M h information improving practice progress with electronic care cards
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M H information : improving practice - progress with electronic care cards. Dr C Bruce Low Consultant Psychiatrist Lead Clinician Clinical Governance. Why ?. clinical governance PAF CSBS user carer clinical effectiveness communication. Why ?.

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M h information improving practice progress with electronic care cards

M H information : improving practice - progress with electronic care cards

Dr C Bruce Low

Consultant Psychiatrist

Lead Clinician Clinical Governance


M h information improving practice progress with electronic care cards

Why ?

  • clinical governance

  • PAF

  • CSBS

  • user

  • carer

  • clinical effectiveness

  • communication


M h information improving practice progress with electronic care cards

Why ?

  • … “recommends that Trusts develop a single system of record keeping which is suitable for documenting the needs of those with long term mental illness and is able to provide an up to date chronological account of a person’s illness and treatment. This system should be compatible with systems in use in partner agencies.”


Why improve

Why improve ?

  • Mental Health and Wellbeing Support Group

  • “insufficient information on which to base sensible planning for services”


What do information systems need to cover

What do information systems need to cover ?

  • MHWBSG

  • CSBS

  • SHAS

  • MWC

  • SIGN

  • HTBS

  • (NICE)

  • and now ...QSBHS


Underlying principles values

Underlying principles / values

  • clinical effectiveness (research and audit)

  • stakeholder involvement

  • information to user and carer on diagnosis prognosis treatment and side effects

  • range of services

  • continuity

  • monitoring auditing and demonstrating what has been done


A clinical example care cards

A clinical example - care cards

  • the motivation

  • what are they

  • the infrastructure

  • the audit

  • the results

  • should we give up

  • the latest


The motivation

The Motivation

  • first CMHT moved off site 1995

  • PAS/ info system had the functionality

  • CMHT keen

  • anxiety re out of hours continuity

  • further dispersal of service anticipated


Care cards content

Care Cards: content

  • patient name

  • diagnosis (ICD 10 code)

  • current Problem inc Relapse signature

  • management Strategy (care plan)

  • risk factors to patient

  • risk to staff / others

  • protective factors for patient

  • psychiatric medication


Data entry

Data entry

  • paper based for clinical practicality

  • secretarial entry on software

  • approach adopted across service

  • updated at any substantive change

  • accurate at time of update

  • motivated people !?


Access and success

Access and success

  • BPCT MH staff on need to know basis

  • by telephone and call back system to GPs on request

  • very helpful to out of hours service

  • assists bed management

  • allows proactive agreement with patients as to crisis response

  • content has proved durable


Audit standards

Audit Standards

  • all patients of Adult, Rehab, addictions Teams

  • all patients with Learning Disability and Dual Diagnosis under Consultant care

  • all elderly patients with functional illness, others with dementia where out of hours crisis expected


Audit standards and method

Audit Standards and Method

  • completed up to date accurate care cards

  • self assessment

  • end user feedback


The audit

The Audit

  • two cycles completed

  • quality gap persists

  • devil’s advocate position !

  • guidelines

  • culture change

  • support and further audit


Developments in progress

Developments in progress

  • develop locally owned categories for problems and interventions based on..

  • audit of free text content of presenting problem and management strategy

  • in patient care pathway core care plans

  • CPA

  • illness specific care plans


Developments in progress1

Developments in Progress

  • balancing act of simplicity utility and specificity

  • continuing culture change to make Care Card the core of communications


Conclusions

Conclusions

  • current values and principles should guide info systems and how they are implemented

  • clinicians value useful information and will use systems when they help them carry out their work

  • joint work between information staff and clinicians can yield positive results via electronic systems


Conclusions1

Conclusions

  • Care Cards initiative demonstrates some successes…….

  • help manage on very tight in patient resource

  • assists fast tracking of patient needing rapid admission

  • quality improvement requires persistence and imagination and is a continuous process

  • ……and it can be fun !


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