Introduction – – What is severe mental illness/severe mental illness – Demography – Common symptoms presented by patients with severe mental illness – Common practice in the management of these symptoms (PRN Medication) – Problems with the common practices/medications used (Benzodiazepines/anxiolytics as PRN) – Common reasons by patients for requesting for PRN – Anxiety OBJECTIVES OR PATIENT OUTCOMES 1. To reduce the amount of Benzodiazepines and Anxiolytics used by patients with severe mental health condition and their detrimental side effects 2. To empower and equip patients with alternative ways of managing mental related anxiety other than medication Background – What is anxiety – Pharmacological management of anxiety and its impacts (addictiveness, weight gain, makes patients non-resilience to recover etc.) – Non-pharmacological or other methods of anxiety management Whats is CBT Literature review: This will look at the impact of CBT on anxiety The Improvement: The improvement will involve the offer of various CBT exercises or skills to patients as alternative to PRN medication. Patients will not be denied medication if they reject this offer. The choice of CBT exercises to be offered are: Graded exposure exercise: Has been found to be effective in reducing anxiety. Mindfulness meditation exercise: Aims to help in disengaging from harmful rumination or obsession. Cognitive Restructuring exercise: Aims to examine unhelpful thinking patterns and coming up with new ways reacting or dealing with problematic situations. Problem Solving exercise: Teaches effective problem solving strategies, help in regaining control and managing difficult situations. (These will be explored and designed to suit patients) It is believed that these skills may: 1. Reduce anxiety related violence incidents on the ward– no injuries to patients, staff, no need for physical restraining (safer wards) 2. Save time for nursing Therapy as patients are able to manage anxiety well 3. Reduce the stigma of violence associated with mental health due to less violence incidents 4. Less anxiety related distress to patients and quicker recovery METHODOLOGY – (This will cover the research methods to be used, why they have been chosen, how they will be utilised; what data will be collected, how and why; participants in the PIP, their settings and why). The following research methods will be used Quantitative Qualitative DATA TO BE COLLECTED (Questionnaires and Observation will be used). 1. RETROSPECTIVE DATA: – The number of patients prescribed Benzodiazepines for anxiety on the ward – The total amount of Benzodiazepine and anxiolytics used as PRN on the ward over the last three months – Number of patient who have used Benzodiazepine and anxiolytics as PRN for a minimum of three times per week over the three months’ period – Total number of Benzodiazepine and anxiolytics used as PRN by individual patients over three months’ period – Patients opinion on the use of Benzodiazepine and anxiolytics as PRNs (questionnaire would be designed and appendix) – Patients awareness of CBT – (Through a questionnaire) 2. PROSPECTIVE DATA: – The number of patients prescribed Benzodiazepines for anxiety on the ward – The total amount of Benzodiazepine and anxiolytics used as PRN on the ward over the last three months – Number of patient who have used Benzodiazepine and anxiolytics as PRN for a minimum of three times per week over the three months’ period – Total number of Benzodiazepine and anxiolytics used as PRN by individual patients over three months’ period – Patients opinion on the use of Benzodiazepine and anxiolytics as PRNs for anxiety management – Patients opinion on the use of CBT for anxiety management (Questionnaires would be designed and appendix) Are these likely to be the same group of patients followed for 6 months? Implementation of the PIP – This will involve: Pilot mental health wards would be selected and staff introduced to the service improvement program staff would be trained on mindfulness exercises CBT exercises will be offered to patients as alternative to PRN. Patients who refused will not be denied medication. Quantitative and qualitative methods will be used to compare the amount and trend of Benzodiazepines and Anxiolytics PRN use prior to and after the implementation of the PIP. A short course for the training of trainers on CBT exercises will be introduced in the locality or nation wide The principle would then be introduced to all patients with severe mental health condition for the management of anxiety o ETHICAL ISSUES – Various ethical issues in relation to the use of mindfulness will be discussed, o DATA ANALYSIS AND PRESENTATION OF THE RESULTS: Data analysis will involves comparing the amount and the trend of benzodiazepines and anxiolytics use, incidents of relapse and aggression and patients’ opinion prior to and after the implementation of the PIP. These will be presented in graphs and pictograms for easy reading. DISSEMINATION- Findings will be disseminated by conference presentation, posters and journal article, sharing at a team meeting and the use of various social media. The chosen strategies will be justified. GANTT Chart– this will be included to demonstrate key time frames/milestones that proposed the practice improvement will take. It will be realistic and justified.