RMH Evidence Week

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RMH Evidence Week

• Evidence at work in Mental Health
• Dr Vaidy Swaminathan,
• Consultant Psychiatrist
• Northern Area Mental Health Service
• The Northern Hospital
• 185, Cooper Street, Epping, VIC 3076

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The need for evidence based practice in
Psychiatry

• Is it individual clinical expertise empirical
  or anecdotal experience OR
• Is it external clinical evidence?
• Is it the Prozac or the puppy that is driving
  depression away?

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What is EBP?

• Well meaning therapies vs therapies that really
  work what would you trust your clinician to do
  for you?
• Ken Keseys One flew over the cuckoos nest was
  perhaps a watershed in public understanding of
  treatments in psychiatry (rather all the wrong
  things about psychiatry)!

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EBP

• For eg ECT was and is still considered as a
  barbaric treatment, seen more as a punishment
  by those not well informed about this particular
  treatment
• Fittingly, therefore, psychiatry is at the
  forefront of promoting EBP in its everyday
  practice.

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EBP is

• Conscientious, explicit and judicious use of
  current best evidence, integrating individual
  clinical expertise with the best available
  external clinical evidence from systematic
  research
• Sackett et al, 1996

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EBP is.

• Individual Clinical Expertise is the proficiency
  and judgement that individual clinicians gain
  through clinical experience and practice
• Best available external clinical evidence is the
  clinically relevant research, particularly from
  patient centred clinical research into the
  accuracy and precision of these
  treatments/interventions

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Research Evidence
Patient Preferences
Clinical Expertise
Resources
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EB health care network and resources in Psychiatry

• Significant presence in the Cochrane
  Collaboration
• Centres for
• Evidence Based Mental Health
• Evidence Based Medicine
• Evidence Based Nursing

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• Other Resources
• OVID databases
• EB Mental Health Journal
• Royal Australian and New Zealand College of
  Psychiatrists guidelines for treatment of
  psychiatric disorders
• International guidelines APA, RCPsych

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Example Nursing Observations in In-patient Unit

• A research project currently being co-ordinated
  by Ms Allison Harrington, RPN and A/Prof Suresh
  Sundram at NAMHS
• Looks at current risk assessment practices at NPU
  and whether this is useful? Need it be changed,
  and if yes, how?

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Nursing Observations in NPU

• Current practice was unsatisfactory, as it really
  did not tell the clinical staff anything. Nursing
  observations did not reflect what the risk
  assessment intend in terms of interventions.
• Risk assessment was inadequate as it merely
  adviced the nursing staff re Observation
  frequencies 15 mins, 30 mins, 60 mins, General
  Observations, etc. No direction about what was
  expected to be done.

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EBP in Psychiatry.

• An answerable question framed Does the risk
  assessment elicit an appropriate intervention in
  terms of the nursing observation? If not change
  it!
• A review of literature was done and gaps between
  current practices and industry standards were
  elicited best evidence identified

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• Evidence appraised..
• Apply evidence to current settings
• New risk assessment protocol identified and
  operationalized - results hoped Improved medical
  documentation of what nursing staff needed to do
  eg 1 on 1, extended mental state assessment, et
  cetera
• New nursing observations protocol identified and
  operationalized resulted in nursing staff
  following need based intervention strategy for
  individual patients, tailored to their needs.
  Hopefully, this will result in improved patient
  and family satisfaction.

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• Evaluations pending. The project is still
  underway.
• Attention!! I had no part to play in the
  research, except that I was member of the focus
  group (by virtue of being the in-patient
  psychiatrist). Just have enough permission from
  A/Prof Sundram to briefly use this example to
  exemplify TRIP in Psychiatry (Translating
  Research into Practice) at work.

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Example 2 The TRIP Initiative

• In 2001, NWMH roled out the TRIP Initiative
  Translating Research into Practice.
• A workshop was developed by NWMH staff and run by
  MHTDU (here at RMH) as..an ambitious initiative
  designed to reduce the lag between identification
  of effective treatments and their implementation
  in clinical services.