Setting

This audit applies to all home treatment teams (HTTs) which use care plans based on the care programme approach (CPA) to guide treatment. By adapting the standards, the documents produced by a community mental health team (CMHT) could be similarly audited.

Background

The CPA process was launched in 1992 to guide more patient-focused mental health provision. The interpretation of how to document care plans varies between services, with some using clearly defined forms and others allowing a less rigid structure. The essence of care planning is to organise service delivery around what the patient needs and wants, and to make sure this is reviewed regularly.

Standards

The expected contents of a CPA care plan are not rigidly defined. The 2006 Department of Health policy booklet suggests that they should:

ᐅ identify the interventions and anticipated outcomes

ᐅ record all the actions necessary to achieve the agreed goals

ᐅ give an estimated time by which the outcomes or goals will be achieved or reviewed

ᐅ detail the contributions of all the agencies involved

ᐅ include appropriate crisis and contingency plans. Based on this document, a list of standards was drawn up (to apply in all cases):

ᐅ A care plan should be present for all patients.

ᐅ Care plans should be completed within 24 hours of admission to the service.

ᐅ Care plans should include sections covering:

ᐅ A record should be present regarding whether the patient has received a copy of the care plan.

As the patient would already be under the most intensive community treatment service, crisis plans were not considered a necessity.

Method

Data collection

Notes from all admissions to the home treatment service were obtained and care plans extracted. Data were collected for all patients on the case-load at a set point in time.

Data analysis

For each of the above points, recording involved yes/no answers only and data were presented as proportions of the total case-load.