Preventing suicide. A toolkit for ambulance services

Transcription

1 Preventing suicide A toolkit for ambulance services

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3 Contents Overview and instructions 2 The standards 4 Standard 1 Consent and capacity 4 Standard 2 Intervention and care 5 Standard 3 Suicide prevention 6 Standard 4 Family or carer contact 7 Standard 5 Appropriate medication 8 Standard 6 Follow-up care 9 Standard 7 Post-incident review 10 Standard 8 Training of staff 11 Useful resources 13

4 2 Preventing suicide: A toolkit for ambulance services Overview and instructions This section gives details of how to use the toolkit, including an explanation of the assessment tools and the use of case note review, and an example completed audit form and checklist. The eight standards are then set out, and a list of useful resources. All the documents are available to download from The standards The eight standards contained in the toolkit reflect changes in practice that have occurred in ambulance services in the last six years. The standards are organised to look at the process of admission through to discharge of a working age adult. Accompanying these standards are detailed audit procedures which will help you measure your current practice and identify areas for improvement. It is necessary to read through each of the standards prior to commencing the general audit tool, in order to provide you with a more detailed context for each standard criteria. Assessment the general audit tool The general audit tool provides ambulance service providers with an annual method of tracking and measuring the level of care provided to patients at risk of suicide or self-harm. It provides a comprehensive view of the level of adherence to the suicide prevention standards contained in the updated toolkit, and combines a review of trust policy, environmental and patient risk assessments, and the review of a small sample of patient records. It is recommended that the general audit tool is used on an annual basis. The general audit tool contains: a performance summary and performance dashboard that are automatically generated after completing responses to each of the questions audit questions relevant to each of the eight standards an action plan that lists all actions that have not reached 100 per cent compliance in the sample of inpatient case notes reviewed. It is recommended that the general audit tool is undertaken on an annual basis. It is also recommended that organisations print the performance summary worksheet to provide both front-line staff and the board with regular feedback on the level of care. However, if your trust has a well functioning method of updating both front-line staff and the board on such matters, there is no need to adopt a new practice.

5 Preventing suicide: A toolkit for ambulance services 3 Example of a completed performance summary Bar Chart Key: Standard 1 - Consent and capacity Standard 2 - Intervention and care Standard 3 - Suicide prevention Standard 4 - Family or carer contact Standard 5 - Appropriate medication Standard 6 - Follow-up care Standard 7 - Post incident review Standard 7 - Training of staff Example of a completed performance dashboard

6 4 Preventing suicide: A toolkit for ambulance services The standards Standard 1 Standard 2 Standard 3 Standard 4 Standard 5 Standard 6 Standard 7 Standard 8 Consent and capacity Intervention and care Suicide prevention Family or carer contact Appropriate medication Follow-up care Post-incident review Training of staff Standard 1 Consent and capacity Issues of consent, capacity and mental ill health in the assessment and treatment of people who self harm should be understood and addressed by all healthcare professionals. 1.1 Is there an up-to-date policy/guidance which encompasses consent to treatment issues and the Mental Capacity Act? 1.2 Does relevant policy/guidance include that all treatments should be explained to the patient unless being delivered in an emergency? 1.3 Is there a policy/guidance in place detailing what staff should do if a patient who lacks capacity or who has not had a capacity assessment completed refuses treatment/transportation? 1.4 Do clinicians know how to access an emergency assessment under the Mental Health Act where required? 1.5 Is there evidence that capacity was assessed? 1.6 If the patient was deemed not to have capacity to consent to treatment, did consultation take place with the lasting power of attorney or court appointed deputy, as appropriate? 1.7 If the patient was deemed not to have capacity to consent to treatment, were the reasons for this recorded in the clinical record? 1.8 Is it recorded that actions taken were in the patient's best interests?

7 Preventing suicide: A toolkit for ambulance services 5 Standard 2 Intervention and care Specific personal, cultural, religious or other factors that need to be considered when examining or treating the individual are ascertained and inform the care given. People who have self-harmed will be treated with the same care, respect and privacy as any patient. Healthcare professionals take full account of the likely distress associated with self-harm. Ambulance crews will collect data and ascertain information, which will be passed on to A&E department staff to inform the initial assessment and treatment plan. 2.1 Is there a policy/guidance in place detailing how staff should access face-to-face and telephone interpreters? 2.2 Is it detailed within policy/guidance that the relatives of the patient should not be used as interpreters except in the case of medical emergency? 2.3 Is there a policy/guidance detailing procedures regarding gender-specific care and chaperoning, as appropriate? 2.4 Does the policy/guidance dictate that patients are offered a choice of assessment and treatment from male and female staff, as appropriate? 2.5 Are there methods of collecting data regarding patient experience in place? 2.6 Are there examples of how patient experience information has been used to inform clinical development within service? 2.7 Is this monitored within trust clinical governance processes? 2.8 Is there evidence of complaints received by patients who received treatment for self-harm? 2.9 Is there evidence of what action was taken in response to those complaints? 2.10 Is there a policy stating that ambulance staff should obtain all substances and/or medications found at the scene of an emergency call and pass these on to A&E department staff? 2.11 Is the scene of the incident recorded? 2.12 Are poisons or equipment used for self-harm recorded? 2.13 Is the environmental context where the incident took place recorded? 2.14 If significant others were present, are their views recorded? 2.15 Is the outcome of the capacity assessment recorded? 2.16 Is there a record of treatments given or offered?

8 6 Preventing suicide: A toolkit for ambulance services Standard 3 Suicide prevention Issues of consent, capacity and mental ill health in the assessment and treatment of people who self harm should be understood and addressed by all healthcare professionals. 3.1 Do all ambulance staff have access to the JRCALC Suicide and Self-harm Risk Assessment Tool? 3.2 Is the quality of assessments audited as part of the trust's annual audit programme? 3.3 Are there examples of how practice has been improved in response to audit outcomes? 3.4 Is the audit process monitored within trust clinical governance processes? 3.5 Is there a process in place for staff to access specialist professionals for advice when assessing children, young adults and older persons over the age of 65, who have self-harmed? 3.6 Is there evidence that this information has been disseminated to staff and is monitored? 3.7 Is there evidence that a risk assessment was carried out? 3.8 Are risk assessments completed in full? 3.9 Is there documentation that a copy of the assessment information has been passed to the patient's GP? 3.10 Is there documentation that a copy of the assessment information has been passed to any relevant mental health services?

9 Preventing suicide: A toolkit for ambulance services 7 Standard 4 Family or carer contact Healthcare professionals will provide emotional support, help and information about sources of help if necessary to any relatives/friends/carers present. 4.1 Is information on crisis and advice organisations, social services departments, independent advocacy services, patient/carer's support groups etc available, as appropriate? 4.2 Is there a process in place for provision of support to carers/relatives, as appropriate? 4.3 Is there a policy/guidance to obtain consent from the patient to involve family/carers in gathering information/contributing to assessment of a patient who has self-harmed, as appropriate?

10 8 Preventing suicide: A toolkit for ambulance services Standard 5 Appropriate medication Adequate anaesthesia and/or analgesia should be offered to people who have self-injured throughout the process of suturing or other painful treatments. 5.1 Is there evidence that auditing of appropriate medication is monitored within trust clinical governance processes? 5.2 Is there evidence that any instances of adequate anaesthesia/analgesia not being given are subject to appropriate management action? Ambulance staff will have access to advice and information at all times. 5.3 Is there a policy to ensure that TOXBASE and National Poisons Information Service (NPIS) is available to ambulance crews at all times?

11 Preventing suicide: A toolkit for ambulance services 9 Standard 6 Follow-up care People who repeatedly self harm should be offered advice on the risks of self harm and advice on minimisation, self management and coping strategies. 6.1 Is there a clinical protocol detailing what advice to give to people who self-harm? 6.2 Does this information include: details for when harm minimisation advice is and is not appropriate (for example, for those who harm themselves by self-poisoning)? details of advice for those who self-poison? details of who should deliver advice to those who self-poison? instructions on how to advise those who inflict superficial injuries regarding wound care, how to obtain appropriate sterile dressings and equipment and how to deal with scar tissue? alternative coping strategies?

12 10 Preventing suicide: A toolkit for ambulance services Standard 7 Post-incident review Services should have access to a dedicated self-harm services planning group which includes A&E department staff, general practitioners, ambulance staff and mental health services. All incidents of serious self-harm or suicide in the community are investigated under the relevant primary care organisation and where applicable, mental health services serious incident procedure. 7.1 Is information available about how to complain and ask questions if a patient is unhappy with their treatment? 7.2 In the terms of reference for Post Incident Review Groups is there evidence of: multidisciplinary working details for cross-organisational audit incorporation of patient views and action taken in response to satisfaction survey data examination of performance data, incidents and complaints and action taken in response to this plans for, and records of cross organisational training practice and service development activity the development and implementation of joint protocols mechanisms for providing formal feedback and information to trust-boards and commissioners 7.3 Is there a policy to ensure that family/carers are included in post incident reviews? 7.4 Does the serious incident policy include: involvement of parents/carers in the investigation process? support for parents/carers in the investigation process? psychological support mechanisms for staff? process for learning and disseminating lessons? process for governance and reporting to trust board and commissioners? The psychological effects experienced by staff should be a component of all major incident plans. 7.5 Is there evidence that staff support was addressed?

13 Preventing suicide: A toolkit for ambulance services 11 Standard 8 Training of staff Staff who have contact with people who self-harm are provided with regular training. Clinical staff who have contact with people who self-harm are provided with appropriate training to equip them to understand and care for people who have self-harmed. Non-clinical staff who come into contact with people who self-harm (including receptionists, domestic staff, security staff etc) should be provided with basic training to equip them to understand and assist people who have self-harmed. 8.1 What proportion of relevant clinical staff have received training to equip them to understand and care for people who have self-harmed in the last three years? 8.2 Is there a policy regarding the provision of clinical supervision to staff who care for those who self-harm? 8.3 What proportion of currently employed clinical staff have received clinical supervision in the last month? 8.4 What proportion of relevant non-clinical staff have received training to equip them to understand and assist people who have self-harmed? 8.5 Does the training course for clinical staff cover: patient involvement? the problems faced by people who self-harm when they have contact with services? an exploration of some of the meaning of and motives for self-harm? capacity and consent in relation to self-harm? risk assessment for suicide and self-harm? early management? the impact of cultural issues on self-harm? carers issues? the content of the NICE guideline? specific issues relating to the safeguarding, care and assessment of asylum seekers, children, young adults and older persons over the age of 65? 8.6 Does the training course for non-clinical staff cover: basic awareness of mental health issues? the problems faced by people who self-harm when they have contact with services? an exploration of some of the meanings of and motives for self-harm? risk awareness? safety issues relating to the care environment in relation to those who have self harmed and are at risk of further self-harm?

14 12 Preventing suicide: A toolkit for ambulance services Ambulance crews should be trained to deal effectively with incidents of self-harm. 8.7 Does the training course include: retrieval of substances/medications from the scene? initial assessment? the management of self-poisoning? when and how to access TOXBASE and NPIS telephone service? the use of IV Naloxone in the event of opioid overdose?

15 Preventing suicide: A toolkit for ambulance services 13 Useful resources New horizons: towards a shared vision for mental health. Department of Health, Available at Clinical practice guidelines Joint Royal Colleges Ambulance Liaison Committee. Available at Self-harm. The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. Clinical Guideline 16. National Institute for Clinical Excellence, Available at National suicide prevention strategy of England. Annual report on progress National Mental Health Development Unit, Available at Better services for people who self-harm. Quality standards for healthcare professionals. Royal College of Psychiatrists, Available at

16 The NHS Confederation 29 Bressenden Place London SW1E 5DD Registered Charity no: National Patient Safety Agency 4 8 Maple Street London W1T 5HD National Patient Safety Agency and Mental Health Network You may copy or distribute this work, but you must give the author credit, you may not use it for commercial purposes, and you may not alter, transform or build upon this work. INF28301