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 Assessing violence risk in general adult psychiatry

2005 ◽  
Vol 29 (4) ◽  
pp. 131-133 ◽  
Author(s):  
Nicola Higgins ◽  
David Watts ◽  
Jonathan Bindman ◽  
Mike Slade ◽  
Graham Thornicroft
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Content Analysis ◽  
Current Practice ◽  
Clinical Implications ◽  
Violence Risk ◽  
Assessment Practice ◽  
Adult Psychiatry ◽  
Harm To Others ◽  
Current Risk

Aims and MethodWe aimed to establish current practice in the risk assessment of harm to others within general adult psychiatry and review risk assessment documentation in use. Consultants working across 66 randomly selected trusts across England were surveyed. A qualitative analysis of risk assessment documentation was carried out.ResultsData were obtained from 45 trusts (68%). Consultants reported that 30 (67%) of the trusts had standardised forms for risk assessment. Forty-one forms were subjected to content analysis. Wide variation was found in the methods used to identify risk factors and in approaches to quantifying risk.Clinical ImplicationsCurrent risk assessment practice is highly variable, indicating a lack of consensus about suitable methods.

scholarly journals Introducing a nurse-led deliberate self-harm assessment service

2001 ◽  
Vol 25 (6) ◽  
pp. 212-214 ◽  
Author(s):  
Gill Griffin ◽  
Jonathan I. Bisson
Keyword(s):  
Mental Health ◽  
Training Needs ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Mental Health Nurses ◽  
Deliberate Self Harm ◽  
Mental Health Nurse ◽  
Health Nurse ◽  
Nurse Assessment ◽  
Self Harm

Aims and MethodThis study considered patients admitted to hospital following deliberate self-poisoning. The characteristics of the patients and the outcomes of assessments by trainee psychiatrists and a mental health nurse were compared.ResultsThere were no significant differences in the outcome of 68 assessments performed by a trainee psychiatrist and 77 by a mental health nurse. The nurse assessment service was well-received by the poisons unit, a medical ward specialising in overdose treatment, and trainee psychiatrists.Clinical ImplicationsPsychosocial assessments following self-poisoning can be provided by appropriately trained and supervised mental health nurses. The introduction of a nurse-led service should enhance relationships with the local poisons unit and reduce the workload of junior doctors without compromising their training needs.

scholarly journals Practical training in the administration of ECT

1998 ◽  
Vol 22 (10) ◽  
pp. 633-634
Author(s):  
Richard Barnes ◽  
David Kingsley
Keyword(s):  
Electroconvulsive Therapy ◽  
Training Programme ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Practical Training ◽  
Significant Positive Effect ◽  
Training Device ◽  
Positive Effect ◽  
The Way

Aims and methodElectroconvulsive therapy (ECT) Is widely used In Britain and in most cases is administered by junior doctors. Many are inexperienced in its administration and the variety of machines available makes acquiring experience difficult. This report discusses a unique training programme involving a specially constructed ‘dummy patient’.ResultsThis allows trainees to experience the practical administration of ECT and also learn in detail about the working of the ECT machine and the interpretation of electroencephalograms prior to giving treatment to patients.Clinical implicationsWe believe this training device will have a significant positive effect on the way junior doctors are trained in ECT.

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.

scholarly journals Junior doctors are performing fewer emergency assessments – a cause for concern

2010 ◽  
Vol 34 (7) ◽  
pp. 268-270 ◽  
Author(s):  
Linda Waddell ◽  
Colin Crawford
Keyword(s):  
Risk Assessment ◽  
Clinical Implications ◽  
Junior Doctors ◽  
Management Planning ◽  
Risk Assessment And Management

Aims and methodDue to concerns regarding the reduced exposure of junior trainees to risk assessment, we have examined emergency assessments carried out in Forth Valley, Scotland, during a 4-month period to ascertain the assessor, time of assessment and outcome.ResultsDuring the 4 months of the audit, an average of 13 emergency psychiatric assessments were carried out by each trainee. The majority of these assessments occurred overnight (81%).Clinical implicationsExperience of emergency assessments by trainees was limited and tended to occur during on-call periods when there is little chance for teaching. With this limited exposure, trainees are missing out on valuable experience in emergency risk assessment and management planning.

Risk factors for violence: an audit on the effect of a tutorial on risk assessment

2004 ◽  
Vol 21 (1) ◽  
pp. 28-29
Author(s):  
Frederick Sundrum ◽  
Stephen Browne
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Previous History ◽  
Management Plan ◽  
Case Note ◽  
Adult Psychiatry ◽  
History Of ◽  
Self Harm ◽  
State Examination ◽  
The Ideal

AbstractObjectives: To evaluate the effect of a risk assessment tutorial on the adequacy of case note documentation in a general adult psychiatry setting.Methods: A comparison of case note documentation of risk factors for violence prior to and subsequent to a risk assessment tutorial.Results: Prior to the tutorial there were very low rates of documentation of risk of violence. Subsequent to the tutorial, statistically significant improvements in documentation occurred in approximately one third of the items being assessed. Significant improvements occurred in the following; recording a collateral history (from 18%-36%) and previous history of deliberate self harm (from 24%-50%), noting emotions related to violence in the mental state examination (from 2%-24%) and documenting a risk management plan (from 2%-28%). However, levels of documentation remained overall sub-optimal.Conclusions: Some improvement in case note documentation can result from providing tutorials in risk assessment. However, the ideal format for teaching risk assessment needs to ascertained.

scholarly journals Audit of handover documentation during patient transfers between learning disability psychiatry community teams

2009 ◽  
Vol 33 (9) ◽  
pp. 341-343
Author(s):  
Ömür Budanur Miles
Keyword(s):  
Risk Assessment ◽  
Clinical Implications ◽  
Patient Records ◽  
Patient Transfers ◽  
Complex Needs ◽  
Local Experience ◽  
Crisis Plan ◽  
Concealed Information ◽  
Clear Information

Aims and MethodThe local experience of having to take over the care of patients newly moved to the Bristol area revealed the lack of clear information on their complex needs. Official guidelines do not exist, therefore a consensus list of expected handover information was produced. the records of two patients were analysed in each of the six teams that agreed to be audited. A standardised handover form was devised and introduced (Part 1). Part 2 of the audit was performed 18 months after the implementation of changes to practice.ResultsPart 1 revealed that diagnosis (11/12) and medications (12/12) were the best-documented items during handover correspondence. Follow-up duration (3/12), crisis plan (3/12), professionals involved (0/12) and risk assessment (3/12) if documented were done so only for patients with complex needs. Part 2 showed improved documentation of information (11/11 for the first two items and 10/11 for the remainder).Clinical ImplicationsAbsent or concealed information in patient notes may contribute to disruption to the continuity of care following patient transfers. the use of a succinct, structured and easily distinguishable handover form in patient records may facilitate communication between professionals.

scholarly journals Designing For Sabotage

2002 ◽  
Vol 124 (09) ◽  
pp. 40-44
Author(s):  
Emily M. Smith
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Scientific Data ◽  
Terrorist Organizations ◽  
Engineering Level ◽  
New Applications ◽  
Standard Risk ◽  
The Way ◽  
Technology Advances

This article focuses on a method that engineers have used to make designs failsafe. Safety has always been implicit in design, but without any scientific data to lead the way in countering terrorism, engineers will have to figure out who decides what the terrorists are going to do, and what loads are needed. Gaining an understanding of terrorist organizations combined with some standard risk factors will help engineers determine where counterterrorism applications must be made. Staying ahead of terrorism, on an engineering level, will require engineers to perform continual risk assessment as technology advances, and new applications for existing technology are practiced.

Study of Urban Complex Project’s Risk Identification

2012 ◽  
Vol 209-211 ◽  
pp. 1350-1354
Author(s):  
Zhi Bin Li ◽  
An Shun Cheng ◽  
Hong Juan Deng
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Risk Management ◽  
Risk Evaluation ◽  
Risk Identification ◽  
Urban Life ◽  
Management Theory ◽  
Urban Complex ◽  
The Way

Versatile and high effciency, the urban complex is an intergrated building combining with more than three functions of urban life such as hotel, housing, working, park, commerce, meeting center. As for risk identification, it is the foundation of risk management, and the reference of risk assessment, prevention, monitoring and management. This paper used risk management theory to identify the risk factors of the urban complex, and then established a system of risk factors, hoping to pave the way for the risk evaluation of the urban complex’s development.

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.

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