Shared learning database

 
Organisation:
Oxford Health NHS Foundation Trust
Published date:
April 2013

The aim of this re-audit was to identify the performance of the Bicester component of the North Oxfordshire Community Mental health team across a selected number of patient satisfaction questions that are related to patient awareness of CPA. The initial audit was performed in February 2011.

Does the example relate to a general implementation of all NICE guidance?
Yes
Does the example relate to a specific implementation of a specific piece of NICE guidance?
No

Example

Aims and objectives

The aim of this re-audit was to identify the performance of the Bicester component of the North Oxfordshire Community Mental health team across a selected number of patient satisfaction questions that are related to patient awareness of CPA. A communication issue between service users and care coordinators was identified in the initial audit. Certain changes in the delivery of the CPA in order to sign post this issue were recommended. Across the audit criteria the standard to be attained was placed at 95% positive responses by patients across all individual items.

Reasons for implementing your project

Patient and carer satisfaction are a key quality measure for NHS service provision. Indeed an annual survey - the National NHS Community mental Health Survey - is undertaken on their opinions. A key component of the survey is patient awareness of CPA (CPA being the touchstone of patient care and service delivery within mental health services).

The National Institute for Health and Clinical Excellence (NICE) produced a clinical guidance CG136 which aims at improving the service users experience in mental health services.

How did you implement the project

Methodology:
The initial audit identified a communication issue between the service users and care coordinators in four of the seven issues in question. This was discussed at a meeting with the care coordinators where the audit was presented. The recommendations were that:
care coordinators would include physical health and substance misuse issues in draft CPA plans and signpost to service users that the care plan had been agreed and the various components of the care plan. Care coordinators identified further good practice in that they would meet with patients to prepare care plans prior to the formal CPA meeting with all professionals.

In the re-audit we tried to see if the changes recommended have resulted in improvement in the following domains:
1. Provision of a written care plan in the last year.
2. CPA meeting in the last year.
3. Whether physical health issues were covered during the regular interviews.
4. Whether drug/alcohol issues were covered during interview.

Some of these domains also match with NICE clinical guidance CG136 quality statements.

Selection:
The first twenty service users who had had their CPA review meetings after 23rd May 2011 were interviewed over the phone. The interviews took place between August and October 2011.


Key findings

Results A table was drawn showing the differences between the results as follows: Sample N=20
Initial audit results /Re-audit results
Provision of a written care plan in the last year:
70% 85%
Care Planning Meeting in the last year:
70% 95%
Whether physical health issues were covered during the regular interviews:
65% 90%
Whether drug/alcohol issues were covered during interview:
65% 90%

Physical health and substance misuse issues were included in all CPA review documents.

Key learning points

1. Continuing the hard work in improving communications with service users.
2. Making the health provision more patient centred.
There was a clear improvement in the communication issues with the service users compared to the initial survey shown by greater awareness of planning across the other three domains (written care plan, physical health and substance misuse issues). While is may be that service users did not recall due to non recall, difficulties with understanding or not reading all the care plan, further reinforcement of signposting across these criteria by care coordinators is required. Of note is that the previous audit showed that the results for the team were higher than those for the trust and national average across these criteria.

Contact details

Name:
Dr Hasnaen Al-Taiar
Job:
Specialty Registrar in Psychiatry
Organisation:
Oxford Health NHS Foundation Trust
Email:
hasanen.al-taiar@oxfordhealth.nhs.uk

Sector:
Tertiary care
Is the example industry-sponsored in any way?
No