Abstract
AimsWe accessed whether medics are following Trust Policy while conducting seclusion medical review and identify the strengths in quality of seclusion medical review and identify the areas which need improvements to improve our quality and standards of patient's care and safety and to reduce risks.BackgroundThe Mental Health Act Code of Practice sets an expectation for mental health services for restrictive interventions (use of restraint, seclusion and rapid tranquilisation) by following good standards. Medical reviews provide an opportunity to evaluate and amend seclusion management plan. This clinical audit was undertaken by looking at quality of record keeping about seclusion review by junior doctors, staff grades and consultants at different times (day, night, and weekend).MethodData analysis was carried out by using Microsoft Excel. The audit had Humber Teaching NHSFT approval. We assessed electronic healthcare records. Data collection was carried out or retrospectively in 2019(n = 40) using following parameters: 1)A review of patient's physical and psychiatric health.2)An assessment medication prescribed and adverse effects of medication.3)A review of observations required.4)An assessment of the risk posed by the patient to others.5)An assessment of any risk to the patient from deliberate or accidental self-harm.6)An assessment of need for continuing seclusion, and whether it is possible for seclusion measures to be applied more flexibly, or in a less restrictive manner.7)Time of Seclusion Review: Within first hour after seclusion and then every 4 hours until internal MDT. After MDT twice a day.8)Record Keeping.ResultKey Successes (above 80%)Time of seclusion review (with in first hour or when required)Record keeping (accurate time and place for clinical notes).Plan for continuing need for seclusion.Good documentation of Risk to self and risk to others.Good documentation of mental state examination.Comments on physical health although it can be improved.Key Concerns(Less than 60%):Prescribed Medications.Medication side effects.Physical ObservationsConclusionMedics are missing some important parts in seclusion medical review. We developed a template for seclusion medical review according to trust guidelines which are based on Code of Practice and to incorporate in already existing seclusion review form. We also delivered teaching and training to doctors and also showed junior doctor's an example of documentation. We will re-audit in 1 years’ time to see improvement.
Highlights
BJPsych OpenTo establish the improvements in the quality of seclusion medical review after introducing a template to complete the review
Medical reviews provide an opportunity to evaluate and amend seclusion management plan. This clinical audit was undertaken by looking at quality of record keeping about seclusion review by junior doctors, staff grades and consultants at different times
Medics are missing some important parts in seclusion medical review
Summary
To establish the improvements in the quality of seclusion medical review after introducing a template to complete the review. To improve the quality of the seclusion medical review, we completed an audit in July 2019 to ascertain whether medics are following Trust Policy. We identified good results (above 90%) in the following areas: Time of seclusion review Record keeping Management plan Good documentation of risk, mental state examination and physical health. We noticed a marked improvement in the quality of seclusion medical review (between 95% and 100%) after introducing a template for it. To continue to use the template for Seclusion Medical Review which has shown significant improvement in the quality of the reviews which will improve patient care. To continue teaching and training of doctors This QIP project motivated nurses to do an audit on nursing seclusion review and made necessary changes
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