Forensic Service Main contacts for workshop:

Transcription

1 Key = Process Step outside RiO = Process Step in RiO = Decision Point = Continues on next page = Continues from previous page = Trigger or end point = Alternative Available Forensic Service Main contacts for workshop: Jason Fee Revised: Pre Go Live, Jason Fee, Terry Holden, Sue Chapman, Debbie Willing, Simon Polak Teams: Ward Teams Patient Affairs Administration Staff: Ward Clerks, Ward Secretaries, Nurses, Consultants, Clinicians (OT, Psychotherapy), Physiotherapy, Pharmacists, Educator tutor Locations: Five Wards - Butler Unit x2 - Avon - Chichester - Dart Final Map Version 3 Revised Support Hours: Wards: 24/7 Patient Affairs Administration 9-5 Mon-Fri All electronic assessment Forms from URL link must be uploaded when completed. All paper s must be scanned and uploaded into RiO when completed

2 Referral to Forensic Service Duty Consultant Referral Coordinator Referral received by various methods (phone/ /letter) If Alias known, record in Additional info & contacts 2A 2b Referral management Request tes and/or Review RiO notes 5 Triage Urgent? Admin Action Sheet and/or Minutes filed (noted in progress notes) 12. MDT Book into urgent assessment RiO appointment slot refer to duty rota Tuesday onsite urgent assessment slot or arrange offsite Appropriate? Advice only 15. Discharge Provide advice record Progress tes or send Editable letter 3. Inappropriate referral & signpost When searching for patients, access reasons will be: Clinical emergency, Administration or Referral Care Setting when registering new referral is not reported upon. (Consultant-led out patient clinic) Referral Reason:, 2 nd opinion, Treatment, Admission Report Requirement: Referral Reason for commissioners full list of KPIs to be analysed with Information Governance Team Unit secretaries require training on RiO Progress tes/screening. Requires validation.

3 Pre-Admission Med Sec Enter agreed outcome code in free text box in appointment outcome screen From New referral 7.c Outcome appointment IF bed comes available, view case managers caseload caseload and go to Admission process If in Prison, must admit in 14 days, otherwise 2 weeks after Initial Consultant/Team Lead HCP/Admin Recovery Planning 12. MDT 6. Allocation Nurse Psychologist Consultant Admit? Agree Team 7b. Individual Appointment management 14. Bed Management Refer to Private Sector and allocate to ANDY JONES Case Manager on RiO. Change Waiting Status as Under Review Available bed now or soon? Case Management (see community generalised process map) Admission 15. Discharge Funding application to commissioners scan and save to documents using agreed naming convention. And write a progress note and refer to the Private sector. Intervention evidence included in the free text box in the Care Plan to meet auditing requirements.

4 Admission Med Sec Ward Nurse/Consultant Referral Coordinator Complete Commissioner forms (Post or urgent) 14. Bed Management To gain agreement send initial assessment & proposed RiO Care Plan Doc Upload noting draft Upload picture of patient to RiO Referral to assessment team is discharged following admission Add to Tracking Forms Database Read Rights: Section 132, sign, copy & send original to MHA. Record in progress notes Commissioner agreement received & scanned into RiO Section required? Create new referral to CRHT/ AMHP Arrange admit day in RiO ward diary/bed scheduler Risk Scan and save documents from external sources See tes for details of assessment te banned items in RiO progress notes & send to storage Send Editable Letter to MoJ and GP. Re: admission Register with local GP Daily Nursing

5 Daily Nursing YES Complete and send to MHA Referral Coordinator Nurse 10. Recovery planning Book patient into Team Clinic e.g. OT Daily Physical monitoring, make a progress note and then on monitoring form to chart over time Clinic set up for every team also used for drop in sessions te bed swaps/ Leave using RiO Ward View Thursday outpatient clinic Annual Health screening from PCT Nurse GP visits writes in tes. Scan in paper notes Care/Treatment in Progress tes. Appointments in Ward Diary, clinics and RiO Diary Forensic teams for clinics - OT - Vocational Rehab - Psychology - Social Workers - Education - Physiotherapy - Psychiatric Health - Pharmacy - Speech & Language - Spiritual Lead Scan in Consent to Treatment when received Generate inpatient client diary daily. Give to patient 3 mth reading rights or Consent to Treatment? 11 CPA/n CPA review Care Plan need to change? OTHER NOTES: - Vocational and OT use current process of forms to track patient journey however book activity into team clinics on RiO Use report: Patient activity by site e.g LANGDON for daily MDT discussion Ward round projectors and keep live notes

6 Section 17 Leave Referral Patient Affairs Nurse/Consultant Coordinator Complete Section 17 Leave template Record what level of leave Leave Care Plan & Carer Care Plan on RiO Electronically complete and upload Is this covered by recovery planning? 8 Risk (HCR20) Register Carer and complete RiO Carer if required Clinical Team Summary MoJ application form sent. Scanned into RiO Form summary or summary pasted into progress notes: Standard process for consultant Create External Referral To MAPPA (copy MoJ) Editable letter Patient leaves: note on RIO Ward view For Escorted/Ground Leave, this is created as a Care Plan. Control Base will note what they are wearing (in a Progress te) and link to a Care Plan. Named nurse is responsible for checking Control Base make this note. PROGRESS NOTES MUST ALWAYS BE LINKED TO A CARE PLAN Forensics to agree set of Care Plans for Ward and add to the Trust-wide Care Plans for Standard Bed Management process

7 Transfer Nurse/Consultant 12 MDT Discussion to transfer, note in progress notes Book RiO appointment and attend viewing with patient MDT Decision to move. te in Progress tes Suitable? Verbal Handover Transfer to ward on site? 15. Discharge from Ward Transfer case to consultant caseload for new ward if on site. Transfer ward Referral Coordinator MPA Application form to MoJ and Commissioners. Upload to RiO Agreed? If patient moving from Medium to Low Security ward, this requires an assessment, formulation and agreement. However, no new referral required for this. s are completed and Progress tes are made when decided to transfer. If going up in security this is not required and patient is simply transferred between wards

8 Discharge Discharge can be to Russell Clinic or Private provider. Send tes Nurse/Consultant Arrange Section 117 Meeting on RiO. Part of CPA review te S117 result on RIO CPA review outcome Complete S117 Review form 10 Recovery Care planning Discharge summary (template) pasted into Progress tes Arrange medication and form scanned into RiO View property and Sign back, arrange transport & escort 15. Discharge from ward

9 Sources: Internal: Plymouth, Cornwall and Torbay/GPs 5xWards (Butler Unit (x2), Avon, Chichester, Dart) Referral received, request notes from DPT or private providers Referral coordinator gathers more information Registers on epex Completes referral form Logs onto Database (Name, DOB, Ref, Commissioner, free text) POLICY: Do not accept GP referrals inappropriate Referral Meeting ALL referrals discussed (inc those from GPs) Inappropriate referrals rejected to referrer using letter template Discharge from epex Triage: Duty Consultant for urgent/non-urgent. Urgent Initial Tuesday allocated slot or arrange offsite with Duty Consultant n-urgent Initial s Allocate to consultant for assessment NOTE within 14 days if in prison, High security in 3 months. MDT assessment team with Nurse and Psychologist Medical secretary types report and sends to relevant professionals CPA1 Form Empty Bed Round Shopping List Spreadsheet kept of CPA1 rejections of admittance (not the waiting list) Referred to Private Sector Discuss in Referral team meetings whether to admit. If so, new admittance. admission write to referrer with report done by med sec, saved to shared drive New admission? Add to admittance waiting list Check bed state Database Daily Ward Report NOTE if in prison must admit in 14 days. If not, admit 2 weeks after receive initial assessment report If no bed in time-frame refer to private sector, close referral, add to shopping list Acceptance of admission Complete and send forms from Commissioners: patients agreement and Proposed Care Plan If urgent in 48 hours the forms. Save to drive, if hard copy scan. Patients affairs check ward report and register on epex Complete admission form on the day Ward clerk makes up file with assessments so far. Also save electronic on network Nurse reads rights Section 132 and send to MHA office. Keep copy for ward. Record being done on template Fax referral for section if required Admission paperwork template: Inc. Admission interview, 72hr Care Plan, Info checklist, Risk, infection control, MRSA, Swine Flu, MDT Team (Ward-based allocation), of capacity (FACE form), capacity heading) Photocopy Swine Flu and send to infection control (internal post) Property confiscated and list completed and banned items noted. Sent to storage Med sec informs of admission in writing Ministry of Justice and GP Register with local GP Daily Nursing Daily Care Plan OBS level Engagement and supportive OBS Psychical Health MOMOR Take picture for AWOL Admission Doctor: Psychical Health (Bloods etc), Perscribing, MSE history Daily Ward Report Spreadsheet updated at 8pm by Ward Nurses of patient names and saved to shared drive Report completed and saved to shared drive weekly Issued to local GP surgery each week >Advice and management >

10 CPA for 1 st 3months Other parallel referrals: - Psychology - OT - Social workers - Education - Physiotherapy - Psyche Health - Pharmacy - Sports & Leisure - Speech & Language - Vocational Rehab - Spiritual Lead Care Review Meetings (twice weekly) Review Care Plans including Nursing Care Plans 3 month reading of rights Copy for file and recorded in notes. Sent to MHA office Consent to Treatment Keep copy for file send to MHA office Ward diary GP appointments, dental, opticians etc Tribunal report writing OT Contact Initial assessment Treatment Plan Separate file kept VR Process Referral Form Initial assessment Allocation session Evaluation report Separate file kept Leave: Ensure have care plan with carer Transfer to another Unit: Visit transfer At referral meeting decision to transfer Ask MoJ and commissioners if can move (MPA Form) Consultants give verbal handover Copy notes for ward Nursing notes: Every entry of date time obs level in progress notes Discharge Arrange section 117 meeting Fully planned CPA Discharge summary (template) Letters to all involved to inform of discharge Arrange medication (template) Sign back property Arrange transportation and escort De-register from local GP Transfer to Russell Clinic Transfer to Private Provider Outpatient clinic Thursday afternoon Annual Psychical Health Screen by PCT Nurse Delayed discharge management in monthly meeting Monthly Management Team Meeting Balanced Scorecard KPI reporting Issues: Psychologist don t currently record in epex Security issues with patient files on shared drive Record keeping policy for OBS? Refer to Vocational rehab service using their referral forms Section 17 leave Complete template te what is wearing Complete leave care plan Clinical team case summary and HCR20 template Ministry of Justice form to complete External referral to MAPPA Copy to Ministry of Justice CPA review After 3 months:- CPA2 &3 review care plan for next 6 months CPA4 6 months HONOS 2&4 CPA notes typed up and issued to attendees and commissioners Logged on a CPA database (different to KPIs) AWOL tify commissioners and referral coordinator who logs on Daily Ward Report database AWOL checklist Overnight stay Transfer notes and meds with them Discharge on epex Re-admit when back GP visits enter notes on site