2 results
An Audit of Information Provided to Paramedics / A&E Staff on Transfer to the Colchester General Hospital
- Oksana Zinchenko, Ahmed Shoka, Yaser Hamza, Aamir Mujtaba, Vincent Mtika, Stephanie Riding
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S116-S117
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Aims
Following feedback from paramedics and staff, escorting patients to the A&E, concerns were raised when some information was missed during the verbal handover from patient/escorting staff to the ambulance/A&E staff. At times the purpose of the transfer was not clear. Essex Partnership University NHS Foundation Trust (EPUT) “Discharge and Transfer Clinical Guidelines” ( CG24) provides clear guidelines to staff when a person is transferred while in the care of the Trust to another service such as another acute trust or, discharged from EPUT services completely. However, there are no current guidelines available for transferring patients for clinical reasons: in case of emergency or acute medical condition, for specialist treatment or investigation. The standard was used: the “Ambulance handover to emergency care standard V1.0” created by Professional Record Standards Body (PRSB). 100% of patients should have a support letter from doctors with relevant information shared with paramedics or the A&E department on transfer to a general hospital. The scope of the audit was Peter Bruff Mental Health Assessment Unit and Ardleigh Acute Inpatient Ward.
MethodsThe data were collected retrospectively from notes available on the electronic health record database (Paris). The audit tool focused on quantitative and qualitative data collection on patient transfer.
Inclusion criteria: all patients admitted to the Peter Bruff MH Assessment Unit (male and female) and the Ardleigh Ward (female) over the period from 1 September to 15 September 2022. All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.
ResultsThere were identified 18 male and 33 female patients on the Peter Bruff MH Assessment Unit. 2 patients were sent to the A&E via ambulance and 4 patients attended the A&E with staff escort. A support letter was available on one occasion. Compliance 17%.
Within the analysed period there were 15 female patients identified on the Ardleigh ward. 5 patients attended the A&E. A support letter was available on two occasions. Compliance 40%.
ConclusionAll transfers should be managed in a sensitive way ensuring all communication is clear, to promote robust information sharing between inpatient wards and A&E.
A template of the care summary and handover letter was created, which provided a standard structure of headings that is meaningful to clinicians and patients.
An Audit of Documentation Relating to a Decision-Making Capacity to Consent to Admission to the Peter Bruff Mental Health Assessment Unit
- Oksana Zinchenko, Sujeeththa Sivakanthan, Yugesh Rai, Ahmed Shoka
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S146-S147
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Aims
Assessment of the capacity to consent to admission is an important legal and ethical issue in daily medical practice. Mental Capacity Assessment (MCA) should be carried out thoroughly based on all the domains mentioned in the Mental Capacity Act (2005) and be recorded in the patient's notes or admission. This audit evaluated the documentation available on the electronic database (Paris) in order to ascertain what information was and wasn't documented. The standard used: “Decision–making and mental capacity”. NICE guideline NH108 (2018) recommendations 1.4 Assessment of mental capacity were used as a standard for this audit. 100% of all admitted patients should have MCA completed during the admission clerking.
MethodsThe data were examined retrospectively from the MCA on admission, available on the electronic health record database (Paris). The audit tool focuses on quantitative data collection on Mental capacity documentation.
A random sample was selected of 15 patients admitted in May, June, September, and October 2022 to the Peter Bruff MH Assessment Unit (male and female). Total 60 patients.
All data were anonymised. Results were tabulated and presented in statistical form back to the clinical teams.
ResultsAll patients who were admitted to the assessment unit were subjected to capacity assessment, consenting to informal admission and acceptance of treatment.
MCA was completed and patients had capacity both on clerking and during the ward review in 85% of cases, (n=61). MCA was completed and 3 % of all patients were found to lack capacity on clerking (n=2). MCA was completed, and patients had the capacity on admission, however, they had no capacity during the review in 5% of cases (n=3). MCA was not completed, or the information was unavailable, for 7% of the cohort (n=4).
Capacity to consent is specific to a decision and can vary over time; a patient is therefore competent or not with respect to a specific decision and for a given moment in time.
We found that after the clerking assessment, when patients were reviewed by the unit doctor and the consultant, whether on the day of admission or shortly after (in a matter of hours), on several occasions some patients were lacking the capacity to consent to the admission.
ConclusionThe missing link to be identified between the MCA capacity assessment that was carried out by the clerking doctor, compared to the MCA that was conducted by the unit doctor and consultant. This could be a restrictive environment on the unit or less attention paid to the quality of capacity assessment and further training is needed for professionals.