Aims: To examine the compliance with local psychiatric admission guidelines requiring a Physical Examination Proforma to be completedfor all psychiatric admissions as per Louth/Meath Mental Health Services Admission Policy, 2016 and, if necessary, introduce change inorder to improve compliance with these local guidelines.Background: The Royal College of Psychiatrists and NICE Guidelines both stress the importance of carrying out physical examination onpsychiatric in-patients due to their high level of physical health issues. Carrying out and carefully documenting these physicalexaminations at the time of admissions allows physical health issues to be appropriately taken into account when creating managementand medication plans and, in more severe cases, can allow diversion for medical treatment if that is required or the underlying cause of thepresentation.Methods: A review of the notes of all in-patients on a specific day in Unit 1, St Brigid’s Complex, Ardee was carried out. Results wereanalysed and feedback obtained from non-consultant hospital doctors. The findings were presented during local teaching to both theconsultant and NCHD bodies and means of improving compliance were discussed openly. These discussions led to a redesign of theproforma to make it shorter and simpler to complete. A re-audit was carried out during a single day on all in-patients in Unit 1 severalmonths after the first phase of the audit. In-patients who remained in Unit 1 since the initial phase of the audit were excluded from the reaudit.Results: The rate of proforma usage increased from 50% (10/20) to 100% (20/20). Furthermore in phase 1 the proformas were onlypartially completed with elements of the physical exam documented on the proforma, other components documented elsewhere in theadmission notes and many elements omitted altogether. Only 15% (3/10) of the proformas contained a complete, documented physicalexamination. In the re-audit 80% (16/20) of the proformas were completed.Conclusions: While all involved agreed that carrying out physical examination on all admissions was advisable the length and complexityof the initial proforma contributed to poor completion rates by NCHDs. A combination of teaching to underline its importance and aredesign focused on usability and speed led to significantly increased completion of the proforma with attendant benefits for patientassessment and treatment.
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