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A questionnaire survey of psychiatrists and mental health nurses was conducted to look at their awareness of nurse supplementary prescribing and its impact on patient care.
Response rate was 49.5% for psychiatrists and 23% for nurses. Most nurses (96.2%) and psychiatrists (91%) were aware of nurse supplementary prescribing, but more nurses than psychiatrists felt that it will provide patients quicker access to medication (P=0.023) and improve patient care (P=0.0003). Although two-thirds of the nurses felt confident to be a nurse prescriber, only 13% had actually approached a psychiatrist to be their supervisor. Most psychiatrists (54.4%) did not feel confident to act as supervisors.
Unlike nurses, psychiatrists were cautious about potential benefits of nurse supplementary prescribing on patient care. Both nurses and psychiatrists expressed concerns. As the expansion of nurse prescribing occurs, it is important for trusts to work actively with nurses and psychiatrists to address these concerns.
The assessment and management of risk is central to mental health practice. This is true in all areas, but especially so in acute settings where risk to self or others is a common concern. The role of crisis resolution teams (CRTs) in England is to assess individuals in a crisis situation and offer home treatment as an alternative to hospital admission where possible. When home treatment is contemplated, risks of suicide, aggression, severe self-neglect and reckless behaviour need to be carefully assessed and decisions made about whether home treatment is likely to be safe. Strategies for monitoring and minimising risk in community settings need to be put in place to enable safe, but responsive, care to be provided. This chapter summarises research on risk in home treatment services and provides guidelines for assessing, monitoring and managing risk to service users, carers, professionals and the community.
The CRTs act as gatekeepers to inpatient services (Department of Health, 2002) and hence work with individuals who, by definition, are potentially in need of high levels of support and care and are likely to present high levels of risk to themselves or, more rarely, to others. There is no evidence to date of increased risk of suicide or violence associated with the use of crisis services as opposed to more traditional approaches such as hospital admission.
A postal questionnaire survey was conducted of the directors of nursing of all mental health NHS trusts in England, in order to examine current activities and attitudes regarding nurse supplementary prescribing (NSP) in psychiatric settings.
Fifty-four per cent of nurse directors returned the questionnaire. They perceived that NSP was an important means for improving patient care and treatment, particularly in community settings. In their opinion, psychiatrists were generally not opposed to its introduction. To date, relatively few mental health nurses have received training in NSP.
Directors of nursing have positive views and experiences of NSP. Widespread implementation of NSP is likely to occur over the next few years and psychiatrists will need to consider how this will impact on their role.
Demographic and clinical details were recorded for individuals with first-episode psychosis, potentially requiring hospital admission, who were assessed by two home treatment/crisis resolution teams over an 18-month period. The aims were to identify the proportion of such individuals that can be treated at home, factors associated with successful home treatment and reasons for hospitalisation when this took place.
Successful home management was achieved in 20 (54%) of cases. No significant difference was found in any demographic variable, diagnostic category and initial Brief Psychiatric Rating Scale (BPRS) ratings between those who were hospitalised and those who were not. The most common reason recorded for admission was that of risk to self.
Many patients with first-episode psychosis otherwise requiring hospitalisation can be managed successfully at home by an intensive home-treatment team. These findings have significant implications for both in-patient and community services, in view of the planned increases in home treatment/crisis resolution services proposed in the NHS Plan.
A community treatment team, offering rapid assessment and intensive home treatment as an alternative to admission is described. The relationship between diagnosis and outcome was examined, in terms of initial ‘take on’ rates, admissions to in-patient areas at both initial assessment and subsequently.
There was a significant relationship between diagnosis and outcome, with marked variation between diagnostic categories.
Home treatment teams prevent admissions with the majority of people from all diagnostic groups, but less successfully with people with personality disorder.
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