Abstract
Aims and MethodThe aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.ResultsOur study yielded relevant information – 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.Clinical ImplicationsRetrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.
Highlights
The importance of systematic assessment of risk has been highlighted in guidelines by the Royal College of Psychiatrists (1996) and recommendations by the National Confidential Enquiry (Department of Health, 1999), and has been formalised in government advice on the implementation of the Care Programme Approach (CPA; Scottish Office, 1998)
The current study describes the initial cohort of those patients referred for CPA
The approach yields relevant results that are felt to be useful by clinicians
Summary
The aim of the study was to assess the practicality of extracting past riskrelated information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined
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