Vulnerable long-term psychiatric in-patients need screening for physical-health problems : an audit of regular hospital statistics and clinical files

Abstract

OBJECTIVE: Maintaining physical health in the presence of severe mental illness remains a challenge. The aims of this study were to identify the most pressing physical health problems of long-term psychiatric in-patients and to identify vulnerable subgroups, as part of a multi-phased programme evaluation project to improve service delivery to and quality of care of long-term patients in Weskoppies Hospital. METHOD: Regular nursing statistics on vital data, infections, injuries, deaths, and adverse incidents, as well as clinical file data, infection-control statistics and dietician statistics were recorded for 268 long-term in-patients at Weskoppies Hospital over six months. Adverse incidents including aggression were recorded because of their potential for injury and nursing implications. Subgroups of patients were compared using two-way tables and Fisher’s Exact Tests, or Mann-Whitney-U and Kruskal- Wallis tests. RESULTS: The blood pressure of hypertensive patients was well controlled. Prevalent problems were epilepsy, respiratory tract infections, and injuries (accidental and from fighting or assault). Most vulnerable are older male patients (prone to respiratory tract infections and lower body weight); patients with cognitive disorders (prone to any injury, especially accidents and falls); and younger male patients (prone to aggression and resultant injury). CONCLUSION: Increased screening should be conducted for older underweight male patients (for chronic respiratory or infectious diseases that might cause cachexia) and of patients with cognitive disorders or who have fallen (for treatable risk factors for falling and preventative measures). More patients should be referred for special diets. Nursing interventions should be emphasised more with aggressive and irritable patients.