BrisDoc provides out of hours urgent Primary Care support to the Riverside Unit. This is a 9 bed, AWP CAMHS inpatient unit for 13-18yr olds. Approximately 60% of patients are admitted because of eating disorders (there is no NG feeding), and the majority of the remaining patients have psychosis, mood disorders or severe anxiety. The average length of stay is 80 days so, inevitably, the young people may experience some level of primary care illness. In hours, the Unit is staffed by Mental Health nurses, Consultant Psychiatrists and a Clinical Assistant (an ex-GP) who helps to manage primary care illness. Out of hours, the Nurses on the Unit have on call Consultant Psychiatrist support.
BrisDoc Professional Line support for Riverside Unit during OOH
The Nurses on the Riverside Unit have had access to the Professional Line since 1st June 2018. The problems that the Unit may typically contact BrisDoc for advice about are:
- primary care illness assessment and management
- an increasing NEWS score the nurses want to discuss and seek advice about
- phlebotomy and blood test results for patients admitted on Fridays, or bloods taken late in the day because the patient has deteriorated
- physical health concerns in patients with eating disorders (see below, and clinical guidance on the Toolkit)
- neuroleptic malignant syndrome (see below, and the clinical guidance on the Toolkit)
- assessment of a self-harm injury
If you are concerned about problems relating to the patient’s underlying mental health condition, please have a low threshold for discussing the case with the on-call Consultant Psychiatrist. BrisDoc’s role is to support the assessment and management of Primary Care physical health problems, but it is important that you are can recognise the clinical features associated with significant malnourishment and with neuroleptic malignant syndrome. To support this, specific information and guidance relating to these conditions is provided on the Toolkit. It is intended that this will help you to recognise concerning features, and when referral to Bristol Children’s Hospital should be considered/ arranged.
On average, there may be 2-3 calls per week from the Riverside Unit, although this can be very variable. The Unit may book a planned BrisDoc follow-up if there are concerns about a patient on a Friday. Paramedics attending the Unit will also be able to contact the Professional Line if they deem this appropriate.
Riverside Unit patients will all be entered on CLEO with the Riverside Unit logged as their own GP. This enables the electronic CLEO record to be sent to the Unit when the case is closed, to support handover of care back to the Unit after the BrisDoc consultation.
Managing patients at Riverside Unit
Queries may be addressed with telephone advice, the young people may be able to come to a base to be seen, or we may need to visit. The nurses will be able to advise if it is safe for the young person to leave the Unit. Where parents are local they may be able to bring the patient to an appointment, otherwise a staff escort will be provided. The parameters for deciding on whether a visit is appropriate will need to include:
- the risk of the patient absconding and
- inpatient dependency levels that would make it difficult for the nurses to escort a young person to an appointment whilst leaving the others on the Unit safely staffed.
Support and further information about patients on the Unit
The on-call Psychiatrist will be available for discussion with the BrisDoc Clinical Coordinator/ Professional Line GP and/ or visiting clinician. The nurses at Riverside will be able to provide their mobile number so you can liaise with them directly if required. Some patients on the Unit are not from the BNSSG area, so it is possible that EMIS records will not be available. If visiting a patient at the Unit, the nurses will be able to access the RIO medical records for you if required.
Relevant clinical guidelines for the Riverside Unit are provided on the Clinical Toolkit. In particular, there is guidance for the assessment and management of patients with physical health problems associated with eating disorders, and to aid clinicians to recognise possible neuroleptic malignant syndrome (NMS).
When you complete your CLEO case records in the usual way, your consultation record will be sent to the Riverside Unit for inclusion in the inpatient record and not to the patient’s own GP.
Prescribing for Riverside Unit Patients
The BrisDoc clinician will assess and determine if a new medication is needed for the patient’s primary care health problem(s). If there is uncertainty about a medicine or urgency, please contact the on-call psychiatrist to discuss this. The Psychiatrist will be responsible for writing up the AWP inpatient drug chart and, depending on the urgency with which a medicine needs to be started, will either write an FP10 for the Riverside Unit staff to collect from a chemist or source the required medicine from the AWP pharmacy. The prescription details in the CLEO case record (sent as a PEM to the Riverside Unit when you close the case) will be used by the psychiatrist, so please make sure instructions are clear – drug, dose, frequency, duration etc. To be clear, if medication is needed, the BrisDoc clinician should make a medication recommendation (with dose/duration etc), but the AWP psychiatrist will prescribe it based on this recommendation. Please do not issue either handwritten or printed prescriptions from BrisDoc for Riverside Unit patients.
Questions:
Please contact Lucy Grinnell, Head of IUC, 0117 937 0934.