Setting

This audit is relevant for in-patient mental health services where standardised in-patient risk assessment tools are used for all patients admitted to hospital.

Background

The increasing expectation on all mental health professionals to identify, appraise and manage risk has led to the introduction of generic risk assessment forms, which are now used in the majority of trusts in the UK and are often mandatory for all in-patients (Higgins et al, 2005).

Standards

The standard used for this audit comes from the Department of Health's Best Practice in Managing Risk (2007), which advocates the use of tools in risk assessment and management. The standard should be that all psychiatric inpatients have adequately completed risk assessment forms.

Method

Data collection

The case notes of all current in-patients on a specified day were reviewed. A standardised form was used to collect anonymised data on the following variables:

ᐅ patient age and gender

ᐅ date and time of admission and admission ward

ᐅ detention status

ᐅ admitting doctor

ᐅ presence of an adequately completed risk assessment tool.

Data analysis

The main outcome measure was the percentage of in-patients with an adequately completed risk assessment form. This ranged from a fully completed form, to an incomplete form, to no form at all. Data were collected on how well each section of the form was completed so that deficiencies in particular areas could be highlighted. Chi-squared tests were used to determine the relationship between incomplete forms and variables such as patient age, gender, admission ward, date and time of admission, detention status and admitting doctor.

Resources required

People

The number of people involved will depend on the number of wards that are included in the audit. If the risk tool is used across a number of hospitals in a trust, then it would be useful to audit all of these hospitals at the same time, which would need more than one person.

Time

It is estimated that at least 6 hours should be dedicated to reviewing the case notes of 40 in-patients.

Results

The percentage of fully completed risk assessment forms was low. There was no association between rates of completion of forms and whether the form was completed during working hours or out of hours, the detention status of the patient or the gender of the patient.