Here - Surrey and Borders Partnership NHS Foundation Trust

Research and Audit
Based on the results of the initial audit,
strategies to improve performance were
implemented. An e-mail was circulated to
all consultants and junior doctors
involved in risk assessment for adult inpatients
highlighting the outcomes and
raising awareness of the need for
adequate risk assessment. The three
questions and the need to fulfill these
were documented in the e-mail along
with the intent to re-audit in 2 months’
time. As the changeover for junior
doctors occurred shortly after the audit,
this e-mail was circulated to both those
doctors completing their post and those
taking over from them.
Re-audit
A re-audit was undertaken in May 2009.
23 sets of notes were randomly selected
from all the in-patients currently on ACU
(split equally across Blake and Clare
wards). The 23 notes selected were then
examined using the method and analysis
outlined in the initial audit. Results were
obtained for an overall view of the
different criteria being assessed. There
was no breakdown of results by
consultant or regularity of ward round as
this showed no impact in the initial audit.
Results were analysed depending on
length of stay, as this was identified as
having an impact. These results were then
compared with those of the initial audit to
see if the heightened awareness had
altered the recording of risk assessment
Based on the results of the first re-audit
and the possible areas of bias, further
strategies to improve performance were
implemented and second re-audit
conducted in November 2009, which was
towards the end of the post for the
cohort of doctors included. The second
re-audit followed the same method and
structure as the earlier re-audit in May
2009. This ensured that there had been
consistency in the doctors completing the
documentation over the last four months
and also a long enough time period to
ensure no notes had been included in the
previous audit cycle. Formal teaching on
risk assessment was delivered to the new
cohort doctors at the beginning of their
post in psychiatry at the ACU, Chertsey.
This included an explanation of the risk
assessment form and its importance, and
was conducted by one of the in-patient
consultants.
Results
Fig.1 Initial audit – distribution overall
100
90
80
70
60
% 50
40
30
20
10
0
Criteria
Initial RA
Initial complete RA
Regular updates
RA accessible to staff
Meets standard guidelines
18 Surrey and Borders Online Journal www.sabp.nhs.uk/journal