An audit of physical examinations in a Psychiatric Intensive Care Unit

Case series of physical examinations on psychiatric inpatients: Influence of a structured form on the quality of documentation

“…The Royal College of Psychiatrists' recommendation that all patients should have a complete physical examination within 24 hours was achieved in 184 out of 236 patients (78%), a result that compares favourably with audits carried out in similar treatment settings (Kelbrick & Haw, 2008;Osborn & Warner, 1998;Vanezis & Manns, 2010). However, it was a concern to note that in 15 of the 36 cases who did not have a complete examination, no reason was documented and there was also no evidence in the notes that these patients had been routinely revisited to ensure that a physical examination had been performed.…”

“…The psychiatric trainees who usually perform the assessment have the chance to rule out physical disease as a cause for the patient's symptoms and identify previously undetected conditions that could hinder the patient's recovery or increase the risk of depression and suicide (Reeves et al, 2000). On some occasions, it may be necessary for the trainee to assess the sequelae of self-harm, ensure that no injuries have been sustained during a prior restraint, or exclude a physical cause for medically unexplained symptoms (Kelbrick & Haw, 2008). At the very least, a screening physical examination on admission enables baseline data to be documented for comparison, should a patient's physical state change at a later date, e.g.…”

Vital signs as predictors for aggression in hospital patients (VAPA)

“…It is well recognised that mental health patients have a high incidence of comorbidities and poor physical health (Felker et al . , Kelbrick & Haw , Stanley & Laugharne ). Patients with a mental illness are two and a half times more likely to die from all main causes of death when compared to the general population (Stanley & Laugharne ).…”

“…Further, there are adverse side effects of antipsychotic medications, particularly increased risk of metabolic syndrome which is characterised by obesity, hypertension, dyslipidaemia and glucose intolerance (Kelbrick & Haw ). Despite the high risks of obesity, cardiovascular disease and type 2 diabetes in mental health patients, the screening of mental health patients for physical health disorders is suboptimal (Kelbrick & Haw , Stanley & Laugharne ). Further, mental health patients are at particular risk of missed diagnoses, and most commonly, it is physical health issues that are overlooked (Tintinalli et al .…”

“…Further, mental health patients are at particular risk of missed diagnoses, and most commonly, it is physical health issues that are overlooked (Tintinalli et al . , Kelbrick & Haw , Carson et al . ).…”