scholarly journals Assessing the quality of risk assessment conducted for new psychiatry inpatients

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S80-S80
Author(s):  
Nikhita Handa
Keyword(s):  
Risk Assessment ◽  
Junior Doctor ◽  
Risk Assessments ◽  
Junior Doctors ◽  
Illicit Substance Use ◽  
Negative Findings ◽  
Acute Psychiatric Wards ◽  
Quantitative Results ◽  
Self Harm

AimsAn audit was conducted to assess if thorough risk assessments had been documented in electronic clinical record notes (ECR) clerking for new patients in two acute mental health wards. Risk assessment is a vital part of admission clerking and when done well it can prevent early incidents and aid the ward nursing team greatly. During induction, junior doctors are advised to document assessed risks when clerking a new patient. A screening of the risks on admission could help determine the levels of observations required to minimise the identified risks whilst the patient awaits their first ward review.MethodThe NHS numbers for the 30 current inpatients across male and female acute psychiatric wards were gathered at the time of the audit (February – March 2020). Admission clerking was analysed for a clear statement of patient risk to self, others or property. Within these categories quantitative results were obtained on how often the risk of self-harm, self-neglect, absconding, vulnerability or aggression was documented. The term ‘risk’ was used for each patient on their ECR notes to search for risk assessments in all entries other than admission clerking.Result12 out of the 30 patients had a junior doctor risk assessment documented in their clerking (40%). 14 patients had no mention of risk assessment on admission (47%) and their first formal risk assessment was documented only in their senior ward review. Of the 12 assessments completed in clerking; all assessed self harm/suicide risk and violent risk to others, 1 mentioned risk of absconding, 8 mentioned risk of illicit substance use and 8 mentioned vulnerability. It was unclear if the risks documented were based on current or historic presentation. Junior doctors were anonymously surveyed following this audit and reported they did not feel confident in how to document a risk assessment or whether to document negative findings.ConclusionClear documentation of risk assessment being performed was lacking in over half of junior doctor admission clerkings. When risks were assessed it was mainly violence/self harm risk documented not vulnerability and physical health risks. Based on these findings we have designed more comprehensive teaching on risk assessments and a template for how to complete a risk assessment. We feel the use of a template will ensure all elements of risk are clearly considered even if they are not present currently. This is being reaudited to assess if the changes have impacted the quality of risk assessment conducted.

Changes in alcohol history taking by psychiatric junior doctors: an audit

1995 ◽  
Vol 12 (1) ◽  
pp. 37-39 ◽  
Author(s):  
Simon J Taylor
Keyword(s):  
Illicit Drug ◽  
Statistical Significance ◽  
Inpatient Admission ◽  
Junior Doctors ◽  
History Taking ◽  
Drug Usage ◽  
Acute Psychiatric Wards ◽  
First Time

AbstractObjective: In recent years a number of articles have highlighted deficiencies in drinking histories taken by junior doctors. This study examines whether standards have improved as a result. It also examines for the first time: 1. the quality of drinking histories taken from patients following parasuicide; and 2. the quality of illicit drug usage histories.Method: An audit of case notes was undertaken of 114 patients admitted to a district hospital's acute psychiatric wards or assessed following overdose. Two periods were considered; one preceding many of the articles, and the second four years later.Results: There was an overall improvement from 58% of histories in 1988 having no mention of alcohol usage to 25% in 1992. (X2MH=10.57, p<0.01). There was, however, insufficient improvement of quantitative histories to reach statistical significance. Histories taken as part of an overdose assessment were not significantly different from those taken for inpatient admission. In 1992, 27% of patients had any illicit drug usage history recorded which represented a statistically significant improvement (X2MH=5.91, p<0.02) compared with four years earlier.Conclusions: Although improvements have been noted, alcohol and drug histories remain inadequate.

scholarly journals An audit of risk assessment in an emergency setting

2002 ◽  
Vol 26 (3) ◽  
pp. 88-90 ◽  
Author(s):  
James Stone ◽  
George Szmukler
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Emergency Setting ◽  
Patient Records ◽  
Changing Practice ◽  
Self Harm ◽  
Harm To Others ◽  
The Way

Aims and MethodPatient records from the emergency clinic at the Maudsley Hospital were analysed from July 1999 to assess the standard of risk assessment for self-harm and for harm to others routinely recorded by junior doctors. The recorded risk factors for the consultation and the evidence that risk had been considered were noted. An intervention that comprised two seminars and two written reminders about the importance of risk assessment was made and the analysis of records in the emergency clinic repeated for July 2000.ResultsRisk factors were recorded more frequently for harm to self than for harm to others. There was little recorded evidence that consideration had been given to the overall risk of harm to self, and there was no evidence of this for harm to others. Recording of risk did not change significantly between 1999 and 2000.Clinical ImplicationsAssessment for risk of harm to others is not a part of the emergency consultation that is emphasised by the majority of junior psychiatrists. Changing practice will require a shift in the way that risk to others is presented in psychiatric teaching.

scholarly journals Improving venous thromboembolism risk assessments on an older age psychiatric ward – a complete audit cycle

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S86-S86
Author(s):  
Syazana JD ◽  
Edward Hart ◽  
Ranjit Mahanta ◽  
Alison Marshall
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Older Adult ◽  
Psychiatric Patients ◽  
Physical Restraint ◽  
Risk Assessments ◽  
Hydration Status ◽  
Common Disease ◽  
Junior Doctors

AimsVenous thromboembolism (VTE) is a common disease amongst hospital patients. Within acute hospitals, there are well established protocols for risk assessment and prevention of VTE via mechanical and pharmacological prophylaxes.In psychiatry, assessment of VTE risk is more commonly overlooked despite many inherent risk factors which are unique to acute psychiatric admissions; including antipsychotic medications, physical restraint, catatonic states, and poor nutritional and hydration status[1]. The risk is compounded in older adult psychiatric patients, in which both patient and admission-related risk factors can act synergistically.Anecdotally, it was reported that VTE assessments were not being completed and documented on the electronic patient record system. Our aim was to introduce a physical VTE risk assessment to attach to paper drug charts, which would act as a prompt for junior doctors, and serve to increase rates of completion.MethodA baseline retrospective audit of all patients admitted to the older adult inpatient ward over an 11-week period (05/08/2019~20/10/2019) was undertaken. The number of completed electronic VTE risk assessments at admission, and at 24 hours post-admission were calculated.Subsequently, a new paper VTE risk assessment proforma was developed, combining the Department of Health VTE risk assessment tool[3] with several VTE risk factors associated with psychiatric patients (catatonia, antipsychotic medication, reduced oral intake, psychomotor retardation). Education was provided to the ward doctors, and regular assessments of VTE risk was incorporated into the weekly MDT meetings.A re-audit was completed to assess the completion rates of the new paper VTE proforma. A snapshot style audit of all inpatients on the ward on Thursday 24th February 2020 was performed.ResultThe baseline audit included 23 patients admitted during the 11-week period, consisting of 21 men and two women. The mean age was 74 years. Three patients (13% of total admissions) had their VTE and bleeding risk assessed on admission.Following the implementation of a new VTE risk assessment proforma, the re-audit showed that all 19 inpatients (100% of total admissions) had a completed assessment. Although none of the patients required mechanical prophylaxis, one patient was receiving ongoing treatment for pulmonary embolism.ConclusionVTE is a preventable disease, which historically has been under-recognised by psychiatric doctors. The introduction of a paper risk assessment proforma increased completion from 13% to 100%. It also prompted regular review of VTE risk during the weekly MDT meetings. This intervention may reduce the incidence of VTE-related pathology on the ward.

An audit of the quality of HCR-20 violence risk assessments in a low secure service

2015 ◽  
Vol 11 (S1) ◽  
Author(s):  
Piyal Sen ◽  
Simone Lindsey ◽  
Nilanjan Chatterjee ◽  
Rajesh Rama-Iyer ◽  
Marco Picchioni
Keyword(s):  
Risk Assessment ◽  
Clinical Improvement ◽  
Action Plan ◽  
Information Gathering ◽  
Risk Assessments ◽  
Clinical Judgement ◽  
Violence Risk ◽  
Secure Unit ◽  
Quality Tool

AbstractIntroductionThe HCR-20 is one of the most popular structured clinical judgement tools used in forensic settings; yet, there are no published tools to assess the quality of its use. This study used the CAI-V, a tool to assess the competency of those carrying out risk assessment, to develop a quality tool for the use of HCR-20.MethodThe audit was carried out between July 2012 and July 2013 on all patients resident in St Andrew’s Essex, a low secure unit. The results of the first audit led to an action plan for clinical improvement, subsequently re-audited a year later.ResultsMost of the HCR-20 ratings scored in the competent range in both audits, but the greatest weakness was identified in the treatment planning section. The re-audit showed improvement, but there remained areas for development.DiscussionThe audit highlighted broad areas of improvement like the need for full multidisciplinary involvement, more attention to formulation, and the need for greater consultation and information gathering from outside professionals and family members. The quality tool developed could be adapted to the requirements of any service, and used accordingly.

scholarly journals Improving risk assessments for CAMHS admissions at Great Ormond Street Hospital

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S107-S107
Author(s):  
Lisanne Stock ◽  
Sacha Evans
Keyword(s):  
Risk Assessment ◽  
Risk Assessments ◽  
Junior Doctors ◽  
List Type ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Early Risk ◽  
Audit Cycle ◽  
Working Day ◽  
The Impact

AimsDuring the COVID-19 pandemic, admissions to the Mildred Creek Unit (MCU), an Inpatient CAMHS Ward at Great Ormond Street Hospital (GOSH) changed.The MCU is a 7–10 bed unit for children aged 7–15 years based on therapeutic milieu principles. The ward accepts patients via a planned national referral pathway, however, during the COVID-19 pandemic, patients were admitted as emergencies and consequently risk assessments were missed. Risk assessment is important in all admissions and as the MCU is not a locked unit, early risk assessment is particularly important.We aimed to review whether risk assessment occurred within one working day of admission, as suggested by the ward risk assessment policy, and if this was not the case, our aim was to ensure that all risk assessments took place within this period via our audit interventions.MethodWe collated data looking at the time between admission to GOSH and the date at which first risk assessments took place. We then put in place three interventions. 1)Posters prompting doctors who were providing on-call liaison input to perform a risk assessment within one working day of admission.2)New junior doctors were provided with written and verbal information to emphasise the importance of early risk assessment.3)Guidelines also highlight that assessment of risk may need to be on-going. We therefore added a prompt section in the weekly ward round proforma with the aim of reducing the interval between risk assessments during admission.The first audit cycle was conducted on the 3/8/2020 and the second on the 28/11/21 to allow for a comparative number of inpatients between the first and second audit cycle.ResultWe found these interventions significantly reduced delays in risk assessments. Prior to the audit's first cycle the average delay between admission to GOSH/MCU and a risk assessment was 2 weeks. After the interventions there were no patients whose risk assessment was delayed outside the next working day parameters.ConclusionThis full cycle audit demonstrates the impact that prompts to clinical practice can make on patient care. It is important to recognise the need for flexible risk assessment with regular review, especially at times of clinical change. We hope that this continued trend for early risk assessment leads to improved clinical care and timely discussion of risk for all new CAMHS inpatients at GOSH.

scholarly journals Risk assessment and management in obsessive–compulsive disorder

2009 ◽  
Vol 15 (5) ◽  
pp. 332-343 ◽  
Author(s):  
David Veale ◽  
Mark Freeston ◽  
Georgina Krebs ◽  
Isobel Heyman ◽  
Paul Salkovskis
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Obsessive Compulsive Disorder ◽  
Careful Consideration ◽  
Risk Assessments ◽  
Obsessive Compulsive ◽  
Children And Young People ◽  
Compulsive Disorder ◽  
Self Harm ◽  
Risk Assessment And Management

SummarySome people with obsessive–compulsive disorder (OCD) experience recurrent intrusive sexual, aggressive or death-related thoughts and as a result may be subjected to lengthy or inappropriate risk assessments. These apparent ‘primary’ risks can be dealt with relatively easily through a careful understanding of the disorder's phenomenology. However, there are other, less obvious ‘secondary’ risks, which require more careful consideration. This article discusses the differentiation of intrusive thoughts and urges in people with OCD from those experienced by sexual or violent offenders; assessing the risk of self-harm and suicide; discussing the nature of repugnant obsessions with a patient; assessing risk of harm and violence to the dependents and family living with someone with the disorder; and assessing the lack of insight and the use of the Mental Health Act. Issues specifically related to children and young people with OCD are also highlighted.

Systematic risk assessment in a mother-baby unit (MBU)–Importance for maternal and infant safety

2017 ◽  
Vol 41 (S1) ◽  
pp. S363-S363
Author(s):  
G. Saraf ◽  
P. Chandra ◽  
G. Desai ◽  
H. Thippeswamy
Keyword(s):  
Risk Assessment ◽  
Infant Health ◽  
Assessment Tool ◽  
Systematic Risk ◽  
Risk Assessments ◽  
Systematic Assessment ◽  
Adequate Care ◽  
Self Harm ◽  
Competing Interest ◽  
Infant Neglect

IntroductionSystematic assessment of risks is an essential component of care in psychiatric mother baby units. Self-harm, infant neglect and harm or the vulnerable physical health of both mother and infant may all pose risks.AimDevelopment of a risk assessment tool and risk assessment among mother-infant dyads at a MBU in Bangalore, India.MethodsBased on data from 200 admissions, doctors and nurses of the unit developed a 15-item tool for risk assessment. Risk was assessed by both nurses and doctors among 58 consecutive mothers admitted to the unit. Risk domains included risks to self, to infant, related to infant health and feeding and violence faced by mother. Frequencies of various risks were calculated. Nurses’ risk assessments were compared to the residents’ risk assessments.ResultsThe mean age of the mothers was 25 (±4) years, age of infant 4 (±4) months and duration of episode was 4 (±14) months. Diagnoses included acute polymorphic psychosis (30%), BPAD (27%) and depression (21%). 47% had high suicidal risk and 28% had made an attempt in the current episode. 22% had expressed ideas of infant harm and 24% had physically harmed the infant. 48% of mothers had been physically violent. Multiple risks were seen in 47%. Doctors were able to identify risks more often than nurses.ConclusionRisks for self-harm, infant harm and related to infant health were high. Systematic risk assessment by both nurses and doctors is important in an MBU to ensure adequate care for the mother infant dyad.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals 919 Surgical Voice Restoration – Improving Out of Hours Management: A Multidisciplinary Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
J McCord ◽  
B Roberts ◽  
S Browning
Keyword(s):  
Junior Doctor ◽  
Working Hours ◽  
Standard Of Care ◽  
Junior Doctors ◽  
Health Board ◽  
Contributing Factors ◽  
Improvement Project ◽  
Out Of Hours ◽  
Voice Restoration

Abstract Aim Swansea Bay University Health Board have a caseload of 37 surgical voice restoration (SVR) laryngectomies. These patients are excellently managed during working hours, by a SALT-led service. Concerns were raised regarding the quality of out of hours management: the aim of this project was to identify and address the factors contributing to the difference in care received. Method A questionnaire was sent to current junior doctors to assess knowledge and confidence when managing SVR patients. Phone interviews were conducted with SVR patients to discuss the issues from a patient’s perspective. The junior doctor team and SALT team liaised to identify contributing logistical issues. Results The junior doctor survey indicated both experience and confidence were low, including amongst senior trainees. 58.3% were unfamiliar with equipment used to change a speech valve. Patient interviews revealed several issues, such as delays to treatment and unnecessary admissions. Logistical concerns included inability to access equipment out of hours and an absence of departmental guidelines. Conclusions This project demonstrates a collaborative approach between junior doctors and SALT, to improve the quality of care for a sub-set of patients with highly specialised needs. We identified the contributing factors for the disparity in services and tailored interventions to provide the junior doctors responsible for out of hours care, with the knowledge and skills to provide a better standard of care.

Comparison of SCORE and Reynolds cardiovascular risk assessments in a cohort without cardiovascular disease

2013 ◽  
Vol 154 (43) ◽  
pp. 1709-1712 ◽  
Author(s):  
Csaba Móczár
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Cardiovascular Risk ◽  
Screening Program ◽  
Risk Group ◽  
Scoring Systems ◽  
High Risk Group ◽  
Risk Assessments ◽  
Gender And Age ◽  
Medium Risk

Introduction: Cardiovascular risk assessment may help in the identification of symptom-free subjects with high cardiovascular risk. Aim: The author studied the correlation between SCORE and Reynolds risk assessment systems based on data from the cardiovascular risk screening program carried out in subjects without cardiovascular disease. Method: Data obtained from 4462 subjects (1977 men and 2485 women; mean age, 47,4 years) were analysed. The comparison was based on risk categories of the SCORE system. Results: There was a strong correlation between the two scoring systems in the low risk population (under <2% SCORE risk the Spearman rho = 1, p < 0.001). A weak correlation was found in the medium risk group (between 3–4% the Spearman rho = 0.59–0.49, p < 0.001 and between 10–14% the Spearman rho = 0.42, ns.) and a stronger correlation in the high risk group (>15% the Spearmen rho = 0.8, p = 0.017). When correlations were analysed in gender and age categories, the weakest correlation was detected in medium risk women over 40 years of age. In cases when the differences between the two scoring systems were significant, the hsCRP levels were significantly higher (4.1 vs. 5.67 mg/L, p < 0.001). Conclusions: Introduction of hsCRP into cardiovascular risk assessments can refine the risk status of symptom-free subjects, especially among intermediate risk middle-age women (two-step risk assessment). Orv. Hetil., 154 (43), 1709–1712.

The Halo Effect in Business Risk Audits: Can Strategic Risk Assessment Bias Auditor Judgment about Accounting Details?

2005 ◽  
Vol 80 (3) ◽  
pp. 921-939 ◽  
Author(s):  
Ed O'Donnell ◽  
Joseph J. Schultz
Keyword(s):  
Risk Assessment ◽  
Performance Evaluation ◽  
Laboratory Experiments ◽  
Halo Effect ◽  
Risk Assessments ◽  
Business Risk ◽  
Auditor Judgment ◽  
Strategic Risk ◽  
Strategic Assessment ◽  
Assessment Bias

Many auditors use an audit methodology that requires a strategic risk assessment of their client's business model as a first step for assessing audit risks. This study examines whether the holistic perspective that auditors acquire in making a strategic risk assessment influences the extent to which they adjust account-level risk assessments when they encounter changes in accounts that are inconsistent with information about client operations. Based on halo theory from the performance evaluation literature, we hypothesize that auditors who (1) perform (do not perform) strategic assessment, and (2) develop favorable (unfavorable) strategic risk assessments, are less (more) likely to adjust account-level risk assessments for inconsistent fluctuations. Data from two laboratory experiments using experienced auditors support both hypotheses. Findings suggest that the halo effect generated during strategic assessment influences judgment by altering auditor tolerance for inconsistent fluctuations.

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