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Meeting NICE self-harm standards in an accident and emergency department

  • Leah Hughes (a1) and Nick Kosky (a2)
Abstract
Aims and Method

An audit in a general hospital accident and emergency (A&E) department and the subsequent development of a triage process for people presenting with self-harm is described. A random sample of 103 people attending with self-harm were selected and their treatment audited against standards derived from NICE guidelines.

Results

The service provided by the A&E department was sub-standard. Of particular concern was the lack of processes addressing risk assessment and safe discharge. A pro forma was designed with the aim of improving assessment of self-harm. A repeat audit 3 months after introduction of the pro forma showed an improvement in the recording of relevant information underpinning risk assessment.

Clinical Implications

Procedures for those presenting to A&E departments with self-harm may not meet recommended guidelines. The use of a pro forma with staff training can improve risk assessment.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Allen, C. (1995) Helping with deliberate self-harm, some practical guidelines. Journal of Mental Health, 4, 243250.
Barr, W., Leitner, M. & Thomas, J. (2004) Self-harm patients who take early discharge from the accident and emergency department: how do they differ from those who stay? Accident and Emergency Nursing, 12, 108113.
Cheng, A. T. A., Chen, T. H. H., Chen, C., et al (2000) Psychosocial and psychiatric risk factors for suicide: case–control psychological autopsy study. British Journal of Psychiatry, 177, 360365.
Cook, A. (1998) Assessing deliberate self harm, a team approach. Emergency Nurse, 6, 2124.
Cooper, J., Kapur, N., Dunning, J., et al (2006) A clinical tool for assessing risk after self-harm. Annals of Emergency Care, 48, 459466.
Department of Health (1992) The Health of the Nation. TSO (The Stationery Office).
Department of Health (1999) National Service Framework for Mental Health. Department of Health.
Department of Health (2002) National Suicide Prevention Strategy for England. Department of Health.
Eastwick, Z. & Grant, A. (2004) Emotional rescue: deliberate self-harmers and A&E departments. Mental Health Practice, 7, 1216.
Hughes, T. & Owens, D. (1996) Management of suicidal risk. British Journal of Hospital Medicine, 56, 151154.
Lyons, C., Price, P., Embling, S., et al (2000) Suicide risk assessment: a review of procedures. Accident and Emergency Nursing, 8, 178186.
McCann, T., Clark, E., Mcconnachie, S., et al (2006) Accident and emergency nurses' attitudes towards patients who self-harm. Accident and Emergency Nursing, 14, 410.
National Institute for Clinical Excellence (2004) Self-Harm. The Short-term Physical Management and Secondary Prevention of Self-Harm in Primary and Secondary Care. NICE.
Owens, D. (2006) Services for assessment and aftercare following self-harm. Psychiatry, 5, 271274.
Pennycook, A., Mcnaughton, G. & Hogg, F. (1992) Irregular discharge against medical advice from the accident and emergency department – a cause for concern. Archives of Emergency Medicine, 9, 230238.
Royal College of Psychiatrists & British Association for Accident and Emergency Medicine (2004) Psychiatric Services to Accident and Emergency Departments (Council Report CR118). Royal College of Psychiatrists & British Association for Accident and Emergency Medicine.
Simpson, A. (2006) Can mainstream health services provide a meaningful care for people who self-harm? A critical reflection. Journal of Psychiatric and Mental Health Nursing, 13, 429436.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Meeting NICE self-harm standards in an accident and emergency department

  • Leah Hughes (a1) and Nick Kosky (a2)
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eLetters

Assessment of self harm in A & E

Shalini Agrawal, SHO in Psychiatry
26 July 2007

The audit by Hughes et al makes for impressive reading. The results of using a specific proforma for self-harm behaviour in A & Eare very obvious from this article.

However there are limitations to applying these kinds of tools specially in day-to-day practice. It is not clear from the article how much extra time and effort it took to fill in these forms. Another good indicator would be the user friendliness of this proforma and staff attitude towards filling in these forms.

From the viewpoint of a psychiatric SHO covering busy A & E departments, it would be very useful to receive appropriate referrals withsome psychiatric assessment done before referral. There can be prejudice in A & E when dealing with patients presenting with self-harm. The A & E staff sometimes feel that they have to deal with physical problemsonly and the rest is up to the psychiatrist. Also some of our clients, whohave a pattern of repeated self-harm, build a reputation for themselves inlocal A & E departments.

The difficulty is in designing a proforma for the range of mental health problems that people present with. The other risk is too much reliance on the scores rather than the mental state of the patient, which might give obvious clues not made evident by scores.

Although completing such proforma does improve clinical practice, what is more important is to change the attitudes and perceptions of staffdealing with people presenting with not just self harm but with any link to mental health services.
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Conflict of interest: None Declared

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