Here - Surrey and Borders Partnership NHS Foundation Trust
Here - Surrey and Borders Partnership NHS Foundation Trust 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
An evolving service – results of a 3 year follow up study of the practice of a community mental health team incorporating the principles of “New Ways of Working” June 2010 By Jeremy Mudunkotuwe, Farida Yousaf Acknowledgements: Helena DuToit, Dipesh Naik Introduction In 2005 the National Steering Group published “New Ways of Working for Psychiatrists”1. This document outlined the way in which teams could change in order to facilitate the time spent by the psychiatrist with the team considering their training and skill set. The requirements for this change necessitated a major change in service at the community psychiatry level. The changes were principally to enhance patients care, but were also planning for a perceived lack of psychiatrists in the future, due to increased retirement and inadequate numbers of doctors in training. Services around the country made changes in-line with the National Service Framework, and the authors sort a way to monitor the changes within our team with regards to psychiatrists’ practice. Aim To assess over time the nature of psychiatrists’ appointments in the Mole Valley Primary Care Mental Health Team with regard to the changes as outlined in the “New Ways of Working” document published in 2005. Method An audit tool listing 15 reasons for psychiatric doctor appointments has been adapted from an audit tool described in the NWW report of 2005 “The Bromley and Greenwich Medical Staff Outpatient Clinic Audit Tool”1(see table 1). Each year from 2005 to 2008, for a 2 month period the psychiatrists within the team were asked to complete the audit tool for each patient they saw, either in their outpatients’ clinic, home visit or any other planned or emergency appointment. After each 2 month data collection period the results were collated and in 2009 the results for the 3 periods of assessment were compared. Table 1: The audit tool Reasons for assessment • DNA • New Assessment • Carer / family education / support • Court report preparation • CPA, or planning for CPA • Crisis planning / resolution • Discharge appointment • Medication review / prescribing • Mental state exam / diagnostic assessment • Physical health care check • Reassurance & support • Risk assessment / monitoring • Reports / benefits • Session of therapy as part of on-going course of therapy • Support than only a consultant can give due to complexity Research and Audit Surrey and Borders Online Journal www.sabp.nhs.uk/journal 21
- Page 1 and 2: Issue 1 Summer 2010 Surrey and Bord
- Page 3 and 4: Do you ever wonder why you agree to
- Page 5 and 6: We are not so aware of the hidden f
- Page 7 and 8: esorting too soon to complex statis
- Page 9 and 10: Bipolar Disorder: how effective is
- Page 11 and 12: Research Method The study was condu
- Page 13 and 14: Screened for Hypomania Yes No Total
- Page 15 and 16: In our sample the GPs screening met
- Page 17 and 18: Audit of risk assessment documentat
- Page 19: Fig. 2 Re-audit May 2009 - distribu
- Page 23 and 24: having clinical responsibility for
- Page 25 and 26: school exposure to psychiatry as an
- Page 27 and 28: The measures outlined above will ho
- Page 29 and 30: Interview with Fiona Edwards, Chief
- Page 31 and 32: Q. Very topical to that is the appo
An evolving service – results of a 3<br />
year follow up study of the practice of<br />
a community mental health team<br />
incorporating the principles of “New<br />
Ways of Working”<br />
June 2010 By Jeremy Mudunkotuwe, Farida Yousaf<br />
Acknowledgements: Helena DuToit, Dipesh Naik<br />
Introduction<br />
In 2005 the National Steering Group<br />
published “New Ways of Working for<br />
Psychiatrists”1. This document outlined<br />
the way in which teams could change in<br />
order to facilitate the time spent by the<br />
psychiatrist with the team considering<br />
their training <strong>and</strong> skill set. The<br />
requirements for this change necessitated<br />
a major change in service at the<br />
community psychiatry level. The changes<br />
were principally to enhance patients care,<br />
but were also planning for a perceived<br />
lack of psychiatrists in the future, due to<br />
increased retirement <strong>and</strong> inadequate<br />
numbers of doctors in training. Services<br />
around the country made changes in-line<br />
with the National Service Framework, <strong>and</strong><br />
the authors sort a way to monitor the<br />
changes within our team with regards to<br />
psychiatrists’ practice.<br />
Aim<br />
To assess over time the nature of<br />
psychiatrists’ appointments in the Mole<br />
Valley Primary Care Mental Health Team<br />
with regard to the changes as outlined in<br />
the “New Ways of Working” document<br />
published in 2005.<br />
Method<br />
An audit tool listing 15 reasons for<br />
psychiatric doctor appointments has been<br />
adapted from an audit tool described in<br />
the NWW report of 2005 “The Bromley<br />
<strong>and</strong> Greenwich Medical Staff Outpatient<br />
Clinic Audit Tool”1(see table 1). Each year<br />
from 2005 to 2008, for a 2 month period<br />
the psychiatrists within the team were<br />
asked to complete the audit tool for each<br />
patient they saw, either in their<br />
outpatients’ clinic, home visit or any<br />
other planned or emergency<br />
appointment. After each 2 month data<br />
collection period the results were collated<br />
<strong>and</strong> in 2009 the results for the 3 periods<br />
of assessment were compared.<br />
Table 1: The audit tool<br />
Reasons for assessment<br />
• DNA<br />
• New Assessment<br />
• Carer / family education / support<br />
• Court report preparation<br />
• CPA, or planning for CPA<br />
• Crisis planning / resolution<br />
• Discharge appointment<br />
• Medication review / prescribing<br />
• Mental state exam / diagnostic<br />
assessment<br />
• Physical health care check<br />
• Reassurance & support<br />
• Risk assessment / monitoring<br />
• Reports / benefits<br />
• Session of therapy as part of on-going<br />
course of therapy<br />
• Support than only a consultant can<br />
give due to complexity<br />
Research <strong>and</strong> Audit<br />
<strong>Surrey</strong> <strong>and</strong> <strong>Borders</strong> Online Journal www.sabp.nhs.uk/journal 21
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