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Implementation of treatment escalation plans in an old age psychiatry inpatient hospital

Implementation of treatment escalation plans in an old age psychiatry inpatient hospital
Implementation of treatment escalation plans in an old age psychiatry inpatient hospital
A Treatment Escalation Plan (TEP) enables timely and appropriate decision making in the management of deteriorating patients. The COVID-19 pandemic precipitated the widespread use of TEPs in acute care settings throughout the National Health Service (NHS) to facilitate safe and effective decision making. TEP proformas have not been developed for the inpatient psychiatric setting. This is particularly concerning in Old Age Psychiatry inpatient wards where patients often have multiple compounding comorbidities and complex decisions regarding capacity are often made.Our aim for this quality improvement project was to pilot a novel TEP proforma within a UK Old Age Psychiatry inpatient hospital. We first adapted a TEP proforma used in our partner acute tertiary hospital and implemented it on our Old Age Psychiatry wards. We then further refined the form and gathered data about uptake, length of time to complete a TEP and the ceiling of care documented in the TEP. We also explored staff, patient and family views on the usefulness of TEP proformas using questionaries
TEP decisions were documented in 54% of patient records at baseline. Following revision and implementation of a TEP proforma this increased to 100% on our two wards. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. Feedback from staff showed improvements in understanding about TEP and improved knowledge of where these decisions were documented.
We advocate the use of TEP proformas on all Old Age Psychiatry inpatient wards to offer clear guidance to relatives and treating clinicians about the ceilings of care for patients. There are potentially wider benefits to healthcare systems by reducing inappropriate transfers between Psychiatry and acute NHS hospitals.
dementia, geriatrics, healthcare quality improvement, mental health, resuscitation
Chua, Anne Y T
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Ghanchi, Adnaan
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Grayston, Jessica
63702dd2-7fe5-4af2-8179-7e9e56d6df97
Woolford, Stephen J
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Wijayaweera, Sahan S.
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Osman-Hicks, Victoria
9df6f4a4-36ea-46a7-ba49-58ac022445ee
Patel, Harnish
e1c0826f-d14e-49f3-8049-5b945d185523
Amin, Jay
692a8880-70ff-4b64-a7e9-7d0d53449a30
Chua, Anne Y T
ddfe6926-98de-4c8f-ae03-e85270af3a14
Ghanchi, Adnaan
e764e6d5-24a4-427c-95ed-321507003931
Grayston, Jessica
63702dd2-7fe5-4af2-8179-7e9e56d6df97
Woolford, Stephen J
f72c05b4-0f71-4a63-a9e8-6d798a57f2db
Wijayaweera, Sahan S.
764b8fb0-9350-45e9-9405-451769869ade
Osman-Hicks, Victoria
9df6f4a4-36ea-46a7-ba49-58ac022445ee
Patel, Harnish
e1c0826f-d14e-49f3-8049-5b945d185523
Amin, Jay
692a8880-70ff-4b64-a7e9-7d0d53449a30

Chua, Anne Y T, Ghanchi, Adnaan, Grayston, Jessica, Woolford, Stephen J, Wijayaweera, Sahan S., Osman-Hicks, Victoria, Patel, Harnish and Amin, Jay (2021) Implementation of treatment escalation plans in an old age psychiatry inpatient hospital. BMJ Open Quality, 10 (4), [e001640]. (doi:10.1136/bmjoq-2021-001640).

Record type: Article

Abstract

A Treatment Escalation Plan (TEP) enables timely and appropriate decision making in the management of deteriorating patients. The COVID-19 pandemic precipitated the widespread use of TEPs in acute care settings throughout the National Health Service (NHS) to facilitate safe and effective decision making. TEP proformas have not been developed for the inpatient psychiatric setting. This is particularly concerning in Old Age Psychiatry inpatient wards where patients often have multiple compounding comorbidities and complex decisions regarding capacity are often made.Our aim for this quality improvement project was to pilot a novel TEP proforma within a UK Old Age Psychiatry inpatient hospital. We first adapted a TEP proforma used in our partner acute tertiary hospital and implemented it on our Old Age Psychiatry wards. We then further refined the form and gathered data about uptake, length of time to complete a TEP and the ceiling of care documented in the TEP. We also explored staff, patient and family views on the usefulness of TEP proformas using questionaries
TEP decisions were documented in 54% of patient records at baseline. Following revision and implementation of a TEP proforma this increased to 100% on our two wards. The mean time taken to complete a TEP was reduced from 7.1 days to 3.2 days following inclusion of the TEP proforma in admission packs. Feedback from staff showed improvements in understanding about TEP and improved knowledge of where these decisions were documented.
We advocate the use of TEP proformas on all Old Age Psychiatry inpatient wards to offer clear guidance to relatives and treating clinicians about the ceilings of care for patients. There are potentially wider benefits to healthcare systems by reducing inappropriate transfers between Psychiatry and acute NHS hospitals.

Text
TEP QIP manuscript v2 - Accepted Manuscript
Available under License Creative Commons Attribution.
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Accepted/In Press date: 20 November 2021
Published date: 20 December 2021
Additional Information: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: dementia, geriatrics, healthcare quality improvement, mental health, resuscitation

Identifiers

Local EPrints ID: 452789
URI: http://eprints.soton.ac.uk/id/eprint/452789
PURE UUID: 3c71dd41-0ac8-48e8-981a-073f0c51cee8
ORCID for Harnish Patel: ORCID iD orcid.org/0000-0002-0081-1802
ORCID for Jay Amin: ORCID iD orcid.org/0000-0003-3792-0428

Catalogue record

Date deposited: 20 Dec 2021 17:50
Last modified: 12 Jun 2024 01:48

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Contributors

Author: Anne Y T Chua
Author: Adnaan Ghanchi
Author: Jessica Grayston
Author: Stephen J Woolford
Author: Sahan S. Wijayaweera
Author: Victoria Osman-Hicks
Author: Harnish Patel ORCID iD
Author: Jay Amin ORCID iD

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