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By Hole Ousia Posted on June 25, 2015January 22, 2023

It is very difficult to challenge a powerful organisation

This week the Cabinet Secretary for Health, Wellbeing and Sport welcomed a new report into management of frailty and delirium This reminded me, that 6 months on, I do not … Continue reading It is very difficult to challenge a powerful organisation

Categories: Ageing, Delirium, History of medicine, Medical Education, Medical humanities, NHS Scotland, Psychiatry, ScreeningTags: #followthefellows, - Scottish Government - hole ousia, 2014, 4AT, A letter to Professor Jason Leitch, a new instrument for rapid delirium screening: a study in 234 hospitalised older people, a tool for every job, agitation, Alasdair MacLullich, along with staff shortages and increased demands on staff time, AMT4, anti-psychotic, Antipsychotic, antipsychotic prescribing, antipsychotics, Antiquary, are making it more rather than less likely that our elders may receive antipsychotic medication that can result in significant harms, Behavioural and Psychological Symptoms of dementia, Bellelli, BMJ, BPSD, brief screening tools, But why am I on this anti-schizophrenic drug?, by Scottish Government figures, CAM, case-finding, Change Page: “Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia, cognitive impairment, comprehensive delirium pathway, comprehensive delirium pathway as developed by SDA and HIS includes use of prescribed Haloperidol, Concerns about the over-prescribing of antipsychotic drugs in the elderly, Concerns about the over-prescribing of antipsychotic drugs in the elderly led me to consider possible explanations for this behaviour by doctors, considerations on delirium assessment, Cumberlege Review, Cumberlege review exposes stubborn and dangerous flaws in healthcare, Delirium, delirium detection, delirium Management, Delirium management comprehensive pathway, Delirium Screening, Dementia, Deming, Derek Feeley, detection, Director General, do not recall having received an answer to this letter, Doing damage in delirium, Doing damage in delirium the hazards of antipsychotic treatment in elderly people, Don Berwick, Don't use antipsychotics routinely, Don't use antipsychotics routinely to treat agitation and aggression, Dr Iona Heath, Dr Margaret McCartney, Dr Peter Gordon, Edward R Marcantonio, elderly, Eran D Metzger, ethics, Evidence Scan, Excel spreadsheet, Experiment, first do no harm, FOI, FOI request to all NHS Boards, frailty, Freedom of Information, Freedom to speak up, General Dental Council, General Medical Council, GMC, Golden lion Hotel, Haloperidol, Haloperidol in Scotland, Haloperidol prescribing in NHS Scotland, Haloperidol prescribing to Scotland's elders, harm, have been asked to try and summarise my considerations on delirium assessment, Health Foundation, Healthcare Improvement Scotland, HIS, Hole Ousia, Hospital prescribing, Hospital prescribing of Haloperidol in your NHS Health Board area, I also wonder if the Mental Welfare Commission may have a view of starting out with a screening test without any perceived need (as per HIS recommendations) for individual consent?, I am concerned that current approaches, IHI, improvement methodology, improvement science, Improvement Science' and the potential for harmful consequences, Improvement work, Improvement Work in Scotland, Institute of Healthcare Improvement, Inverse care, ISD, ISD Scotland, It is the case, It is very difficult to challenge a powerful organisation, Jason Leitch, journal of Age and Ageing, Lanarkshire NHS Board, Lancet, Lancet Psychiatry, Letter to Cabinet Secretary for Health and Wellbeing, Letter to Shona Robison 6 Dec 2014 - hole ousia, Lothian NHS Board, mandatory delirium screening, Mandatory screening, Mary Midgley, Mechanical metaphors, Mental health prescriptions hit ten-year high, mental Welfare Commission, most patients with delirium discharged on a new antipsychotic had no instructions for discontinuation, National Clinical Director, National Health Service (Scotland) Act, new report into management of frailty and delirium, NHS, NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Forth Valley, NHS Grampian, NHS Greater Glasgow and Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Orkney, NHS Scotland, NHS Scotland requires a culture that listens to all, NHS Scotland: Improvement Science, NHS Shetland, NHS TAYSIDE, NHS Western Isles, no special training is required, off-label, off-label prescribing, Older People in Acute Care, Omphalos, Omphalos films, OPAC, OPAC tools are working, over-medicalisation, patient safety, Payments from NHS Scotland to the USA, Peter Gordon, philosophy, Plan-Do-Study-Act, powerful incentives in our health-care systems promote prescription of antipsychotics for patients with delirium, Prescribed harm, prescribing, Prescribing and Medicines, prescribing figures, prescribing figures for Haloperidol in NHS Scotland, Prescribing Statistics - Medicines used in Mental Health, primum non nocere, Principles and Practice of Screening for Disease. World Health Organisation, Professor Alasdair MacLullich, Professor Jason Leitch, Professor Jason Leitch - letter of the 2nd June 2015 on Haloperidol prescribing ro Scotland's older generation, Psychiatric medications and potential effects on cardiac rhythm, Psychiatry, QI, QI connect, Quality & Safety Fellows, Quality Improvement, Quality Improvement for NHS Board Members, rapid delirium screening, Realisic Medicine, Realistic Medicine, rebel antiquary, Red Road, reductionism, result in worsened clinical outcomes, Rev. I. M. Jolly, Robert Francis, Robert K Merton, Science, Scotsman, Scottish Delirium Association, Scottish Government, Scottish Parliament, Scottish Philosophy & Psychiatry, Scottish Philosophy and Psychiatry Special Interest Group, screening, screening for cognitive impairment, SDA, Sensitive to the faltering steps of age, Sharon K Inouye, Should we not be spelling out this shortfall to Scottish Government as part of improvement recommendations, SIGN 86, Social maverick, Stirling, Studies show dramatic increase in antipsychotic treatment with mandatory delirium screening, takeover, Temple of Decision, that antipsychotic prescribing is increasing year-on-year in NHS Scotland, The Antiquary, The communications indicate a tone of disdain for those who may write to the Scottish Government's Department of Health with concerns about patient wellbeing and safety, The faltering unfaltering steps, the full toolset, the hazards of antipsychotic treatment in elderly people, The Health Foundation, the history of reductionism versus holistic approaches to scientific research, The patient paradox, the protection and the improvement of their population’s health and for the delivery of frontline healthcare services, The Rebel Antiquary, The use of antipsychotic medication for people with dementia: Time for action, THINK delirium, Too much Medicine, Toolkits, Tools, Transforming Delirium Care in the Real World, truly madly deeply, unforeseen consequences, USA, Validation of the 4AT, We must be wary of faltering steps into a world of inverse-care, we need to engage beyond clinicians and improvement staff, what it says on the tin, why ethics matter, why ethics matters to us all, William Edwards Deming, William Osler, Wilson and Jungner

By Hole Ousia Posted on June 22, 2015January 22, 2023

Promises to listen to our elders

The “Care Standards for Older people in Hospital”, which replace the previous 13 year old standards, were published this month. As a doctor working in NHS Scotland whose work for twenty … Continue reading Promises to listen to our elders

Categories: Ageing, British Medical Journal, Classification of mental illness, Delirium, Dementia, History of medicine, Medical Education, Medical humanities, Medical writings, NHS Scotland, Philosophy, Psychiatry, Scotland, ScreeningTags: #followthefellows, 'Offering the best possible care for older people', - Scottish Government - hole ousia, 2014, 4AT, A letter to Professor Jason Leitch, a new instrument for rapid delirium screening: a study in 234 hospitalised older people, a protocol issued by an NHS Board in Scotland, A Screening Instrument, a tool for every job, ageism, agitation, Alasdair MacLullich, all patients 65 and over must be Sreened for cognitive impairment, along with staff shortages and increased demands on staff time, AMT4, anti-psychotic, Antipsychotic, antipsychotic prescribing, antipsychotics, Antiquary, are making it more rather than less likely that our elders may receive antipsychotic medication that can result in significant harms, as a "screening tool". The validation studies, assessment, Behavioural and Psychological Symptoms of dementia, Bellelli, BMJ, BMJ 2015;350:h2697, BPSD, brief screening tools, But why am I on this anti-schizophrenic drug?, by Scottish Government figures, call for system abuse to be acknowledged and addressed by incorporating older people’s views when designing health services, CAM, Care of Older People in Hospital Standards, Care Standards, Care Standards for Older People, Care Standards for Older people in Hospital, case-finding, Chair of the the group developing the Standards, Change Page: “Don’t use antipsychotics routinely to treat agitation and aggression in people with dementia, cognitive impairment, comprehensive delirium pathway, comprehensive delirium pathway as developed by SDA and HIS includes use of prescribed Haloperidol, Concerns about the over-prescribing of antipsychotic drugs in the elderly, Concerns about the over-prescribing of antipsychotic drugs in the elderly led me to consider possible explanations for this behaviour by doctors, considerations on delirium assessment, Cumberlege Review, Cumberlege review exposes stubborn and dangerous flaws in healthcare, Delirium, delirium detection, delirium Management, Delirium management comprehensive pathway, Delirium Screening, delrium, Dementia, Deming, Derek Feeley, describe the 4AT as a "screening" tool., detection, Director General, do not recall having received an answer to this letter, Doing damage in delirium, Doing damage in delirium the hazards of antipsychotic treatment in elderly people, Don Berwick, Don't use antipsychotics routinely, Don't use antipsychotics routinely to treat agitation and aggression, Dr Christine McAlpine, Dr Christine McAlpine stated that "we need to involve patients", Dr Iona Heath, Dr Margaret McCartney, Dr Peter Gordon, Edward R Marcantonio, Elder abuse is often the result of the organisation of health systems rather than the fault of individuals, elderly, Eran D Metzger, ethics, Evidence Scan, Excel spreadsheet, Experiment, first do no harm, FOI, FOI request to all NHS Boards, frailty, Freedom of Information, Freedom to speak up, General Dental Council, General Medical Council, Given that there has been no change to the test itself, GMC, Golden lion Hotel, Haloperidol, Haloperidol in Scotland, Haloperidol prescribing in NHS Scotland, Haloperidol prescribing to Scotland's elders, harm, have been asked to try and summarise my considerations on delirium assessment, he Chair of Healthcare Improvement Scotland confirmed, Health Foundation, Healthcare Improvement Scotland, HIS, Hole Ousia, Hospital prescribing, Hospital prescribing of Haloperidol in your NHS Health Board area, I also wonder if the Mental Welfare Commission may have a view of starting out with a screening test without any perceived need (as per HIS recommendations) for individual consent?, I am concerned that current approaches, I am still left wondering whether the voices of our elders have been given reasonable opportunity to be heard?, I would suggest that this is relabelling, I wrote to the Chair of Healthcare Improvement Scotland asking for clarification on the involvement of "older people" in the development of these NHS Scotland standards, IHI, improvement methodology, improvement science, Improvement Science' and the potential for harmful consequences, Improvement work, Improvement Work in Scotland, Institute of Healthcare Improvement, instrument, Inverse care, Invited feedback on Care Standards for Older people in Hospital, ISD, ISD Scotland, It is the case, It is very difficult to challenge a powerful organisation, Jason Leitch, journal of Age and Ageing, June 2015, ladder of participation, Lanarkshire NHS Board, Lancet, Lancet Psychiatry, Letter to Cabinet Secretary for Health and Wellbeing, Letter to Shona Robison 6 Dec 2014 - hole ousia, Listening to the voices of abused older people: should we classify system abuse?, Lothian NHS Board, mandatory delirium screening, Mandatory screening, Mary Midgley, Mechanical metaphors, Mental health prescriptions hit ten-year high, mental Welfare Commission, most patients with delirium discharged on a new antipsychotic had no instructions for discontinuation, National Clinical Director, National Health Service (Scotland) Act, new report into management of frailty and delirium, NHS, NHS Ayrshire and Arran, NHS Borders, NHS Dumfries and Galloway, NHS Fife, NHS Forth Valley, NHS Grampian, NHS Greater Glasgow and Clyde, NHS Highland, NHS Lanarkshire, NHS Lothian, NHS Orkney, NHS Scotland, NHS Scotland requires a culture that listens to all, NHS Scotland: Improvement Science, NHS Shetland, NHS TAYSIDE, NHS Western Isles, no special training is required, none of the responses read as if 'first-person' comments. The comments read as if almost entirely by "stakeholders". If so, Now we are sixty (and a bit), off-label, off-label prescribing, Older People in Acute Care, older people's views should be sought when restructuring healthcare systems, Omphalos, Omphalos films, OPAC, OPAC tools are working, over-medicalisation, patient safety, Payments from NHS Scotland to the USA, Peter Gordon, philosophy, Plan-Do-Study-Act, powerful incentives in our health-care systems promote prescription of antipsychotics for patients with delirium, Prescribed harm, prescribing, Prescribing and Medicines, prescribing figures, prescribing figures for Haloperidol in NHS Scotland, Prescribing Statistics - Medicines used in Mental Health, primum non nocere, Principles and Practice of Screening for Disease. World Health Organisation, Professor Alasdair MacLullich, Professor Jason Leitch, Professor Jason Leitch - letter of the 2nd June 2015 on Haloperidol prescribing ro Scotland's older generation, Promises to listen to our elders, Psychiatric medications and potential effects on cardiac rhythm, Psychiatry, QI, QI connect, Quality & Safety Fellows, Quality Improvement, Quality Improvement for NHS Board Members, rapid assessment test for delirium, rapid delirium screening, Re-labelled, Re-labelled: "A Screening Instrument", re-labelling, Realisic Medicine, Realistic Medicine, rebel antiquary, Red Road, reductionism, result in worsened clinical outcomes, Rev. I. M. Jolly, Robert Francis, Robert K Merton, Rudi Gerardus Johannes Westendorp, Science, Scotland's elders by-proxy, Scotsman, Scottish Delirium Association, Scottish Government, Scottish Parliament, Scottish Philosophy & Psychiatry, Scottish Philosophy and Psychiatry Special Interest Group, screeining, screening, screening for cognitive impairment, SDA, Sensitive to the faltering steps of age, Sharon K Inouye, Should we not be spelling out this shortfall to Scottish Government as part of improvement recommendations, SIGN 86, Simon Biggs, Social maverick, stakeholders, still underway, Stirling, Studies show dramatic increase in antipsychotic treatment with mandatory delirium screening, takeover, takes less than 2 minutes, Temple of Decision, that antipsychotic prescribing is increasing year-on-year in NHS Scotland, the 4AT has been re-labelled, the 4AT has been relabelled as, the 4AT has been relabelled as: 'Rapid assessment test for delirium', The 4AT has recently been re-branded an "assessment test", The 4AT was developed and promoted as: a screening instrument for cognitive impairment and delirium, The 4AT was promoted for several years, The 4AT: a screening instrument for cognitive impairment and delirium, The Antiquary, The communications indicate a tone of disdain for those who may write to the Scottish Government's Department of Health with concerns about patient wellbeing and safety, The faltering unfaltering steps, the full toolset, the hazards of antipsychotic treatment in elderly people, The Health Foundation, the history of reductionism versus holistic approaches to scientific research, The ladder of participation, The patient paradox, the protection and the improvement of their population’s health and for the delivery of frontline healthcare services, The Rebel Antiquary, The use of antipsychotic medication for people with dementia: Time for action, THINK delirium, this "screening instrument" has been relabelled by Healthcare Improvement Scotland, this would represent Scotland's elders by-proxy., Too much Medicine, tool, Toolkits, Tools, Transforming Delirium Care in the Real World, truly madly deeply, UKNSC, unforeseen consequences, USA, Validation of the 4AT, We must be wary of faltering steps into a world of inverse-care, we need to engage beyond clinicians and improvement staff, we need to involve patients, what it says on the tin, WHO, why ethics matter, why ethics matters to us all, William Edwards Deming, William Osler, Wilson & Jungner, Wilson and Jungner, with the support of Healthcare Improvement Scotland, Yuliya Mysyuk, Yuliya Mysyuk and colleagues

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