ECT, Serious Incident, Restraint, Seclusion and Medication error (FOI- 800)
 
Please provide ECT information under the FOI act to the following questions: -
 Please supply patient’s information ECT leaflet. 
There is not a single leaflet. All patients are supplied with the ECT Information pages from the Consent Record Form, the Royal College of Psychiatrists Information Booklet on ECT and, if under the Mental Health Act, a copy of the CQC booklet “Electro-convulsive therapy (ECT) – Your rights about consent to treatment” https://www.cqc.org.uk/sites/default/files/documents/20120821_mha_ect_booklet_final.pdf  
 
 Please supply patient ECT consent form.
The ECT Consent Record Form , which is completed for all patients, is attached
 
 Please supply any ECT reports/investigations
We need clarification about which ECT reports/investigations you are referring to
 
 How many ECT in 2019?
342 (this is the total number of contacts that were recorded in 2019)
 
5. What proportion of patients were men/women?

21 – Female 12 - Male

  
How old were they?

Age Band	Count
20-34	6
35-49	6
50-59	5
60-69	5
70+	8

 
What were the diagnoses and in what proportions?
Most recent confirmed primary diagnosis. The ECT team have advised that ECT is only used to treat Depression, which may be recurrent and may be in the context of bipolar disorder and that is either Severe (with or without psychosis), or Moderate and treatment resistant, Mania that is severe and/or treatment resistant, Schizophrenia, especially catatonic schizophrenia.

Diagnosis	Count
Severe depressive episode with psychotic symptoms	5
Recurrent depressive disorder, current episode severe with psychotic symptoms	*
Recurrent depressive disorder, unspecified	*
Severe depressive episode without psychotic symptoms	*
Bipolar affective disorder, current episode manic with psychotic symptoms	*
Catatonic schizophrenia	*
Bipolar affective disorder, current episode severe depression without psychotic symptoms	*
Bipolar affective disorder, unspecified	*
Subcortical vascular dementia	*

*= less than 5

 
What proportion of patients were classified BAME? 2/31
 
How many were receiving ECT for the first time?
26 (number of people that had their first ECT contact in 2019)
 
10. How many patients consented to ECT?

18 (had at least one contact with the ECT team where they were categorised as consenting)

 
How many ECT complaints were investigated outside the NHS and CCG? The trust does not hold this information
 
How many patients died during or soon after ECT and what was the cause (whether or not ECT was considered the cause)?
None.
 
How many patients died a few months after ECT and what was the cause (whether or not ECT was considered the cause)?

We do not collate this data

 
How many patients died by suicide within a few months of receiving ECT (whether or not ECT was considered the cause)?
We do not collate this data.
 
How many patients have suffered complications during and after ECT and what were those complications?
This question implies an occurrence after ECT that goes well beyond minor side effects, such as headache. Our records indicate that no patients suffered serious complications.
 
Have there been any formal complaints from patients/relatives about ECT? None
 
If so, what was their concerns?

N/A

 
How many patients report memory loss/loss of cognitive function?
We do not collate this data. To answer how many patients report memory loss/loss of cognitive function would require accessing the individual patient records of all the patients treated with ECT and analysing the data in terms of the type, severity and duration of any such effects. This would be more of the nature of a research project.
  
What tests are used to assess memory loss/loss of cognitive function?
All patients undergoing ECT have their cognitive status assessed prior to starting ECT, between their first and second ECT treatments, and weekly thereafter until the end of their course using either the MMSE(Modified Mental State Examination) or the MoCA (Montreal Cognitive Assessment).  
 
Have MRI or CT scans been used before and after ECT?
There would be no clinical rationale to perform CT or MRI scans before and after ECT.
If so what was the conclusion?

N/A

 
22. How does the Trust plan to prevent ECT in the future?
ECT is a treatment option approve by NICE for the clinical management of moderate and severe depression, mania and catatonia, and as such the Trust does not have a plan to prevent it.  
 
Please provide SERIOUS INCIDENT information under the FOI act to the following questions: -
 
Please supply SERIOUS INCIDENT REPORTS patient’s information leaflet. The Trust does not have a Serious Incident Patient Information Leaflet.
 
Please supply patient SERIOUS INCIDENT REPORTS consent form. The Trust does not have a Serious Incident consent form. 
 
Please supply any serious incident reports/investigations
All investigation reports are confidential. NHS England publish independent investigation reports at https://www.england.nhs.uk/london/our-work/ind-invest-reports/  
How many SERIOUS INCIDENT REPORTS in 2019?
There has been 75 Serious Incidents reported
 
What proportion of patients were men/women?
40 were female and 35 male
 
How old were they?
It ranges from age of the youngest of 13 years old to oldest 89 years old
 
What were the diagnoses and in what proportions?
We do not collect information on Patient Diagnosis for Serious Incidents
 
What proportion of patients was classified BAME?

33.3%

 
How many were receiving SERIOUS INCIDENT REPORTS for the first time? We do not record this information in this format
 
How many patients consented to SERIOUS INCIDENT REPORTS? We do not require consent to investigate serious incidents
 
How many SERIOUS INCIDENT REPORTS were investigated outside the NHS and CCG? All Investigations are conducted within the Organisation
 
How many patients died during or soon after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)? We do not record this information in this format
 
How many patients died a few months after SERIOUS INCIDENT REPORTS and what was the cause (whether or not SERIOUS INCIDENT REPORTS was considered the cause)? We do not record this information in this format
 
How many patients died by suicide within a few months of receiving SERIOUS INCIDENT REPORTS (whether or not SERIOUS INCIDENT REPORTS was considered the cause)?

We do not record this information in this format

 
15. How many patients have suffered complications during and after SERIOUS INCIDENT REPORTS and what were those complications?

We do not record this information in this format

 
Have there been any formal complaints from patients/relatives about SERIOUS INCIDENT REPORTS? Yes
If so, what was their concerns?
How many patients report memory loss/loss of cognitive function? We do not hold information in that way relating to serious incidents

Not satisfied with the quality of the investigation or not satisfied with the quality of care provided

 
What tests are used to assess memory loss/loss of cognitive function?
Addenbrooke’s (ACE III), Montreal Cognitive Assessment (MOCA), Mini Mental State Examination (MMSE), Frontal Assessment Battery, MOHO (occupational therapy assessment), Rowland Universal Dementia Assessment scale (RUDAS)
 

The psychologists tend to carry out longer assessments with a range of assessments (neuropsychs)  

 
Have MRI or CT scans been used before and after SERIOUS INCIDENT REPORTS? We do not record this information in this format
 
If so what was the conclusion?

N/A

 
22. How does the Trust plan to prevent SERIOUS INCIDENTS in the future?
The purpose of the Serious Incident Investigation is to identify learning and therefore make improvements in clinical care and practice. The Trust has a number of work streams in place identified through themes from Investigations for example Improving the monitoring of Physical Health.
The Trust will follow National Guidance to implement a Patient Safety Strategy in 2020.
Please provide restraints information under the FOI act to the following questions: - 1. Please supply RESTRAINTS patient’s information leaflet.
We have a patient information leaflet for use of restrictive practice which includes restraint and seclusion, attached.
 
2. Please supply patient RESTRAINTS consent form.

We do not have a consent form for restraint/seclusion

 
3. Please supply any Restraints/investigations
All incidents are subject to a level of investigation.  
 
The cost of complying with this component of your request would exceed the limit set by section 12(1) of the Freedom of Information Act. So on this occasion we will not be taking this component of your request further.
The law allows us to decline to answer FOI requests when we estimate it would cost us more than £450 (18 hours, calculated at £25 per hour) to identify, locate, extract, and then provide the information that has been asked for.   This would entail reviewing details of 2094 incidents (see the response below). To complete this work in under 18 hours would require over 116 incidents an hour to be processed in order to be below the maximum, and that would exclude the time taken to respond to the other components of your request. I do not believe that this is possible and have therefore concluded that the position is in excess of the limit prescribed in the act.
Although the Trust cannot answer this component of your request at the moment, we might be able to answer a refined request within the cost limit. Please be aware that we cannot guarantee at this stage that a refined request will fall within the FOIA cost limit.
You can find out more about Section 12(1) by reading the full text of the Act, available at http://www.legislation.gov.uk/ukpga/2000/36/section/12.  
I am sorry that on this occasion I have not been able to answer this aspect your request. You have the right to appeal our decision if you think it is incorrect. Details can be found at the end of this letter Due to the volume of work to print and copy this information to send this number of incident forms this would fall outside of the time allowed within section 12 of the Freedom of Information Act
 
4. How many RESTRAINTS in 2019?

Total number: 2094

 
What proportion of patients were men/women?
Female - 198
Male – 234
 
How old were they?

Age Band	Patients
Under 18	36
18-25	89
26-64	283
65-74	13
75+	15

 
What were the diagnoses and in what proportions?
 

Primary Diagnosis https://icdcodelookup.com/icd-10/common-codes/mental-behavioral-health	Patients
F001	*
F002	*
F019	*
F024	*
F03X	*
F100	*
F101	*
F112	*
F120	*
F121	*
F125	*
F127	*
F191	8
F195	6
F200	74
F201	*
F202	*
F206	*
F209	5
F220	*
F229	*
F232	*
F239	5
F250	21
F251	*
F252	7
F259	37
F29X	56
F302	*
F308	*
F309	*
F310	6
F311	7
F312	21
F314	*
F317	7
F318	*
F319	21
F321	*
F322	*
F323	*
F329	*
F331	*
F333	*
F339	*
F411	*
F412	*
F430	*
F431	*
F432	*
F500	10
F501	*
F602	5
F603	43
F607	*
F61X	*
F840	*
F841	*
F900	*
F913	*
F938	*
F939	*
H539	*
R104	*
R458	*
R468	*
X600	*
X640	*
X780	*
X788	*
X849	*
Z004	*
Z911	*

*=less than 5
 
What proportion of patients was classified BAME?

43%

 
8. How many were receiving RESTRAINTS for the first time?
 
Number of patients restrained for the first time in admission in 2019 (not first time overall, we do not have enough historical data nor hold this data from any other trusts the patient was admitted to): 394
 
How many patients consented to RESTRAINTS?
See item 7
 
 
How many RESTRAINTS were investigated outside the NHS and CCG ?

None

 
12. How many patients died during or soon after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?

Number of patients deceased within 1 week of restraint: 0

 
13. How many patients died a few months after RESTRAINTS and what was the cause (whether or not RESTRAINTS was considered the cause)?

We do not record data in this way

 
14. How many patients died by suicide within a few months of receiving RESTRAINTS (whether or not RESTRAINTS was considered the cause)?

We do not record this information in this format

 
How many patients have suffered complications during and after RESTRAINTS and what were those complications?
We do not record this information in this format
 
Have there been any formal complaints from patients/relatives about RESTRAINTS?
4 restraints complaints
 
If so, what was their concerns?
Complaints that a restraint was inappropriate
How many patients report memory loss/loss of cognitive function?
Our Trust does not routinely capture this specifically in the context of restraint
 
What tests are used to assess memory loss/loss of cognitive function?

Addenbrooke’s (ACE III), Montreal Cognitive Assessment (MOCA), Mini Mental State Examination (MMSE), Frontal Assessment Battery, MOHO (occupational therapy assessment), Rowland Universal Dementia Assessment scale (RUDAS) The psychologists tend to carry out longer assessments with a range of assessments (neuropsychs)  

 
Have MRI or CT scans been used before and after RESTRAINTS? We do not record this information in this format
 
If so what was the conclusion?

N/A

 
22. How does the Trust plan to reduce restraints in the future?
Yes. The Trust has an overall Framework to reduce the use of restrictive practices, attached.
 
Please provide SECLUSION information under the FOI act to the following questions: -
 
Please supply patient’s information SECLUSION leaflet.
We currently do not hold this information. However this is something that the Trusts’ Restrictive Practice Group will consider introducing
 
Please supply patient SECLUSION consent form.
The Trust does not employ a specific consent form for seclusion. However seclusion is used to support patient safety and well-being and wherever possible will be done with in cooperation with the patient.
 
 
 
Please supply any SECLUSION reports/investigations
The data from the seclusion reports has been provided in the response to the questions asked below. The Trust is not aware of any investigations specifically around the use of seclusion and therefore there are no other seclusion reports available.
How many SECLUSION in 2019?
Total number: 364
 
What proportion of patients were men/women?

Female - 39 Male – 98

 
How old were they?

Age Band	Patients
5-15	6
16-17	10
18-25	28
26-27	6
28-64	87
75+	Less than 5

 
What were the diagnoses and in what proportions?

Primary Diagnosis	Patients
F001	*
F100	*
F121	*
F125	*
F127	*
F191	6
F195	*
F200	21
F201	*
F232	*
F239	*
F250	8
F252	*
F259	15
F29X	21
F302	*
F310	*
F311	*
F312	*
F314	*
F317	*
F319	5
F333	*
F412	*
F432	*
F602	*
F603	20
F913	*
F939	*
R104	*
R458	*
R468	*
X640	*
Z004	*

 
What proportion of patients was classified BAME?

48%

 
How many were receiving SECLUSION for the first time?
Number of patients secluded for 1st time in admission in 2019 (not necessarily first time overall, we do not have enough historical data nor hold this data from any other trusts the patient was admitted to): 91
 
How many patients consented to SECLUSION?
See item 7
 
How many SECLUSIONS were investigated outside the NHS and CCG ?

None

12. How many patients died during or soon after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?

Number of patients deceased within 1 week of seclusion: 0

 
13. How many patients died a few months after SECLUSION and what was the cause (whether or not SECLUSION was considered the cause)?

Number of patients deceased within 6 months of seclusion: 0

 
14. How many patients died by suicide within a few months of receiving SECLUSION (whether or not SECLUSION was considered the cause)?

Number of suicides within 6 months of seclusion: 0

 
15. How many patients have suffered complications during and after SECLUSION and what were those complications?

We do not record this information in this format

 
Have there been any formal complaints from patients/relatives about SECLUSION? Yes, there was one complaint
 
If so, what was their concerns?
The complainant stated that he was on Ellis ward, and that he was restrained and brought over to seclusion on Ward 1. The complainant said that during the transfer his smart phone got smashed. The complainant asked for his phone to be fixed.
 
How many patients report memory loss/loss of cognitive function?
The Trust is not aware of any such cases
 
What tests are used to assess memory loss/loss of cognitive function?

Addenbrooke’s (ACE III), Montreal Cognitive Assessment (MOCA), Mini Mental State Examination (MMSE), Frontal Assessment Battery, MOHO (occupational therapy assessment), Rowland Universal Dementia Assessment scale (RUDAS) The psychologists tend to carry out longer assessments with a range of assessments (neuropsychs)  

 
Have MRI or CT scans been used before and after SECLUSION? We do not record this information in this format
 
If so what was the conclusion?
The Trust is not aware of any cases where this has been required in regards to seclusion.
How does the Trust plan to prevent SECLUSION in the future?

Yes. The Trust has an overall Framework to reduce the use of restrictive practices, attached

 
Please provide MEDICATION ERRORS information under the FOI act to the following questions:
-
1.Please supply patient’s information MEDICATION ERRORS leaflet.
 
Information is available on our external website for patients regarding reporting medication incidents:
 
 
 
 
 
Please supply patient MEDICATION ERRORS consent form. There is no document of this nature
 
Please supply any MEDICATION ERRORS reports/investigations 1 medication error was an SI and investigated
 
How many MEDICATION ERRORS in 2019?

662 medication incidents were reported in 2019 – not all incidents are errors

 
What proportion of patients were men/women?
        231            were female and 225 were male, 206 gender was not reported on the incident form
 
How old were they?
Age ranged from the youngest 13 and oldest 91
 
What were the diagnoses and in what proportions?
We do not record this information in this format
 
 
8.What proportion of patients were classified BAME?

28%

 
9. How many were receiving MEDICATION ERRORS for the first time? We do not record this information in this format
 
10.How many patients consented to MEDICATION ERRORS?
This is not a valid question
 
11. How many MEDICATION ERRORS S were investigated outside the NHS and CCG?

All Investigations are conducted within the Trust

 
How many patients died during or soon after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)? None
 
How many patients died a few months after MEDICATION ERRORS and what was the cause (whether or not MEDICATION ERRORS was considered the cause)? None
 
How many patients died by suicide within a few months of receiving MEDICATION ERRORS (whether or not MEDICATION ERRORS was considered the cause)? None
 
How many patients have suffered complications during and after MEDICATION ERRORS and what were those complications?

Information not held in this format

 
Have there been any formal complaints from patients/relatives about MEDICATION ERRORS?
Yes, there were 12 complaints classified as medication related
 
If so, what were their concerns?
 

Here are summary details of medication related complaints during the period

Complaint by patient’s mother that team can't administer monthly depot without being reminded and chased. Stress and serious stomach pain due to delays

Psychiatrist told complainant to stop a medication she had been on for seven years without problems, because she decided it may not be effective. Schedules a follow-up appointment for three months later, without any arrangements to get medication back if needed it.

Complainant accompanied sister to appointment with a consultant where it was agreed that the dosage for prescribed medication would be reduced. The GP then stated that the new lower dosage would only start from the next appointment in a month's time. Uunhappy this has led to remaining on higher dose for an entire month.

Complainant stated her current depot is causing numbness, stiffness and shortness of breath and she is finding it difficult to walk.

Complainant feels that the medication her son is on is having a serious side effect on him - twitching and he appeared to be unable to control his physical movements. Consultant stated that he has been administering another drug to counteract side effects but this is not working.

Patient has been advised to stop taking medication Patients mother would like to know if it is safe to do over the period of 4 days.

Complainant suffering bad effects from current medications but the doctor would not change them.

Complainant would like new medications that are not harmful to him

Increased dosage of medication. Lack of communication from care coordinator about change. Side effects since dosage increased. Feels the care coordinator had a grudge and raised medication to punish her.

Antipsychotic medication reported to be affecting the patient’s cardiac health( Subsequent to withdrawal of medication, complainant experienced Insomnia. An alternative antidepressant, resulted in restless syndrome side effect.

Complainant’s daughter refused medication, due to it not being on the system and then having to wait for the 24 hour duty doctor to come and give the mediation in the early hours of the morning.

Side effects of medication during pregnancy

Alleged overmedication

 
How many patients report memory loss/loss of cognitive function? We do not hold information in this format
 
What tests are used to assess memory loss/loss of cognitive function?

Addenbrooke’s (ACE III), Montreal Cognitive Assessment (MOCA), Mini Mental State Examination (MMSE), Frontal Assessment Battery, MOHO (occupational therapy assessment), Rowland Universal Dementia Assessment scale (RUDAS) The psychologists tend to carry out longer assessments with a range of assessments (neuropsychs)  

 
 
Have MRI or CT scans been used before and after MEDICATION ERRORS? We do not record this information in this format  
 
If so what was the conclusion? N/A
How does the Trust plan to prevent MEDICATION ERRORS in the future
All medicine incidents are investigated and reviewed by the Medicines Safety Officer (MSO) and / or the patient safety pharmacist. This is to ensure they have been properly investigated and that any necessary actions have been taken and all the possible learning identified. Regular reports on medication incidents, identifying common themes, are submitted to the Safe Medication Practice Group (SMPG). The SMPG is a multidisciplinary group chaired by the Chief Pharmacist. System changes are implemented to reduce the risk of medicines incidents in the future and learning lessons are shared throughout the organisation through the Trust wide monthly learning bulletins, changes in policy, procedure and training.