Quality Standards for Liaison Psychiatry Services. Fourth Edition 2014

Transcription

1 Quality Standards fr Liaisn Psychiatry Services Furth Editin 2014 Editrs: Lucy Palmer, Rhanna Cawdrn, Eleanr Pllck, Jim Bltn and Jenna Spink

2 A manual f standards written primarily fr: Prfessinals wh deliver liaisn psychiatry services Cmmissiners Managers Als f interest t: Peple with physical and mental health prblems Carers f peple with physical and mental health prblems Nn-mental health prfessinals in the general hspital Crisis Reslutin/Hme Treatment Teams Out-f-hurs mental health services Researchers Plicy makers Furth Editin: January 2014 Publicatin number: CCQI163 Crrespndence: Lucy Palmer, Rhanna Cawdrn r Ella Pllck Psychiatric Liaisn Accreditatin Netwrk Ryal Cllege f Psychiatrists Centre fr Quality Imprvement 21 Presct Street, Lndn, E1 8BB Tel: / plan@rcpsych.ac.uk This dcument can be dwnladed frm ur website Ryal Cllege f Psychiatrists

3 Cntents Sectin Page Hw t use these standards 3 Intrductin 4 Dmain 1: Cre Standards fr all Adult Teams 9 Cre Cmmissining and Resurces 9 Referral Prcedures 10 Mental Health Assessment and Care Planning 11 Invlving Patients and Carers 15 Cllabrative Wrking in the General Hspital 18 Interfaces with Other Services 20 Staffing, Supprt and Cmmunicatin 21 Quality, Audit and Gvernance 27 Dmain 2: Prviding Emergency Mental Health Care t Adults f all Ages 29 Dmain 3: Prviding Rutine Mental Health Care t Wrking Age Adults 30 Dmain 4: Prviding Rutine Mental Health Care t Older Peple 31 Dmain 5: Prviding Interventins 33 Dmain 6: Prviding Training t Hspital Clleagues 34 Appendix 1: Examples f Training Prvided t Acute Clleagues 36 Appendix 2: Examples f Liaisn Psychiatry Staffing Levels 37 Appendix 3: Examples f assessment rms 42 Appendix 4: Examples f Interventins Recmmended by NICE 44 Appendix 5: Examples f Interventins Recmmended by SIGN 45 Appendix 6: Key t References 46 Appendix 7: Acknwledgements 48 2

4 Hw t use these standards Belw is an explanatin f the varius terms used thrughut this dcument. Fr further infrmatin, please cntact the PLAN team n /2730. N.: this relates t the criterin number. Standard: this describes the verarching aim r value f a particular grup f criteria. Criterin: a mre specific statement explaining what needs t happen. Please nte, in rder t pass a standard, a team must meet the majrity f criteria within it. Standard 1: Liaisn psychiatry services t general hspitals are adequately planned and cmmissined N. Type Criterin Liaisn services are explicitly cmmissined/cntracted against agreed service standards Liaisn services are planned, develped and reviewed by a jint planning frum Ref. ACAD Cmmissining includes prvisin fr lcal advcacy services JOINT Type: this relates t the rating f the standard i.e. Type 1: Failure t meet these criteria wuld result in a significant threat t patient safety, rights r dignity and/r wuld breach the law. Type 2: Criteria that an accredited service wuld be expected t meet. Re Ref: this refers t the surce that inspired r relates clsely t the criterin in questin. Please see Appendix 5 n page 46 fr full details f the references. Type 3: Criteria that an excellent service shuld meet. Sme criteria, thugh very imprtant, are nt the direct respnsibility f the liaisn team and therefre cannt be rated as Type 2 r 3. Please nte Where there are ntes underneath sme criteria (in italics) these are fr additinal guidance. The standards and criteria in this dcument exist t guide best practice and d nt verride the individual respnsibility f a prfessinal t make apprpriate decisins n a case-by-case basis. 3

5 Intrductin What is the Psychiatric Liaisn Accreditatin Netwrk (PLAN)? PLAN is a netwrk f mental health liaisn psychiatry services run by a central prject team at the Ryal Cllege f Psychiatrists Centre fr Quality Imprvement (CCQI). PLAN facilitates quality imprvement and develpment in liaisn psychiatry services thrugh a supprtive peer review netwrk. PLAN is pen t all liaisn psychiatry services in the United Kingdm and Ireland. T speak t a member f the PLAN team, please telephne r plan@rcpsych.ac.uk Each year, mental health liaisn teams are evaluated against the PLAN service standards. Members are expected t take part in self review every year and peer review every tw/three years. What are the benefits f PLAN? The netwrk enables cmmunicatin between services and the sharing f best practice. PLAN supprts members in their endeavrs t imprve and develp, at a pace which suits the individual service. By applying standards develped frm literature reviews and cnsultatins with experts, and using prven quality imprvement methds, PLAN: Recgnises achievement and identifies areas fr imprvement; Raises awareness f the value f liaisn services; Encurages services t cnstantly strive fr imprvement; Prvides funders with the cnfidence t invest in accredited services. The PLAN cycle 7. Annual Members Meeting 1. Agree standards 6. Actin planning 2. Self review 5. Accreditatin decisin 3. External peer review 4. Lcal reprts cmpiled 4

6 Hw have the PLAN standards been develped? The standards were initially develped fllwing a review f the literature and a perid f cnsultatin with varius experts, including: Patients and carers; Liaisn mental health prfessinals, including nurses, psychiatrists, scial wrkers, therapists and psychlgists; Experts frm vluntary sectr rganisatins; Healthcare prfessinals frm emergency departments and general hspital wards; Managers and directrs; Individuals with expertise in quality imprvement research and audit. The cnsultatin prcess invlved a written cnsultatin exercise, expert grup meetings, telephne and discussins and an exercise where peple independently rated the standards. The standards are updated every tw t three years t reflect changes in plicy and legislatin. Hw are the standards measured? The standards are measured in tw stages; the self and peer review. The self review During the self review perid (8-10 weeks), PLAN members are prvided with brief, annymus questinnaires (either nline r n paper) t be cmpleted by: All members f the liaisn team; Prfessinals wh refer patients t the liaisn team; Patients and carers wh have recently been seen by the liaisn team. The liaisn team als reviews a number f case ntes and cmpletes a checklist. Liaisn teams are prvided with bespke tls and guidance ntes. Members are als given an actin planning dcument, and supprt t make imprvements t the service where needed. These changes may be based n the PLAN standards r may have already been in the pipeline. The peer review The peer review is a ne-day visit frm a review team made up f ther liaisn staff as well as a patient r carer. It ffers an pprtunity fr multi-disciplinary and multi-agency discussins, and gaining an insight int ther services. The aim f the peer review is t validate the data frm the self review and recrd any changes that have taken place since the self review. Liaisn prfessinals, referrers, patients and carers are all invited t reflect n the achievements f the liaisn team and discuss hw the service culd be imprved r develped in the future. 5

7 Hw is accreditatin decided? Data frm the self and peer review are cmpiled by the central PLAN team int a summary reprt f the service s strengths and areas fr imprvement. This reprt is then cnsidered by the PLAN Accreditatin Cmmittee (AC), which makes a recmmendatin abut accreditatin status. The liaisn team in questin is prvided with ample pprtunity t cmment n their reprt and infrm the cmmittee f any new develpments t supprt the decisin. Hw many standards must be met t gain accreditatin? There are fur categries f accreditatin status Categry 1: accredited with excellence. The service wuld: meet all Type 1 standards; meet at least 95% f Type 2 standards; meet at least 80% f Type 3 standards, with a clear plan fr hw t achieve the thers; excel in ther areas, such as research, audit r teaching. Categry 2: accredited. The service wuld: meet all Type 1 standards; meet at least 75% f Type 2 standards; meet at least 60% Type 3 standards. Categry 3: accreditatin deferred. The service wuld: fail t meet ne r mre Type 1 standards but demnstrate the capacity t meet these within a reasnable perid f time; fail t meet a substantial number f Type 2 standards but demnstrate the capacity t meet the majrity within a reasnable perid f time. Categry 4: nt accredited. The service wuld: fail t meet ne r mre Type 1 standards and nt demnstrate the capacity t meet these within a reasnable perid f time; fail t meet a substantial number f Type 2 standards and nt demnstrate the capacity t meet these within a reasnable perid f time. 6

8 What happens if a team is nt meeting sufficient numbers f standards? In cases where accreditatin cannt be awarded at the first attempt, the AC wuld nrmally defer the team fr an agreed perid f time and the central PLAN team will prvide the service in questin with advice n hw t meet the standards that need t be addressed. The team will be ffered time and supprt t develp an actin plan and make psitive changes, giving teams the best chance f meeting the standards required. After an agreed perid f time, the PLAN team will fllw this up with the service t determine if the service nw meets sufficient standards t be accredited. Which standards will teams be measured by? PLAN recgnises that functins differ between liaisn teams. The standards in this dcument are therefre laid ut in different dmains accrding t the different functins that liaisn teams perfrm. When teams sign up t PLAN they are asked t infrm us which areas f service they prvide. Teams are then measured against the dmains which apply t them and exempt frm thse which are nt. The dmains are as fllws: Cre standards fr all liaisn teams Prviding rutine mental health care t wrking age adults Prviding rutine mental health care t lder peple (aged 65 and abve) Prviding interventins t patients Prviding training t hspital clleagues Accreditatin certificates and details n the PLAN website will state which dmains each team has and has nt been measured against. They will als state that accreditatin is fr the liaisn team, and nt any ther services, such as ut-f-hurs services. 7

9 Ntes abut the standards Psychiatric liaisn services differ widely in their functin, rganisatin, funding, staffing and levels f service, even within the same Trust r rganisatin. The standards therefre fcus n functin rather than any particular mdel f service delivery. Where standards relate t the satisfactin level f patients, carers, referrers r liaisn staff, the AC expects at least 75% f respnders t respnd psitively if the standard is t be cnsidered met. Fr example, if 20 referrers have been surveyed abut a standard, 15 f them will need t give psitive respnses. Where measurement against the standard is based n the judgment f reviewers, this means that the evidence will be lked at by the PLAN central team, the peer reviewer visitrs, the PLAN Accreditatin Cmmittee, r any cmbinatin f the abve. Many f the standards relating t patient invlvement assume that the patient in questin has the required capacity t engage in their treatment and understand the infrmatin being prvided. In sme situatins, this may nt be the case and the PLAN prcess will take this int accunt. In rder t meet these standards, teams perating acrss multiple sites must be able t demnstrate a cnsistently high service n all sites. Fr example, the standards arund assessment facilities need t be met at all sites with emergency departments that the team perates at. The standards and criteria in this dcument exist t guide best practice and d nt verride the individual respnsibility f a prfessinal t make apprpriate decisins n a case-by-case basis. Healthcare prfessinals shuld adhere t the cde f cnducts established by their wn gverning prfessinal bdy (fr example the Nursing and Midwifery Cuncil, the General Medical Assciatin etc). Organisatinal and persnal interests must never be allwed t utweigh the duty t be hnest, pen and truthful. 8

10 Dmain 1: Cre standards fr all Liaisn Services (Wrking-age and Older Adults) Cre Cmmissining and Resurces Standard 1: Liaisn psychiatry services t general hspitals are adequately planned, cmmissined/cntracted and managed N. Type. Criterin Ref Liaisn services are explicitly cmmissined/cntracted against agreed service standards. ACAD Nte: This is detailed in the Service Level Agreement (SLA) Operatinal Plicy, r equivalent dcument and has been agreed by funders The liaisn service is cmmissined/cntracted t prvide emergency/urgent assessment and treatment t adults f all ages thrughut the hspital. Nte: If care is nly prvided t ne age grup then PLAN members will be asked t specify wh prvides care t the ther age grup The liaisn service is cmmissined/cntracted t prvide emergency/urgent care t all patients, regardless f the patient s address. Please nte: Standards relating t the cmmissining f mental health care fr wrking age adults can be fund n page 29. Standards relating t the cmmissining f mental health care fr lder peple can be fund n page 30. Standard 2: The liaisn team has access t essential facilities and resurces N. Type. Criterin Ref The liaisn team has ffice space which is fit fr purpse, with essential facilities such as cmputers, telephne and the internet The liaisn team has an additinal breakut rm fr cnfidential activities such as supervisin. PIG 9

11 Referral Prcedures Standard 3: The liaisn team prvides an effective service t referrers N. Type. Criterin Ref The liaisn team prvides referrers with infrmatin n hw t refer patients t the liaisn team (and if applicable, wh t cntact ut-f-hurs) Referrers are satisfied with the cmmunicatin prvided by the liaisn team between initial referral and assessment. Nte: This includes updates n waiting times and any delays and telephne advice t the referrer Referrers are satisfied with the infrmatin prvided by the liaisn team after the assessment Referrers are satisfied with the time it takes t receive a senir pinin frm the liaisn team when required Referrers are satisfied with the amunt f mental health input prvided within the liaisn team s wrking hurs Liaisn prfessinals practively seek referrals and raise awareness f the liaisn functin, fr example thrugh visiting wards, prviding staff training and prmting the liaisn team at multi-disciplinary meetings. Nte: It is acknwledged that this is nt practical fr small r ver stretched teams but this shuld be a lng term aspiratin There is a clear pathway fr referrers t access advice frm a cnsultant psychiatrist, where needed, during the liaisn team s nrmal wrking hurs. JOINT ACAD Nte: This may be thrugh the liaisn team r thrugh anther mental health service Referrers are satisfied with the referral prcess. 10

12 Mental Health Assessment and Care Planning Standard 4: Mental health assessments take place in an apprpriate and safe envirnment Teams perating acrss multiple sites must have access t acceptable facilities at all sites. Sufficient private space shuld exist t ensure that patients and liaisn staff d nt have t travel far thrugh the hspital t find a rm suitable fr assessment. The use f a curtain arund a patient s bed des nt ensure privacy and shuld nly be used rarely, and as a last resrt, i.e. if there is significant risk and n safe alternative rm, r if it is nt physically pssible fr the patient t be mved t a mre private setting. N. Type. Criterin Ref The liaisn team, patients and reviewers agree that assessment rms are sufficiently private. PIG Nte: Facilities shuld be private enugh s that cnversatins cannt be easily verheard and that sme visible privacy is prvided. Large windws that have n cver and are in full view f passers-by d nt ffer sufficient patient privacy. (See Appendix 3 fr examples f PLAN cmpliant assessment rms) The liaisn team has a prcedure fr estimating the level f risk invlved in cnducting an assessment (i.e. checking past ntes, liaising with ther clleagues) The liaisn team has a clear prcedure fr managing high risk assessments. Nte: Written guidance shuld include: A descriptin f suitable facilities fr high risk assessment in the emergency department/medical assessment unit (see 4.4); Arrangements fr alerting acute clleagues that the assessment is taking place, including where it is taking place; Guidance n the frequency f checks and bservatins, depending n the nature f the cncern; Agreements abut mre experienced liaisn r acute staff being present during the assessment, if apprpriate; Agreements fr invlving security staff where needed; 11

13 4.4 1 The liaisn team has access t facilities and equipment fr cnducting high risk assessments. Facilities shuld: ASS T a) Be lcated within the main emergency department; b) Have at least ne dr which pens utwards and is nt lckable frm the inside; c) Have an bservatin panel r windw which allws staff frm utside the rm t check n the patient r staff member. A cmmn and effective apprach is t use windws with built-in adjustable blinds, which allw partial viewing f the rm and the ptin fr staff t view the rm fully if a situatin requires it, whilst still ffering a degree f patient privacy. Anther apprach is t use bscured glass t prvide privacy, in which case a small sectin f this must be clear s that staff can still lk in if needed. d) Have a panic buttn r alarm system (unless staff carry alarms at all times); e) Only include furniture, fittings and equipment which are unlikely t be used t cause harm r injury t the patient r staff member. Fr example, sinks, sharpedged furniture, lightweight chairs, tables, cables, televisins r anything else that culd be used t cause harm r as a missile are nt permitted; f) Nt have any ligature pints. Nte: Whilst nt mandatry fr accreditatin, PLAN highly recmmends that assessment facilities shuld have tw drs t prvide additinal security. All new assessment rms must be designed with tw drs. 12

14 Standard 5: Mental health assessments are cmprehensive, supprtive and fcus n patient needs N. Type. Criterin Ref Liaisn staff and patients are satisfied with the length f time spent n mental health assessments Reviewers agree that patients plans f care r discharge are well cnstructed and clearly dcumented. Nte: Plans shuld: Demnstrate that the assessr has made effrts t access past ntes; Include a clear frmulatin r diagnsis; Indicate a care/discharge plan which aims t address prblems and needs, and builds n the patient s (and carer s) prtective factrs and strengths Reviewers agree that patients plans f care r discharge are cmmunicated t ther services in a timely manner. PIG PIG PIG Nte: I.e. fr high risk cases, n the same day; fr thers, within 7 wrking days If the patient presents with a cmpanin, the patient is ffered the chice f them being present during the assessment. SH Nte: If invlving carers, it is gd practice fr the assessr t spend time alne with the patient first, t ensure that the patient can speak privately. In ther cases, where the carer wishes t speak t the assessr in private, this shuld als be facilitated (with the patient s permissin) The liaisn team is able t cnduct dementia assessments, r signpst patients t a service that can d s. NICE1 Nte: Peple wh are assessed fr the pssibility f dementia shuld be asked if they wish t knw the diagnsis and they shuld be asked with whm the utcme shuld be shared. 13

15 Standard 6: Assessment includes cnsideratin f issues arund risk and mental capacity N. Type. Criterin Ref Assessment f the patient s risk (t self and thers) is judged by reviewers t be clearly dcumented. Nte: The risk assessment may include sme f the fllwing: Harm t self - i.e. current suicidal intent, hpelessness, ability t resist suicidal thughts, depressin and selfneglect; Vulnerability - e.g. risk factrs fr lder peple and the prtectin f vulnerable adults, including peple with learning disabilities; Triggers t symptms and behaviurs; Deteriratin; Abscnding; Nn-adherence t treatment; Harm t thers, including child prtectin issues The liaisn team has a written plicy n managing different levels f risk. PIG CWP Nte: This is likely t include: Develping a risk management plan; Prcedures and timescales fr cmmunicating the plan t relevant clleagues Where risk has been established, the assessr recrds a risk management plan in the case ntes and cmmunicates this with clleagues Liaisn prfessinals are available t advise clleagues n issues arund mental capacity. PIG Nte: It is nt the sle respnsibility f the liaisn team t assess mental capacity; this shuld be undertaken by the medical prfessinal prpsing the actin being taken. Hwever, in cmplex r brderline cases, the liaisn prfessinal may be able t ffer valuable insight, and shuld endeavur t d s The liaisn team can access advcacy services, including PALS, Independent Mental Health Advcates, Independent Mental Capacity Advcates and Mental Health Act advcates. 14

16 Invlving Patients and Carers Nte: The default psitin shuld be t invlve the patient as fully as pssible. It is acknwledged that there are ccasins where patients cannt be fully invlved and infrmed (i.e. where it wuld cause distress, r where the patient lacks the capacity t understand what is being said r written, even with supprt). Carers shuld als be invlved when it is in the patient s best interest. Standard 7: Patients are fully invlved in the assessment and care planning prcess N. Type. Criterin Ref Patients reprt that they were invlved in discussins abut their prblems and the different treatment ptins available. NICE Nte: This includes encuraging individuals t express preferences and invlving them as fully as pssible in decisins abut discharge r nward care. Fr patients with emergency care plans, crisis cards r advance directives, the cntents f these shuld be taken int accunt Patients reprt that liaisn staff treated them with dignity, respect and understanding Patients are ffered a written summary f the assessment and what will happen next. NICE NICE Nte: This may be in the frm f a handwritten summary, r infrmatin filled in n a patient leaflet, r a cpy f a letter t anther prfessinal. PLAN will lk fr evidence in the case ntes that this infrmatin was ffered t patients Patients are ffered the chice f receiving cpies f letters between the liaisn team and ther services, unless there is a gd reasn nt t d s. DH Nte: This guidance derives frm Department f Health guidance fr services in England and Wales. Services in ther jurisdictins shuld have similar means f infrming patients f their rights t view their recrds. PLAN will lk fr evidence in the case ntes that patients are being ffered the chice f receiving letters Patients are tld hw t access emergency help, where needed. PIG Nte: Where apprpriate, this might include helping the patient draw up an actin plan fr future mental health crises if this has nt already been undertaken. 15

17 7.6 2 The liaisn team ffers patients a leaflet describing the rle f the liaisn service The liaisn team ffers patients written infrmatin abut any mental health prblem the patient is experiencing. Nte: This might be in the frm f a leaflet frm the trust/rganisatin, r leaflets frm mental health charities, Ryal Cllege f Psychiatrists etc The liaisn team ffers patients infrmatin n hw t access supprt thrugh ther health services, scial services, advcacy and vluntary sectr services Patients are satisfied with the infrmatin prvided t them by the liaisn team. Nte: Fr example, infrmatin abut the liaisn team, any relevant mental health prblems, hw t access different services etc The Trust/rganisatin has a plicy n cnfidentiality and infrmatin sharing. PIG Nte: This shuld prvide the liaisn team with guidance n infrming patients abut where infrmatin abut them is being sent, and why. Standard 8: The liaisn team invlves carers in discussins abut assessment and treatment Nte: Subject t the patient giving cnsent, and/r carer invlvement being in the best interest f the patient N. Type. Criterin Ref Carers reprt that they were invlved in discussins abut the patient s care and treatment The liaisn prfessinal ffers carers written infrmatin explaining what had been discussed in the assessment. JOINT NICE Nte: Designated carers shuld be invlved as fully as pssible The carer is ffered the chice f being cpied int written cmmunicatin between the liaisn team and ther services if apprpriate Carers wh had cntact with the liaisn team reprted that liaisn staff were supprtive and helpful The liaisn team supprts carers t be invlved in the patient s care whilst she/he is in hspital. Nte: Fr example, this may include re-rientatin r stimulatin fr patients with dementia. DH NICE 16

18 Standard 9: The liaisn team can cmmunicate effectively with a range f patients and carers N. Type. Criterin Ref The liaisn team can access infrmatin in a range f frmats t suit individual patient needs. JOINT Nte: The hspital shuld be able t access key infrmatin in languages ther than English, and fr peple with sight, hearing, learning r literacy difficulties Liaisn prfessinals have timely access t prfessinal interpreters/signers thrugh the prvider Trust/rganisatin. CQI1 Nte: Relatives shuld nt be used as sle interpreters; Where apprpriate, telephne interpreters can be used, but ideally shuld nt be used fr initial assessments; The Trust/rganisatin shuld have agreed timescales fr prviding these Liaisn prfessinals can access equipment t facilitate cmmunicatin with peple with visual and/r hearing impairments, cgnitive impairment r learning disability. Nte: this might include a white bard, marker pen and ther visual aids, a hearing amplifier and similar aids. 17

19 Cllabrative Wrking in the General Hspital Standard 10: There is effective cllabratin between the team and general hspital staff N. Type. Criterin Ref Liaisn and acute staff have effective systems in place t alert each ther t ptentially at-risk patients If the liaisn team prvides a service t the emergency department, a member f the liaisn team meets with emergency department staff at least quarterly If the liaisn team prvides a service t the general hspital, a member f the liaisn team meets with hspital staff at least quarterly Liaisn prfessinals can access the physical health recrds f their patients Members f the liaisn team can access bth mental health and acute infrmatin systems Liaisn and acute managers ensure that there is a mechanism which allws the liaisn team and acute staff t discuss differences f clinical pinin If members f the liaisn team prescribe drugs, there is a plicy regarding the use f medicatin. CR118 JOINT PIG Nte: This shuld be in line with lcal medicines management and include: The team s agreed use f different medicatin; Mechanisms fr checking cntraindicatins between different medicatins being taken fr mental and physical prblems, including ver-the-cunter prducts, that may adversely affect cgnitive functining; Mechanisms fr mnitring side effects and advising the patient n self-mnitring, where apprpriate; The different respnses t medicatin in different age grups; Mechanisms fr the safe administratin f medicatin; Guidance n hw t access a pharmacist; The use f hnrary cntracts fr the liaisn team Liaisn prfessinals attend jint case reviews with medical teams t advise n cmplex cases. CR183 18

20 Standard 11: Unless the liaisn team prvides 24 hur cver, there is effective cllabratin between the liaisn team and ut-f-hurs services (e.g. Crisis Reslutin Hme Treatment teams, n-call staff etc) N. Type. Criterin Ref Jint prtcls fr ut-f-hurs cver are in place between the liaisn and ut-f-hurs service(s). Nte: A written summary shuld be develped in cnsultatin with ut-f-hurs staff and is likely t include guidance n: The wrking hurs and days f the liaisn service and the ut-f-hurs team(s); The clinical respnsibilities f each service; The handver respnsibilities f each service The liaisn team and ut-f-hurs services wrk tgether t share ntes and develp jint plans fr patients wh frequently attend the general hspital The liaisn team has written wrking arrangements detailing wh is respnsible fr assessing patients wh may need t be detained under mental health legislatin. ACAD PIG CR118 Nte: E.g. Apprved Mental Health Prfessinals and/r Sectin 12 (England) and Sectin 20 (Sctland) dctrs, r the Crisis Reslutin Hme Treatment Team. Details f hw t cntact Independent Mental Health/Mental Capacity Advcates shuld als be included. 19

21 Interfaces with Other Services Standard 12: The liaisn team has an peratinal plicy r written guidance that explains hw t refer patients t services including: N. Type. Criterin Ref Lcal mental health services (i.e. Cmmunity Mental Health Teams, inpatient units, Hme Treatment Teams, Imprving Access t Psychlgical Therapies Services) Lcal primary care health services Specialist mental health services fr lder peple. Nte: A decisin t refer smene t services fr lder peple shuld be based n need and nt just age Lcal scial services departments. PIG Lcal child r adlescent services, including details f when it is apprpriate fr child r adlescent patients t be seen by the wrking age adult liaisn team. JOINT Nte: This shuld be based n need and nt just the persn's age. A written summary shuld be develped in cnsultatin with Child and Adlescent Mental Health Services (CAMHS). This may include guidance regarding referral/discharge t CAMHS, if apprpriate Liaisn prfessinals take steps t check that referrals t ther services have been received. 20

22 Staffing, Supprt and Cmmunicatin Standard 13: The service is adequately staffed by a skilled team and can access specialist skills where needed N. Type. Criterin Ref The liaisn team cmprises a number f staff t ensure that it can perfrm its cre functins safely The liaisn team cmprises a number f staff that is prprtinal t natinal best practice guidance (see appendix 2). PIG CR187 MSS In the event f staff absence (i.e. sickness, maternity r annual leave), there is a mechanism in place t bring in additinal staff t cver cre wrk. CCQI1 Nte: In cases where cver is insufficient, the service has an acceptable cntingency plan, such as minr and temprary reductin in nn-essential services. This shuld be in the frm f a written summary which is agreed with ther services, if apprpriate The liaisn team has access t a drug and alchl wrker The liaisn team has access t a learning disability nurse r similar specialist The liaisn team has access t a mental health pharmacist The liaisn team has access t a supprt, time and recvery wrker (STR) There has been a review f the staff and skill mix f the liaisn team within the past 12 mnths t identify gaps in the team. MSS MSS CR187 MSS Nte: The review shuld result in an actin plan r business plan being submitted t the managing rganisatin. This plan shuld then be used t infrm decisins n recruitment and staff training. 21

23 Standard 14: Structures are in place t prvide clear lines f accuntability, supprt and supervisin N. Type. Criterin Ref There are up-t-date dcuments which state the managerial and clinical respnsibility and accuntability f staff. CCQI All staff receive an annual appraisal. CCQI All staff are able t cntact a senir clinical and managerial clleague at any time. CCQI All staff are able t meet with their peers fr supprt. CCQI There are debriefing/reflectin pprtunities fr staff fllwing traumatic incidents Members f the liaisn team are ffered regular clinical supervisin. CCQI1 Nte: Frequency f supervisin shuld be in line with natinal guidance fr the persn s particular prfessinal grup. Staff shuld have sme chice in wh supervises them, including access t an external supervisr if preferred Liaisn staff are satisfied with the frequency f supervisin they receive Liaisn staff are satisfied with the quality f supervisin they receive Liaisn prfessinals can access advice when necessary (i.e. n the use f legal framewrks, cnfidentiality, capacity and cnsent issues etc). JOINT Standard 15: There is clear cmmunicatin within the liaisn team N. Type. Criterin Ref The liaisn team meets regularly (i.e. daily cntact and weekly meetings). PIG Nte: Fr larger liaisn teams which perate acrss varius sites and shifts, arrangements are in place t ensure that staff frm each grup are represented in cre team meetings and all staff receive regular updates The liaisn team has ne cre set f liaisn health care recrds The liaisn team agree that cmmunicatin within the team is effective. PIG 22

24 Standard 16: Structures are in place t ensure that the liaisn team has access t training, educatin and guidance N. Type. Criterin Ref Liaisn staff are asked abut their training needs at least annually by their line manager Staff are nt rutinely denied relevant training due t a lack f funding r staff cver There is a rlling training prgramme fr liaisn prfessinals which is repeated t accunt fr staff rtatin and changes. CCQI2 HE Nte: Training prgrammes shuld include regular updates fr lng-term staff, nt just new staff. A list f cre cmpetencies fr liaisn nurses can be accessed by ing S.Eales@city.ac.uk All liaisn staff knw hw t access the team s plicies, prcedures and written guidance relevant t their rle Liaisn staff can access the intranet and relevant shared drives f their prvider Trust r rganisatin Liaisn staff can access nline jurnals, reference guides r text bks There are pprtunities fr liaisn staff t shadw clleagues r attend placements in ther areas f the hspital (e.g. emergency department, general medical wards, elderly wards etc) There are pprtunities fr liaisn staff t shadw mental health clleagues frm utside f the hspital The liaisn service prvides an inductin t new liaisn team members which is based n an agreed list f cre cmpetencies. CCQI1 CCQI2 CCQI2 PIG HE Nte: An inductin checklist can be used t list the cmpetencies which new staff are expected t demnstrate, with timescales attached. 23

25 Standard 17: Clinical and nn-clinical members f the liaisn team have access t training and educatin in: N. Type. Criterin Ref A basic awareness f cmmn mental health prblems. SH A basic awareness f risk. SH Nte: Including safety issues relating t the hspital envirnment, such as ensuring that patients are nt islated fr lng perids and staff knwing when t alert clleagues t ptential hazards Infrmatin sharing and cnfidentiality. CCQI Culturally sensitive practice, disability awareness and ther diversity and equality issues Mental health and stigma Ageism and stigma Recgnising special needs and knwing hw t prvide/access supprt fr peple with visual, hearing, literacy r learning disabilities. CCQI1 24

26 Standard 18: Clinical members f the liaisn team have access t advice, training, and develpment pprtunities apprpriate t the patients they wrk with, in rder t allw them t perfrm their cre rle N. Type. Criterin Ref Clinical liaisn staff have access t advice, training and develpment in all f the fllwing areas: Wrking with year lds, if relevant. Wrking with lder peple, including the detectin and management f dementia, delirium and depressin. Cnducting mental health assessments f acute hspital patients. Assessing and managing a patient s risk t self and thers. The use f legal framewrks, such as cnducting assessments, deprivatin f liberty, assessing capacity and prviding medic-legal advice t clleagues. Detecting and managing acute disturbance in physically ill peple f all ages (e.g. delirium, psychsis etc) including the use f rapid tranquilisatin, if used. The prtectin f vulnerable adults and child prtectin issues, including respnding t suspected abuse r dmestic vilence. Understanding why peple self-harm and the difference between self-harm acts and acts f suicidal intent (fr wrking age adults and fr lder peple). Suicide awareness, preventin techniques and appraches. Preventing and managing challenging behaviur. Detecting the misuse f alchl and knwing where t signpst if necessary. Detecting the misuse f drugs and knwing where t signpst if necessary. PIG CCQI1 SH 25

27 Clinical liaisn staff have access t advice, training and develpment in at least 60% f the fllwing areas, apprpriate t their rle: Understanding the interface between cmplex physical and psychlgical prblems. Recgnising and managing emtinal respnses t trauma. Recgnising and managing medically unexplained symptms. Recgnising and managing rganic mental health disrders. Persn-centred care planning. The use f therapeutic appraches in the assessment prcess, such as psychtherapeutic theries. Awareness f the prcesses invlved in adjusting t illness, including issues f nn-adherence and phbic respnses t illness. Wrking with peple diagnsed with persnality disrder. The impact f cultural differences n mental health and use f services. The needs f peple with learning disabilities. Awareness f the liaisn team s rle fllwing majr incidents. The rle f nutritin and diet in liaisn psychiatry patients. Eating disrders. Pain management. 26

28 Standard 19: Training prvided t the liaisn team is planned and delivered in cllabratin with key partners N. Type. Criterin Ref Patients r carers are actively invlved in the planning r delivery f training t liaisn prfessinals. PIG Nte: This might be thrugh a Trust/rganisatin r third sectr and may include develping a training sessin, develping materials, DVDs and s n Liaisn and acute staff wrk tgether t deliver jint training t the liaisn team. ACAD Nte: Fr example, a geriatrician and liaisn nurse culd jintly prvide dementia training t the rest f the liaisn team. Quality, Audit and Gvernance Standard 20: The perfrmance f the liaisn service is mnitred N. Type. Criterin Ref The liaisn team has reviewed its perfrmance in the past twelve mnths. PIG Nte: Fr example using clinical audit, service evaluatin, perfrmance indicatrs r clinical utcme measures The liaisn team has a written dcument detailing key perfrmance indicatrs. Nte: Examples include, respnse times t referrals, reductin in mental health related 4-hur Emergency Department breaches, number f peple wh have self-harmed being ffered a psychscial assessment etc Written infrmatin is ffered t patients and carers abut hw t give feedback t the team, including cmpliments, cmments, cncerns and cmplaints There is evidence f actin and feedback frm any negative cmments and cmplaints made abut the liaisn team The liaisn team uses findings frm service evaluatin t supprt r infrm business cases and changes t the service. PIG CCQI2 27

29 An integrated gvernance/jint planning grup (r similar) invlving senir clinicians and managers frm the liaisn service and acute hspital meet at least quarterly. CR183 Nte: The grup shuld:- Review matters relevant t clinical and rganisatinal risk and quality; C-rdinate planning f service develpments; C-rdinate plans fr high risk clinical scenaris especially where these are likely t invlve several services r rganisatins; Reprt thrugh lcally determined management structures The managing Trusts/rganisatins have an agreed prtcl in place fr reprting and respnding t safety cncerns raised by staff frm either Trust r rganisatin. Nte: This shuld link t gvernance structures Liaisn prfessinals are invlved in Trust/rganisatinal meetings which address critical incidents, near-misses and ther adverse incidents, where relevant t the liaisn team. 28

30 Dmain 2: Prviding Emergency Mental Health Care t Adults f all Ages Definitins f emergency and urgent referrals Emergency: An acute disturbance f mental state and/r behaviur which pses a significant, imminent risk t the patient r thers. Urgent: A disturbance f mental state and/r behaviur which pses a risk t the patient r thers, but des nt require immediate mental health invlvement. Standard 21: Peple with mental health needs are assessed within the apprpriate timescales Imprtant ntes: The fllwing standards relate t the respnsiveness f the liaisn team within its usual perating hurs and nt the respnse f ther services such as ut-f-hurs teams. When standards relating t respnse times are being measured, the prcess will take int accunt legitimate reasns fr delayed assessment (such as patients nt being fit fr assessment). The definitins f emergency and urgent referrals abve are prvided fr the purpse f the standards. It is nt being suggested that teams must necessarily adpt this system f classificatin. N. Type. Criterin Ref Patients referred fr emergency mental health care are seen within 60 minutes. CR118 Nte: If the liaisn team is nt based n site and are unable t respnd t emergency assessments, there are clear arrangements regarding whse respnsibility it is t d s. There shuld als be clear arrangements fr immediate telephne advice t the referrer Patients referred fr urgent mental health care are seen within the same wrking day Referrers are satisfied with the liaisn team s speed f respnse t emergency referrals Referrers are satisfied with the liaisn team s speed f respnse t urgent referrals. 29

31 Dmain 3: Prviding Rutine Mental Health Care t Wrking Age Adults Definitins f referral type Emergency: An acute disturbance f mental state and/r behaviur which pses a significant, imminent risk t the patient r thers. Urgent: A disturbance f mental state and/r behaviur which pses a risk t the patient r thers, but des nt require immediate mental health invlvement. Rutine: All ther referrals, including patients wh require mental health assessment, but d nt pse a significant risk t themselves r thers, and are nt medically fit fr discharge. Standard 22: Liaisn psychiatry services fr the rutine care f wrking age adults are adequately planned and cmmissined/cntracted Nte: Rutine refers t all cases which are nt emergency r urgent referrals. N. Type. Criterin Ref The liaisn service is cmmissined/cntracted t prvide rutine assessment and care t wrking age adults thrughut the hspital The liaisn service is cmmissined/cntracted t prvide rutine assessment and care t all wrking age adults, regardless f the patient s address. Standard 23: Peple with nn-urgent mental health needs are assessed within the specified timescales N. Type. Criterin Ref Patients referred fr rutine mental healthcare are seen within tw wrking days Referrers are satisfied with the liaisn team s speed f respnse t rutine referrals fr wrking age adults Fr teams that are striving fr an excellent accreditatin status: the tw day target fr nn-urgent referrals is cnsistently exceeded All lder patients under the care f the liaisn team wh have a diagnsis f dementia have a review f antipsychtic medicatin during their hspital stay. MSS 30

32 Dmain 4: Prviding Rutine Mental Health Care t Older Peple Please nte: these standards are nt the nly standards relating t the care f lder peple; all f the ther standards relate t the prvisin f emergency mental health care t lder peple. This sectin relates t services which als prvide rutine mental health care t lder peple. Definitins f referral type Emergency: An acute disturbance f mental state and/r behaviur which pses a significant, imminent risk t the patient r thers. Urgent: A disturbance f mental state and/r behaviur which pses a risk t the patient r thers, but des nt require immediate mental health invlvement. Rutine: All ther referrals, including patients wh require mental health assessment, but d nt pse a significant risk t themselves r thers, and are nt medically fit fr discharge. Standard 24: Liaisn psychiatry services fr lder peple are adequately planned, cmmissined/cntracted and managed N. Type. Criterin Ref The liaisn service is cmmissined/cntracted t prvide rutine assessment and care t lder peple thrughut the hspital The liaisn service is cmmissined/cntracted t prvide rutine assessment and care t all lder peple, regardless f the patient s address A designated lead fr lder peple s mental health attends a frum which meets quarterly, and includes the discussin f key peratinal, clinical and gvernance issues including safety. WCW 31

33 Standard 25: The liaisn team respnds prmptly t rutine referrals fr lder peple N. Type. Criterin Ref Patients referred fr rutine mental healthcare are seen within tw wrking days Referrers are satisfied with the liaisn team s speed f respnse t rutine referrals fr lder peple Fr teams that are striving fr an excellent accreditatin status - the tw day target fr rutine lder adult referrals is cnsistently exceeded. Standard 26: Liaisn teams wrking with lder peple have access t advice, training and develpment pprtunities apprpriate t their cre rle, including: N. Type. Criterin Ref Detecting and managing dementia in lder peple Detecting and managing delirium in lder peple Detecting and managing depressin in lder peple Undertaking specialist assessment f a patient with cgnitive impairment. Nte: This might include: Examinatin f attentin and cncentratin, rientatin, shrt and lng-term memry, praxis, language and executive functin; Frmal cgnitive testing using a standardised instrument, e.g. the Mini Mental State Examinatin (MMSE); Arranging fr mre in-depth neurpsychlgical testing as indicated, e.g. fr early nset r cmplex dementia; Talking t carers/family members; Assessing the impact n daily living and mental health well-being The rles f the different health and scial care prfessinals, staff and agencies invlved in the delivery f care t lder peple Referral pathways and jint wrking arrangements with lcal health services fr lder peple. 32

34 Dmain 5: Prviding Interventins Guide t timescales fr interventins: Brief interventins: up t six sessins. Lnger term interventins: mre than six sessins. Standard 27: The liaisn team is able t prvide effective interventins, where needed N. Type. Criterin Ref The liaisn service is cmmissined/cntracted t prvide brief, time-limited fllw-up care t patients The liaisn team prvides brief, time-limited, evidence based interventins. NIMHE PIG Nte: See Appendix 4 fr evidence-based interventins recmmended by NICE The liaisn team is cmmissined/cntracted t prvide lnger term interventins in the general hspital The liaisn team prvides lnger term therapeutic interventins The liaisn team can access sufficient space in the hspital t deliver interventins safely The majrity f patients were satisfied with the length f time it tk them t receive an appintment with the utpatient team The majrity f patients were satisfied with the number f fllw-up sessins that are ffered t them The majrity f patients and peer reviewers agree that the utpatient facilities are safe The majrity f patients and peer reviewers agree that utpatient facilities are private Liaisn prfessinals actively fllw up nnattenders wh have missed an appintment with the liaisn team The liaisn team r service manager has ensured that liaisn staff have received sufficient training in any therapeutic interventins they prvide Liaisn prfessinals receive supervisin relating t any therapeutic interventins they prvide. NICE NICE NICE NICE PIG 33

35 Dmain 6: Prviding Training t Hspital Clleagues Standard 28: The liaisn team prvide training t hspital clleagues N. Type. Criterin Ref The liaisn service is funded t deliver mental health training t staff in the emergency department The liaisn service is funded t deliver mental health training t staff in the general hspital (wards and s n) The liaisn team has a rlling prgramme f training fr general hspital staff which is repeated t accunt fr staff changes The liaisn team regularly prvides inductin training t junir dctrs The liaisn team recrds details f the training it prvides, such as the curriculum, a list f attendees and a summary f feedback The liaisn team has develped the training prgramme in cnsultatin with training participants The liaisn team evaluates the effectiveness f its training Acute clleagues are satisfied with the amunt f training prvided by the liaisn team Acute clleagues are satisfied with the quality f training prvided by the liaisn team. ACAD NHSC ACAD NHSC CR183 CEM CR183 Standard 29: The liaisn team has prvided a range f training t hspital prfessinals in the past 12 mnths, including tpics such as: N. Type. Criterin Ref Hw t make an initial mental health assessment f an acute hspital patient Wrking with adults aged ver 65, including the detectin and management f dementia, delirium and depressin Hw t assess and manage the patient s risk t self and thers. 34 CR118 CR The use f mental health legislatin. CR Detecting and respnding t acute disturbance in physically ill peple f all ages e.g. delirium, psychsis etc Understanding why peple self-harm and the difference between self-harm and acts f suicidal intent (including fr lder peple). CR118 NICE

36 Suicide awareness, preventin techniques and appraches Preventing and managing challenging behaviur. PIG Recgnising and respnding t rganic mental health disrders Detecting the misuse f alchl. JOINT Detecting the misuse f drugs. JOINT Recgnising and respnding t emtinal respnses t trauma Recgnising and respnding t medically unexplained symptms Awareness f the prcesses invlved in adjusting t illness, including issues f nn-adherence and phbic respnses t illness The impact f cultural differences n mental health and use f services. PIG JOINT ACAD SH Mental health and stigma Ageism and stigma Wrking with peple diagnsed with persnality disrder. See Appendix 1 verleaf fr suggested appraches t training acute clleagues. Standard 30: The liaisn team prvides supprt and supervisin t acute clleagues, including: N. Type. Criterin Ref Prviding infrmal supervisin, such as case reviews, multi-disciplinary discussins etc t acute clleagues Prviding frmal regular supervisin t acute clleagues Prviding frmal regular supervisin t trainee psychiatrists and dctrs The liaisn team has a rlling prgramme f training fr Emergency Department staff which is repeated t accunt fr staff changes Acute staff are satisfied with the amunt f supprt and supervisin prvided by the liaisn team Acute staff are satisfied with the quality f supprt and supervisin prvided by the liaisn team. CR118 JOINT CR118 CR118 CR118 35