Book contents
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- 42 Alcohol history
- 43 Care plans in community drug and alcohol teams
- 44 Care programme approach: home treatment teams
- 45 Care programme approach: prisons
- 46 Care programme approach: secondary care
- 47 Confidential waste
- 48 Documentation of the psychiatric history
- 49 Documentation of ward reviews
- 50 Letters to general practitioners
- 51 Medication alerts in electronic patient records
- 52 Risk assessment: forms for in-patients
- 53 Risk assessment: medium-secure unit
- V Service provision
- VI Training
- VII Treatment
- Appendices
53 - Risk assessment: medium-secure unit
from IV - Record-keeping
Published online by Cambridge University Press: 02 January 2018
- Frontmatter
- Contents
- Editors
- Contributors
- Foreword
- Preface
- Introduction
- Completing an audit project
- I Disorders
- II Legislation
- III Physical health
- IV Record-keeping
- 42 Alcohol history
- 43 Care plans in community drug and alcohol teams
- 44 Care programme approach: home treatment teams
- 45 Care programme approach: prisons
- 46 Care programme approach: secondary care
- 47 Confidential waste
- 48 Documentation of the psychiatric history
- 49 Documentation of ward reviews
- 50 Letters to general practitioners
- 51 Medication alerts in electronic patient records
- 52 Risk assessment: forms for in-patients
- 53 Risk assessment: medium-secure unit
- V Service provision
- VI Training
- VII Treatment
- Appendices
Summary
Setting
This audit is particularly relevant in forensic settings but also applies to any adult psychiatric service, both in- and out-patient.
Background
An assessment of the risks posed by patients, whether self-harm, absconding or violence to others, should be recorded in the patient's notes. In the trust audited, these assessments are based on the HCR-20 (Historical Clinical Risk),a 20-item structured clinical risk assessment tool that is widely used in forensic settings (Khiroya et al, 2009).
Standards
The National Institute for Health and Clinical Excellence (NICE) has produced a guideline (2005) on the short-term management of disturbed and violent behaviour in in-patient psychiatric settings. It states that ‘there should be an effective risk assessment and risk management plan … in the case notes of each service user at high risk and that this should be reviewed on a regular basis’. For the purposes of this audit, this was interpreted as all patients having an HCR-20 form in their notes, which had been reviewed within the past 12 months.
Method
Data collection
The medical records of all in-patients on one specific day were reviewed and the following data collected:
ᐅ whether an HCR-20 form was present in the notes
ᐅ whether it had been completed
ᐅ whether it had been reviewed in the past 12 months
ᐅ the number of disciplines involved in the risk assessment (i.e. whether it was a multidisciplinary assessment).
In addition the length of stay of each patient was noted.
This audit was conducted in combination with an audit of risk assessment documentation for the care programme approach (CPA) within the trust.
Data analysis
The percentage of sets of case notes meeting the standards was calculated for:
ᐅ those with an HCR-20 form
ᐅ those that were complete
ᐅ those that had been reviewed in the preceding 12 months.
The number (and nature) of disciplines involved was counted and displayed in a bar chart.
Resources required
People
Depending on the size of the population being studied, this audit would be suitable for one or two people, of any discipline.
Time
About 4 hours should be allowed for an audit of 90 patients.
- Type
- Chapter
- Information
- 101 Recipes for Audit in Psychiatry , pp. 131 - 132Publisher: Royal College of PsychiatristsPrint publication year: 2011