Devon De Silva & Arun Dhandayudham
Devon De Silva
Devon De Silva works for WDP, a national substance misuse service provider, and oversees the organisations Innovation and Research Unit (IRU). The IRU bridges the gap between academia and service delivery and is responsible for designing and contributing to research within the sector whilst also developing innovations that enhance service delivery. The IRU’s current portfolio includes evaluating the impact of WDP’s digital innovations and adapting interventions traditionally used within the mental health field e.g. Animal Assisted Therapy/Open Dialogue.
I have been a Consultant in Addictions Psychiatry and a frontline clinician since 2005. My clinical roles have included being Clinical Director of substance misuse services across Northamptonshire and Bedfordshire as well as Clinical Lead for CGL in Northamptonshire. I have been in my current role as Joint CEO and Medical Director of WDP since 2015.
WDP is a charity provider of substance misuse services across London, the South East and the North West and treatment is provided across inpatient, community and prison settings. I oversee medical practice across WDP and manage complex detoxes at Passmores House which is an inpatient detox unit in Harlow. I am therefore acutely aware of day to day issues in substance misuse services.
My clinical interests include chronic arousal states such as pain and anxiety and their impacts on addiction, online shopping addiction as well as developing protocols to manage the increasingly complex detoxes for inpatient admissions. I am also passionate about a systems improvement approach and the use of technology such as WDP’s capital card for contingency management.
I have been a member of the Royal College of Psychiatrists Addictions Faculty for several years and have chaired the Patient and Carer group until 2018. I am currently the coordinator for the Regional Representatives of the Faculty.
ECG findings in inpatient admissions at Passmores House
To determine how effectively the ECG System had been integrated into everyday admission practice and whether it identified abnormalities that have/would have otherwise been missed during patient admission.
ECG service audit.
Passmores House is a WDP-run inpatient detoxification and rehabilitation unit based in Essex.
Clients accessing inpatient detox at Passmores House.
Passmores House introduced Broomwell Healthwatch’s ECG System in 2016 and all patients receive an ECG on admission.
60 case files were audited to establish if files had missing ECGs and if pre-existing and new conditions were identified. The audit also sought to establish if abnormal ECGs were acted upon. All cardiac related conditions where included except for Sinus Tachycardia and Bradycardia.
Findings and conclusions
– 58 files included ECGs.
– 12 clients had known pre-existing cardiac/cardiovascular pathologies, history of stroke, electrolyte abnormalities and/or history of hypertension and chest pain. Of these, 6 clients had a normal ECG and 6 had known conditions such as hyponatremia and conduction delays.
– Hospital treatment was required for two patients.
– 6 clients had no known pre-existing cardiac issues but upon admission conditions such as axis deviations and ST-T abnormalities were detected.
– All abnormal ECGs were actioned/discussed with relevant parties and included within discharge summaries.
The use of ECGs within inpatient detoxification units is beneficial for monitoring pre-existing conditions and identifying previously undetected conditions. If some of these conditions remained undetected they could have seriously complicated treatment, increased morbidity and potentially led to service user death.