A retrospective audit of service users admitted to an inpatient mental health service for anxiety and/or depression.
Data were collected on service users care and treatment over a period of six months from their date of admission.
Data collection was open between June - September 2018.
The national report is expected to be published in October 2019, with local reports following soon after.
1. The Trust/organisation routinely collects data to assess equity of access. Guidance: This includes age, gender, ethnicity, employment and accommodation status.
2. Service users have timely access to inpatient care when required.
3. Service users’ assessments are comprehensive and include consideration of:
- identification of social support and/or stressors in relation to finance, education/employment and relationships
- previous traumatic experiences or associated symptoms
- previous treatments and response to them (if applicable).
4. Service users’ physical health is considered as part of their assessment and treatment, with support, advice or onward referral offered where appropriate. Guidance: This includes blood pressure; BMI; blood tests, and Lifestyle factors (e.g. diet, exercise, smoking, drug and alcohol use).
5. The needs of service user’s family members, friends or carers are considered as part of the assessment process and they are offered an assessment of their needs.
6. Care plans are jointly developed with service users and their family member, friend or carer (if applicable), and they are given a copy with an agreed date for review.
7. Psychotropic medication is provided in line with the relevant NICE and BNF guidance for the service user’s diagnosis/condition.
8. Psychological therapies are provided in line with relevant NICE guidance for the service user’s diagnosis/condition.
9. Within 24 hours of discharge a discharge letter is emailed to the service user’s GP and a copy of the service user’s care plan is sent to the accepting service (if applicable).
10. The service user and their family member, friend or carer (if applicable), receives at least 24 hours’ notice of discharge and this is documented.
11. Service users discharged from an inpatient setting receive a follow-up within 48 hours of discharge.
12. Service users have a crisis plan agreed and in place prior to discharge from an inpatient service.
13. Assessments include the use of an appropriately validated outcome measures (e.g.symptoms, level of functioning and/or disability) which are used to monitor, inform and evaluate treatment.
The National Clinical Audit of Anxiety and Depression is in the process of developing a new data management system for the prospective audit that will begin in 2020. The tool has been developed for the purpose of continuous data collection so hospitals will be able to readily see how they are performing and where they can make improvements. The system will also readily generate charts to enable services to compare themselves regionally and nationally.
The new tool is currently being tested as part of a pre-pilot with two Trusts, followed by a full pilot with 10 hospitals in October 2019, which will run for two months. Each Trust will be required to sample five patients discharged from 1 hospital consecutively from the starting date of 1 October 2018. Feedback will be gathered from everyone involved in the pilot, including experience of data extraction, data entry and QI functionality.
The pilot project set four high-level clinical improvement goals for this audit. The improvement goals are based on the key findings and recommendations of the NCAAD core audit and alignment with national guidance and evidence.
1. Hospitals increase the proportion of service users who have crisis plans in place at the point of discharge, within this audit period.
2. Hospitals increase the proportion of service users followed up within 72 hours of discharge, within this audit period.
3. Hospitals increase the proportion of service users offered psychological therapies in line with NICE guidance within this audit period.
4. Hospitals increase the proportion of carers offered a carers assessment within this audit period.
The audit is committed to sharing QI initiatives and areas of best practice to improve the quality care for people with anxiety and depression. During November and December 2019 the NCAAD team ran six Quality Improvement workshops across England for audit leads and Trust staff involved in the both the core and spotlight audits. Each workshop was facilitated by an expert in quality improvement and gave an overview of QI methods and tools.
Find out more about QI workshops and what people thought here.
The NCAAD team have set up a free to use forum called Knowledge Hub which enables Trusts to share QI knowledge, tools and best practice with others. This has been created for attendees of the Quality Improvement Workshops that have been run across England, where we helped Trusts to develop practical applications to address specific shortfalls identified following the National Clinical Audit of Anxiety and Depression report.
All attendees are invited to join Knowledge Hub to:
- Share best practice and quality improvement plans
- Connect with other members and seek advice
- Discuss methodologies, tools and training relating to QI in healthcare
- Offer feedback to the NCAAD team
To sign up, register to Knowledge Hub here, search for NCAAD and start sharing your ideas!