Recent policy changes has meant Community Mental Health Teams are now referred clients with eating disorders in our Trust. It was unclear how these clients were managed in this setting and what knowledge CMHT's had in relation to specialist and voluntary sector services. This audit used a vignette approach to identify gaps in knowledge and quantify the scale of the problem in terms of treatment and referral pattern.
Sheffield Health and Social Care FT (SHSCFT)
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?
The NICE guidance on the management of eating disorders (anorexia nervosa, bulimia nervosa and related eating disorders) was published in 2004. In common with procedures for NICE implementation for SHSCFT, a guideline group has been established to oversee the process. We established an electronic online audit using a case based vignette approach in order to determine current practice with eating disorders clients managed by Community Mental Health Teams (CMHT's). 1] To understand CMHT's treatment approach with these clients 2] To indentify significant variation in treatment options/patterns 3] To identify CMHT's needs to improve management of this client group
The NICE guidance on the management of eating disorders (anorexia nervosa, bulimia nervosa and related eating disorders) was published in 2004. In common with procedures for NICE implementation for SHSCFT, a guideline group has been established to oversee the process. The Sheffield Eating Disorders Service (SEDS) works closely with the University Health Service and South Yorkshire Eating Disorders service and voluntary organisations who have considerable experience with managing this client group. Following changes in the referral pathway, Community Mental Health Teams (CMHT's) now refer into SEDS but it is unclear how many clients are seen in the community who are referred with an eating disorders problem and the degree to which CMHT's are familiar with this client group. To begin to understand the current situation; a baseline audit was implemented with CMHT's using a case based vignette approach. The vignettes were designed to represent cases of increasing severity. Responses should map to this in relation to NICE guidance in terms of the provision of treatment.
1]The approach identified significant variation in the overall treatment approaches. Some teams referred low severity cases to specialist services, while other suggested self help options and referral back to the general practitioner for example. 2] There was significant variation in treatment options across teams for the same case vignette. Suggesting CMHT's may be behaving autonomously in this respect. 3]Some individuals within teams had not used specialist services 4] Some expressed lack of confidence/experience with this client group 5] There was a clear demand for specialist training in this area 6] There was a need identified for better coordination between agencies
The guideline group has now met to discuss the implications of this work. Training has been identified as a key requirement. The audit tool is designed to be re-implemented electronically once these initiatives have been progressed.
Vignette based audits provide a rich source of information. They are economical as they can reveal gaps in clinical knowledge, variation in treatment approaches (given each case is identical for each team)and they also give an opportunity for teams/groups to suggest how they would like this to be improved. In this case, some teams volunteered their lack of understanding and familiarity with this client group and indentified training as a significant need. Having identified the problems, improvements can be made and their effect assessed using the same audit tool. As this is a web based approach, this can be achieved efficiently. However, it may be better if teams are fully informed of this approach and methodology in order to maximise the response. In this case, team managers were approached rather than all staff within the teams. Efforts should be made to maximise inclusivity at the early stages. The audit tool has been submitted to the Shared Learning Coordinator via the website.
Sheffield Health and Social Care FT (SHSCFT)
Is the example industry-sponsored in any way?