Here - Surrey and Borders Partnership NHS Foundation Trust

Research and Audit
Discussion
When considering the results of the initial
audit, the numbers in several categories
are too small to be of value when
analysing the data by the different factors
felt to be possible influences on the
results. Results should be interpreted with
this in mind. There was no clear variation
of results by consultant or regularity of
ward round. There does however appear
to be a link between increasing length of
stay and decreasing fulfillment of criteria.
This may be due to becoming less aware
of a patient’s risk the longer they stay and
an assumption that the risk is stable and
therefore the update is not completed as
frequently and is more likely to be
forgotten. The achievement of the
recommended targets actually
deteriorated when re-audited. This was
mainly due to a reduction in completed
risk assessments on admission and also a
smaller percentage of risk assessments
were updated regularly. There was also
less evidence on re-auditing that length
of stay impacted on achievement of
recommended targets.
Heightened awareness by e mail appears
to have been ineffective therefore in
improving standards. However, various
factors could have impacted upon this.
As a large number of junior doctors
changed between the two data collection
points, this could have affected the
results as new doctors were less likely to
have experience and remember to
complete risk assessment forms than
those who had been doing the job a few
months. Also some notes would have
been included in the data collection on
both occasions, and this may have also
altered results. Notes which had not met
standards initially were unlikely to meet
standards in the re-audit, which would
have led to a disproportionately larger
amount of notes not meeting standards
in the re-audit compared to the initial
audit. It was therefore beneficial to
repeat the audit at a later stage towards
the end of one group of junior doctors’
employment (i.e. November/December
2009). This allowed a long enough time
period to ensure that no notes audited in
earlier cycles are audited for a second
time, which was a source of bias in the
initial re-audit. This also allowed for
consistency in documentation completion
and had the advantage of identifying if
time spent working in psychiatry helped
increase awareness and completion of
risk assessments and gave a more
accurate picture of the benefit of any
interventions that were implemented.
Formal teaching on risk assessment was
recommended during induction or in an
early teaching session for this cohort of
doctors as this has not been included in
previous years. An improvement in
meeting the recommened guidelines was
evident from the re-audit in all areas, and
length of stay appeared to have less
impact than in the previous cycles.
It appears from the second re-audit that
structured interventions and formal
teaching that heighten awareness of the
importance of risk assessment and how
to complete the relevant paperwork have
led to improvements in meeting the
recommended guidelines. With the
introduction to the ACU of the new
computer system, RIO, such interventions
will become all the more important in
order to ensure risk continues to be
documented to the highest standard. The
overall outcome of this audit suggests
that formal face to face teaching along
with time spent working in psychiatry
and heightened awareness on the ward
of risk documentation are all necessary to
optimise meeting the guidelines and such
interventions should be regularly
employed by the Trust for doctors, both
at induction and throughout their
rotation.
20 Surrey and Borders Online Journal www.sabp.nhs.uk/journal