Matthew Anastasis
I am a CT3 Psychiatry Trainee working in North London. I have a burgeoning passion for quality improvement – not just a tickbox for ARCP(!) but effecting genuine change and improvement for patients.
It was in my placement in the Islington Drug and Alcohol Service, Better Lives, where I got involved in this project. I worked together with Dr Caroline Allfrey (GP with special interest in Substance Misuse), Dr Shivanthi Sathanandan (Consultant Psychiatrist), Emma Scott (QI Coach), plus enthusiastic keyworkers who were keen to champion the project.
My other projects involve:
Improving the care of patients with both intellectual disability and severe mental illness in the Community Intellectual Disability Service by creating a novel, multisite, co-produced Mental Health Care Plan.
Supporting junior doctors in clerking and prescribing for out-of-hours admissions to acute mental health wards by creating a trust protocol and prescribing guideline for Camden & Islington NHS Foundation Trust.
Mind the QT gap: Improving the monitoring of patients on high-dose methadone, a service development quality improvement project – a simple solution for hard times?
Aim: To improve the monitoring of patients prescribed high-dose methadone. Setting: Our drug and alcohol service in London.
Participants: All patients prescribed high-dose methadone.
Design: We identified all participants and audited documentation of QT interval and ECG in their notes. We also audited yellow prescription records, a previously introduced intervention to flag those on high-dose methadone to the prescriber.
Intervention: We created a database of the participants. We wrote to drug key workers (KWs) and discussed the issue at our Service Development meeting to raise awareness. A KW volunteered to champion the issue alongside the doctors.
Measurements: Pre-intervention: Out of 21 participants, 12 (57%) had yellow prescription records, 5 (24%) had documentation of QT interval, and 4 (19%) had a copy of the ECG. Post-intervention: 21 (100%) had yellow prescription records, 9 (43%) had documentation of QT interval and 6 (29%) had a copy of the ECG.
Findings and conclusions: Our interventions improved the monitoring despite the challenges of the COVID-19 pandemic. The champions will maintain the work and it has been added to our annual audit plan. There is room for improvement. It seems the most useful further intervention is procuring an ECG machine for our clinic. We presented our findings and our management team agreed. Our KW champion would like to train in taking ECGs. We can then expand monitoring to those with other risk factors such as those taking antipsychotics. This is an example of simple interventions leading to real service change and improvement for our patients.