The mean duration between admission and Vitamin D testing was 464 days.Results ranged from 10.3 to 118.5nmol/L. A high rate of Vitamin D deficiency was identified (54%), whilst a further 16% had ‘inadequate’ levels.23% of those identified as requiring treatment did not receive any supplementation, whilst 59% of those with sufficient Vitamin D were prescribed treatment.Only 48% had their levels rechecked following treatment; of these, only 59% now had an adequate Vitamin D status.ConclusionThis audit demonstrates limited Vitamin D monitoring within male forensic inpatients. There was a high prevalence of Vitamin D insufficiency in this population, yet a substantial proportion of patients with identified deficiency were not prescribed any treatment. Ongoing monitoring and review of treatment effectiveness was poor. We argue that more consideration should be given to this population, with robust guidelines introduced for the treatment of this specific ‘at-risk group’.

An audit of vitamin D monitoring and management of deficiency in women's secure services

AimsTo audit the investigation, identification and treatment of vitamin D deficiency within Women's Secure Services.BackgroundIt has been suggested that vitamin D and vitamin D deficiency may play a role in the pathogenesis of psychiatric illness. There is evidence that vitamin D inadequacy is prevalent among patients in long-term hospital settings. Patients within secure hospitals are considered to be at high risk due to their often lengthy admissions, having been transferred from other hospital or prison settings. Ardenleigh in Birmingham is a blended female secure unit. Here we present the findings of an audit, completed in 2019, of vitamin D monitoring and treatment in this service.MethodA retrospective review of electronic patient records, for all inpatients admitted within women's secure services at Ardenleigh as of 1st September 2019 (n = 27). Standards were based on the Trust accepted guidelines for management of vitamin D deficiency.ResultKey findings included:-The majority of inpatients were Caucasian (44%) and African-Caribbean (41%). Median age was 31 years (range 20–56).Approximately two-thirds (60%) had been in hospital for over a year.89% of patients had their vitamin D level checked at some point during admission.Of those checked, 25% were tested within 1 week of admission. Seven patients were tested after being in hospital for over one year (30%).Only 25% of patients tested were found to have adequate vitamin D levels. Nine patients were found to have insufficient levels of vitamin D (37.5%) or deficiency (37.5%).89% of those identified as requiring treatment were prescribed supplementation, of which the majority was prescribed at the correct dose for the appropriate duration (94%). One patient refused treatment. Of those with sufficient levels, 67% were prescribed ongoing maintenance treatment due to previously detected deficiency.Of those found to have sufficient vitamin D in the last 12 months (n = 14), 71% were continued on maintenance treatment.ConclusionWe identified a high prevalence of vitamin D insufficiency in women admitted to secure services. Testing was delayed for a number of patients from the point of admission. However, once identified, the vast majority of those in need of treatment were managed appropriately by the medical team. We advise that vitamin D be considered an essential routine blood test at the point of admission to minimise delays in identifying those with deficiency and establishing necessary supplementation.

The physical healthcare of patients in secure hospitals: setting standards for medical equipment

AimsThe increased morbidity and mortality relating to the poor physical health of patients with severe mental illness has repeatedly been an area identified as requiring improvement. Despite this, no national minimum standard has been published around the minimum level of physical health equipment that should be available within an inpatient psychiatric setting.The aim of this project was to improve and standardise availability of physical health equipment across the five clinical areas within a medium secure inpatient forensic setting, thus enabling optimal and timely medical care and physical examination of patients to occur.MethodThis project used a combination of audit and quality improvement practices. An audit standard was created and current practice was established within the 5 clinical areas of a Medium Secure Forensic Unit. Improvements were made in a systematic and measured way and two audit cycles were completed.ResultAt baseline, the attainment of audit standard ranged from 14-76%. Clinical areas were sharing equipment and there was an inconsistency as to where and how equipment was being stored. Changes implemented included redistribution and reorganisation of equipment which increased attainment to between 48% - 86%. Following this further equipment was ordered and the equipment was separated into that which was required on a daily basis to conduct physical observations and more specialist specific examination equipment. Re-audit found attainment across the five clinical areas being between 90-100%.ConclusionMonitoring of physical health within psychiatric inpatient settings is a key area of patient care, and is frequently identified as requiring improvement. Without access to equipment to monitor and assess physical health, this becomes challenging and potentially poorly completed. By standardizing available equipment and furthermore through practical steps such as separating the equipment required on a daily basis and that used less frequently the retention of equipment improved. This enables delivery of high quality, timely and thorough monitoring and assessment of physical health to be achievable.