Transcript Quality of Risk Assessments Across Scotland

Introduction
 Restricted patients
 The importance of the RMO annual report
 Most reports are of a high standard
 Reminder: risk assessments!
Restricted Patient Annual
Report Completion
Jan-July 2014
Dr Jackie Drummond
ST6 in Forensic Psychiatry
22nd May 2015
Background
 Responsible Medical Officers (RMOs) are required to provide
Annual Reports for restricted patients (CORO, TTD, HD)
 Memorandum of Procedure (MoP) (2010) contains a
template
 Some Annual Reports not aligned to template, have unclear
opinions or opinion is not supported by any justification
 Since 2012, RMOs have been notified by the Restricted
Patient Team if their report is deemed not to meet the
standards outlined in the MoP
 RMOs given 4 weeks to amend, and if not satisfactory the
Restricted Patient Team will contact their Medical Director
 Audit completed at the request of the PMO and Restricted
Patient Team to evaluate whether or not RMOs were using
the template and how complete reports are
Method
 All annual reports submitted in first 7 months of
2014
 Files obtained
 Compared content and layout of annual reports to
MoP template
 Recorded
 Timeliness of reports
 Whether data was present or missing, using
Microsoft Excel
 Did RMO appear to be using the MoP template?
Sample
 154 reports
 10 NHS health boards, 3 private providers
 Security levels
 High – 45
 Medium – 41
 Low/other ward – 42
 CD – 26
 Orders
 CORO – 132 (inc. CD)
 TTD – 20
 HD – 1
 TTD + ICO – 1
Results
 Reports on time/overdue
 On time – 84
 Late – 68
 Unknown – 2 (date received not clear from file)
 Late reports
 Range from 1-52 days late
Results
 Assessed completion of 25 items as detailed in MoP
template (excluding patient name and DoB)
Patient details
Diagnosis and
Treatment
Risk Management
Opinion and
Recommendations
1. CHI/Hosp. no
8. Diagnosis
16. Date RMP
updated
24. Legal tests
2. Legal status
9. Mental state
17. Amber/red
incidents
25. Level of security
3. Index offence
10. Activities
18. Adverse incidents
4. Date of original
order
11. Progress
19. Change in level of
risk
5. Date of renewal
12. Treatment
20. Media/victim
issues
6. Date of tribunal
13. Compliance
21. Drug and alcohol
issues
7. MAPPA level
14. Changes in
circumstances
22. Dates and results
of testing
15. Response to SUS
23. CPA minutes
Results
 Section 1 - Patient details
 All reports contained patient name and DoB
Yes
Yes (in body of
text)
No
% of
reports
with data
missing
CHI/Hosp. no
146
0
8
5.1%
Legal status
148
4
1 (+1 wrong) 1.3%
Index offence
115
16
23
14.9%
Date of
original order
134
7
13
8.4%
Date of
renewal
97
2
55
35.7%
Date of
tribunal
29
3
118
76.6%
MAPPA level
104
2
48
31.2%
Results
 Section 2 – Diagnosis and treatment
Yes
Yes (in body of text)
No
% of reports
with data
missing
Current Dx
118
33
3
1.9%
Current mental
state
90
47
15 (+ ‘stable’
x2)
11%
Activities
81
43
30
19.4%
Progress since
last report
101
48
5
3.2%
Treatment
76
58
20
13%
Compliance
60
69
25
16.2%
Changes in
circumstances
61
56
37
24%
Response to SUS
(where applicable)
47
45
36
28.1%
Results
 Section 3 – Risk Management
Yes
Yes (in body
of text)
No
% of reports with
data missing
Date RMP updated
88
-
66
42.9%
Amber/red incident
details
59
42
53
34.4%
Other adverse event
details
60
73
21
13.6%
Change in level of
risk
55
15
84
54.5%
Media/victim issues
62
25
67
43.5%
Issues with D&A
66
49
39
25.3%
Dates and results of
testing
62
19
73
47.4%
CPA minutes
enclosed?
108
-
46
29.9%
Results
 Section 4 – Opinion and Recommendation
Yes
Explained?
No
% of reports
with data
missing
Mental disorder
153
Yes in 45, Dx only in
106, no in 2
1
0.65%
Serious harm
138
Yes in 107, no in 31
16 (inc. 4
TTDs)
10.4%
Medical treatment*
153
Yes in 140, no in 12
1
0.65%
Significant risk*
151
Yes in 128, no in 23
2
1.31%
CO(TTD/HD) necessity*
152
Yes in 128, no in 24
1
0.65%
RO necessity (where
applicable - 132)*
130
Yes in 111, no in 19
1
0.76%
Detention in hospital (N/A in 26
CDs - 128)
121
Yes in 106, no in 15
7
5.5%
Special security
(N/A in 26 CDs - 128)
79
Yes in 53, no in 26
49
38.3%
Other security (N/A in 71
CD/special security – 86)
65
Yes in 50, no in 15
18
20.9%
Results
 Legal tests – 22 reports (14.4%) did not address all legal
tests. 1 report had page missing from file
 Level of security – 19 inpatient reports (14.8%) did not
mention either category of security level
 Use of the Annual Report template as provided in the MoP




Exactly as per template – 48
Yes but with fewer headings – 44
Yes but with more headings – 13
Does not appear to follow template – 49
 Overall, use of template apparent in 68.2%
Patient details
Diagnosis and
Treatment
Risk Management
Opinion and
Recommendations
1. CHI/Hosp. no
8. Diagnosis
16. Date RMP
updated
24. Legal tests
2. Legal status
9. Mental state
17. Amber/red
incidents
25. Level of security
3. Index offence
10. Activities
18. Adverse incidents
4. Date of original
order
11. Progress
19. Change in level of
risk
5. Date of renewal
12. Treatment
20. Media/victim
issues
6. Date of tribunal
13. Compliance
21. Drug and alcohol
issues
7. MAPPA level
14. Changes in
circumstances
22. Dates and results
of testing
15. Response to SUS
23. CPA minutes
Assessment of Completeness
Patient details
Diagnosis and
treatment
Risk management
Discussion
 Majority of clinicians appear to be using Annual Report
template (68.2%)
 Just over half of Annual Reports are received on time (54.5%)
 Most reports contain most of the information required!
 Items which are most frequently missing are tribunal date, date
of Risk Management Plan update, changes in level of risk and
dates and results of alcohol/drug tests
 49 reports state all test negative but no dates provided
(although for purpose of audit information was considered to
be present if report indicated that testing had been completed)
Discussion
 Legal test which was most frequently not addressed
was the ‘serious harm test’
 The section which is least fully completed is the Risk
Management section
 Mean % completion
 Section 1 – Patient details - 75.3%
 Section 2 – Diagnosis and Treatment - 85.4%
 Section 3 – Risk Management - 63.6%
 Section 4 – Legal tests and Security Level - 85.4%
 MoP is in process of being revised – an opportunity
for RMOs to provide feedback on the Annual Report
template!
Conclusion
 Quality of Annual Reports remains variable, but overall the
majority of reports contain most of the required information!
 The standard template appears to have been adopted by
most clinicians
 The least fully completed section is Risk Management
 It is helpful to provide some explanation of how the legal
tests are considered to be met (or not)
 A well written Annual Report is of value to the clinician as
well as the Restricted Patient Team – a worthwhile time
investment when facing a potentially difficult tribunal!