Appendix D: Technical detail on the criteria for audit

Appendix D: Technical detail on the criteria for audit

Objectives for the audit

One or more audits can be carried out in different care settings to ensure that:

  • individuals who self-harm are involved in their care

  • treatment options are appropriately offered and provided for individuals who self-harm.

Individuals to be included in an audit

A single audit could include all individuals who self-harm. Alternatively, individual audits could be undertaken on specific groups of individuals such as:

  • people who self-poison or self-injure

  • a sample of people from particular populations in primary care.

Measures that could be used as a basis for an audit

See following table.

Standards

Criteria

Audit methods

1. Staff show respect and understanding to people who self-harm and present to an emergency department

1.1 People who self-harm and present to an emergency department report that they:

  • are treated respectfully

  • are given full information about their treatment and care

  • are fully involved in decisions about their treatment and care

  • are provided with written information about relevant local services

Survey of a consecutive series of people attending an emergency department after self-harm

2. Trusts provide appropriate training for healthcare staff who have contact with people who self-harm

2.1 Training includes:

  • the problems faced by people who self-harm when they have contact with services

  • an exploration of some of the meanings of and motives for self-harm

  • capacity and consent in relation to self-harm

  • assessment of people who self-harm

  • early management, including the use of activated charcoal

  • the content of the NICE guideline

A. Review of trusts' training records

B. Survey staff perceptions of the quality of training

3. Activated charcoal should be immediately available to ambulance and emergency department staff involved in the care of people who have self-harmed by poisoning at all times

3.1 Ambulance crews give activated charcoal at the earliest opportunity and within 1 hour following ingestion to a person who has self-poisoned

3.2 Emergency department staff give activated charcoal at the earliest opportunity and within 1 hour following ingestion to a person who has self-poisoned (unless administered previously)

3.3 Emergency department staff give activated charcoal between 1 and 2 hours of ingestion to people who have self-poisoned and are at risk of significant harm

Review of Ambulance staff/emergency department records of consecutive series of patients assessed by ambulance/emergency department staff

4. Healthcare staff who have first contact with people who self-harm conduct an adequate initial assessment

4.1 Ambulance staff who attend a person who has self-harmed record:

  • information about home environment

  • social and family support network

  • history leading to self-harm

  • patient's emotional state and level of distress

4.2 Ambulance staff collect all substances and medications found at the scene

4.3 The triage assessment in the emergency department includes:

  • capacity and willingness to stay and accept treatment

  • needs for physical care

  • need for urgent psychosocial and/or psychiatric assessment (the use of a standardised mental health triage system such as the Australian Mental Health Triage Scale would fulfil this criterion)

4.4 The triage assessment takes account of information provided by the ambulance staff if they were involved in conveying the person to hospital

Review of written ambulance staff/triage nurse assessments of consecutive series of patients who attend emergency department having self-harmed

5. Emergency departments have appropriate facilities for the care of people who have self-harmed

5.1 Emergency departments offer people who have self-harmed the option of waiting for treatment in an environment that is safe, supportive and that minimises distress. This must include regular contact with a named member of staff

Survey of a consecutive series of people attending an emergency department after self-harm

6. Healthcare staff offer treatment for the physical consequences of self-harm, regardless of the patient's willingness to accept psychosocial assessment or psychiatric treatment

6.1 Physical treatment includes:

  • wound assessment

  • adequate anaesthesia and/or analgesia, to be reassessed throughout treatment

  • tissue adhesive

  • sedation

Survey of a consecutive series of people attending an emergency department after self-injury

7. Healthcare professionals offer full information about the treatment options

7.1 Healthcare staff who attend a person who has self-harmed make all efforts necessary to ensure that someone who has self-harmed can give, and has the opportunity to give, meaningful and informed consent before any and each procedure or treatment is initiated

Survey of a consecutive series of people attending an emergency department after self-harm

8. A healthcare professional conducts and records a comprehensive assessment of psychosocial needs for every person who self-harms and presents to the health service

8.1 The needs assessment includes:

  • social situation (living arrangements, work, debt)

  • personal relationships

  • recent life events and current difficulties

  • psychiatric history (including previous self-harm, drug/alcohol use)

  • mental state examination

  • enduring psychological characteristics associated with self-harm

  • motivation for the act

8.2 Decision about referral for further management should be based upon a combined needs and risk assessment

Review of emergency departments/mental health records of consecutive series of patients assessed following an episode of self-harm

9. A healthcare professional conducts and records a comprehensive assessment of risk for every person who self-harms and presents to the health service

9.1 The risk assessment includes:

  • characteristics of the act of self-harm (intent, medical seriousness, use of violent methods, evidence of planning, precautions taken to prevent rescue)

  • characteristics of the person (hopelessness, forensic history, future suicidal intent)

  • circumstances of the person (social class, physical illness, recent bereavement, social isolation)

Review of emergency department/mental health records of consecutive series of patients assessed following an episode of self-harm

Clinicians should review the findings of measurement, identify whether practice can be improved, agree on a plan to achieve any desired improvement and repeat the measurement of actual practice to confirm that the desired improvement is being achieved.