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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

 POMH-UK

Information for service users and carers, and service user issues

 

People

 

There is a relatively wide range of medications available for the treatment of psychiatric conditions. The relief from symptoms provided by such medication is often gained at the cost of unpleasant, and sometimes disabling or harmful, side effects. When trying to choose the best medication for an individual, it can be difficult to predict the likely benefits and risks. It is recommended that such decisions about medication are made by the service user and clinician in partnership, informed by national, evidence-based standards. 

 

 

 

What is POMH-UK?

?The national Prescribing Observatory for Mental Health (POMH-UK) was launched in 2005 and aims to help specialist mental health Trusts/healthcare organisations improve their prescribing practice.  POMH-UK with its member organisations identifies specific topics within mental health prescribing and develops audit-based quality improvement programmes (QIPs).

 

Organisations are able to benchmark their performance against one another and identify where their prescribing practice meets nationally agreed standards and where it falls short.  Wide participation in audits creates a picture of prescribing practice nationally.

 

POMH-UK was originally funded by a tapering grant from an independent charity, the Health Foundation under its ‘Engaging with Quality’ initiative. The project is now funded by subscriptions from member organisations. POMH-UK does not receive any funding from the pharmaceutical industry.

 

 

The partner organisations include the Royal College of Nursing, the United Kingdom Psychiatric Pharmacy Group, Rethink, Mind, the College of Mental Health Pharmacists, the British Association for Psychopharmacology, and mental health service users. 

 

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How does POMH-UK work?

 

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So far, more than 60 mental health Trusts and other specialist organisations have taken part in POMH-UK quality improvement programmes. These programmes are based on nationally recognised standards from either standards from the Care Quality Commission or recommendations from various NICE guidelines.  When a topic starts, it is necessary to look at what wards or community teams are doing in the area in question by doing a ‘baseline’ audit (collecting data about the subject in question).  This information about the people in hospital or the community is collected anonymously and sent to the POMH-UK team in London.  They look at all the data and produce a report, which allows Trusts to compare their prescribing practice with other participating Trusts.  Again this is anonymous as all Trusts have a number that only they know.

 

After the baseline audit, Trusts receive interventions to help them improve practice.  These can take the form of slide sets, good practice guides, posters, information about the evidence base, aids to practice and information packs. POMH-UK then re-audits using the same questions as the first audit so the Trusts can see if there has been any improvement. 

 

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What type of things has POMH-UK looked at?

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So far the things POMH-UK has looked at, or is currently looking at are: 

Topic 1: High dose and combined antipsychotics in acute adult inpatient settings 

Topic 2: Screening for metabolic side effects of antipsychotic drugs in patients treated by assertive outreach teams 

 

Topic 3: Prescribing of high dose and combined antipsychotics for patients on forensic wards 

 

Topic 4: Benchmarking prescribing of anti-dementia drugs

 

Topic 5a: Benchmarking the prescribing of high dose and combination antipsychotics on adult acute and PICU wards (time-series benchmarking) 


Topic 5b: Continued benchmarking as Topic 1, using time-series charts 

 

Topic 6: Assessment of side effects of depot antipsychotics 

 

Topic 7: Monitoring of patients prescribed lithium 

 

Topic 8: Medicines Reconciliation 

 

Topic 9: Use of antipsychotic medication in people with Learning Disabilities

 

Topics 10: Use of antipsychotic medication in CAMHS

 

Topic 11: Use of antipsychotics in dementia. 

 

Topic 12: Prescribing for people with a personality disorder 

Topic 13: Prescribing for ADHD in children, adolescents and adults

Topic 14: Prescribing for substance misuse: Alcohol detoxification

 

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Are there mental health service users in POMH-UK, and where are they?

 

meetingPOMH UK tries to involve service users and carers at all levels of its work.  There are service users and/or carers on every single one of POMH's advisory groups.  When a new topic is decided, a team of expert advisors, including service users (and carers where appropriate) is recruited to advise on all aspects of the programme, including interventions.  In addition, because Mind and Rethink are partners in the organisation, the views of other service users and carers are also brought to the programme.   

 

POMH UK have developed a number of service user and carer led interventions, including a popular patient-held card advising and promoting annual physical health checks.  If you are a service user or carer and would like a free copy of the patient-held physical health card, please email us.  POMH-UK member Trusts can order these cards in bulk, email us.

 

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What happens at the local level?

When a Trust joins POMH-UK they are encouraged to set up a local group consisting of a senior pharmacist, senior psychiatrist and a clinical audit person. It is recommended that nurses and service users are co-opted from relevant services for each individual Topic.

 

How can service users and carers help at the local level?

workingLocally users and carers may be involved in different ways from the users on the central team.  Obviously, since auditing a service usually requires getting information from psychiatric patient notes (which are confidential), service users cannot be involved in this part of the programme.  However once the baseline report is received and the interventions are introduced, the local service users on the local POMH team are an extremely important part of the process, because they usually know what is happening within their services and often also what the other services users and carers in the area want and find helpful.

 

 

For example, in Topic 2 it was suggested that service users on antipsychotics had blood tests to look at their blood sugars and lipids.  Local service users were able to advise on how to make this convenient and accessible for the majority, and helped enormously to promote the use of patient-held physical health cards in their area.

 

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What happens if my Trust is not a member?

POMH-UK is genuinely committed to improving prescribing practice and would encourage service users and carers to persuade their Trust to become a member.  See a list of member organisations here.

 

My Trust is a member, but what they do is not communicated to the service users.  What should we do?

 

?POMH-UK wholeheartedly supports the involvement of service users both centrally and on a local level. As with other areas of involvement this should be undertaken in partnership with service users and service user groups, and should follow good practice.

 

 

Because all local teams are built in a way that makes sense in their Trust, they are all slightly different.  Some may not meet physically in a room together, but communicate by email, or have a continuing item on the agenda at a particular meeting.  This means that that the central POMH team cannot dictate how they involve service users, but we aim to guide and advise local teams in ways to involve service users as a central part of the quality improvement process.  We would suggest that all local POMH teams have at least one service user as part of the central team, and someone from the local POMH team is invited to user group meetings to talk about what has been done in the Trust and allow service users to ask them how they could be involved.

 

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Where do the topics come from?

ideaThe people from all member Trusts can suggest new topics.  It helps if these suggestions are based around national standards that either the Care Quality Commission or the National Institute of Health and Clinical Excellence (NICE) have made, because the people running the Trust will be focusing in this area anyway.  Other suggestions come from the central team and the steering group.  It was the service users on the steering group who wanted to look at side effects and this gave rise to Topic 6.

 

Who runs POMH-UK?

The POMH-UK team:

 

Joint heads of POMH UK: Carol Paton 

Professor Thomas Barnes

Programme Manager:   Krysia Zalewska
Deputy Programme Manager: Suzie Lemmey
Project Workers:

 

Oda Skagseth

Sonya Chee

*Mental health service user enquiries to:  POMH-UK

 

*Please note that POMH-UK are only able to answer service user enquiries regarding the work of POMH-UK or service user involvement in POMH-UK work.  If you have a general query regarding mental health care or medication, we recommend you visit one or more of the links below, all of which have excellent information.

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Where else can I get information about medication or being in hospital?

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The British National Formulary:

The British National Formulary is where most doctors get their information about medication.  It lists all drugs with the maximum dose and side-effects.  It also gives charts of medications that interact badly with each other.  It is up-dated every year. 

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Choice and Medication:

This is a site run by the UK psychiatric pharmacy group and NIMHE (national institute for mental health in England) about psychiatric medication.

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National Institute for Health and Clinical Excellence (NICE):

This is the body that makes recommendations about medication and treatment based on clinical evidence to the NHS.  NICE guidelines about mental health problems can be found here.

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The MHRA 'Yellow Card' scheme:

If someone has a have a side effect that has not been listed for that medication, they can report it to the Medicines and Healthcare products Regulatory Agency by downloading a form from this site, filling it in and sending it back to them.

Mind

 

 

 

 

Mind:

A mental health charity which supports people who have mental health problems.  They provide information leaflets on medication.

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Rethink:

A mental health charity who support people who have mental health problems and their carers.  They also work with the Cochrane Collaboration to provide plain language summaries about pharmacological and psychotherapeutic trials of treatments for schizophrenia.

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National Patient Safety Agency (NPSA):

National Patient Safety Agency is a watchdog for the NHS.  Theylead and contribute to improved, safe patient care by informing, supportingand influencingorganisations and people working in the health sector.

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Medicines and Healthcare products Regulatory Agency (MHRA):

The MHRA are a Government agency who license medication and medical devises.

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The Care Quality Commission (CQC):

If someone is in hospital under the Mental Health Act you have certain rights. The CQC visits psychiatric hospitals to check whether the care being given is of a good enough quality.  They are available to talk the detained patients at that time.

RCPsych logo The Royal College of Psychiatrists:

Provides information on medication and other treatments.

 

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