Early Intervention in Psychosis audit Patient-level data collection form

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Wesley Summers
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Early Intervention in Psychosis audit Patient-level data collection form Please complete a separate form for each patient. All data must be collected and submitted online by 23 December 2015.

Please note that between the 23 December and 6 January no assistance with data submission will be available due to the College closure.

1 Early Intervention in Psychosis audit Patient-level data collection form Please complete a separate form for each patient. All data must be collected and submitted online by 23 December An emergency extension period can be offered until and not later than 6 January Please note that between the 23 December and 6 January no assistance with data submission will be available due to the College closure. Information on how to submit data online will be ed to the audit leads. For further assistance and information please contact your local EIP audit lead in the first instance. You may also contact the central team at the Royal College of Psychiatrists on AEIP@rcpsych.ac.uk or /2707, or visit our website at Your local EIP audit lead is (to be completed by the EIP audit lead) Patient identifier (this is a code which will allow you to identify the patient on whom data are collected for the purposes of data cleaning, see guidance notes) Initials of data collector/ clinician The name of the EIP service / team where the patient is receiving treatment (to be completed by the EIP audit lead) Copyright HQIP

2 PATIENT INFORMATION Q1. Year of birth Y Y Y Y Q2. Gender Male Female Other Q3. Ethnicity White Black or Black British Asian or Asian British Mixed Other ethnic groups British African Bangladeshi Asian & white Chinese Irish Caribbean Indian Black African & white Any other ethnic background Any other white background Any other black background Pakistani Black Caribbean & white Any other Asian background Any other mixed background EMPLOYMENT / EDUCATION STATUS Q4. Employment / education status (See guidance notes) Employed Unemployed and seeking work Student who is not working or actively seeking work Long-term sick or disabled receiving benefits Homemaker not working or actively seeking work t working or actively seeking work Unpaid voluntary work and not working or actively seeking work Retired t Stated Copyright HQIP

3 Q5. If seeking work (Q4), has the patient been offered any supported employment programme? (Please tick all that apply) (See guidance notes) Employment support programme (individual placement and support) Employment support programme (other) Vocational support programme Apprenticeship programme Education programme Other (please specify): REFERRAL AND DIAGNOSIS Q6. Condition for which the patient is being referred: (See guidance notes) First episode of psychosis At risk mental state (ARMS) Suspected psychosis Other (please specify): Q7a. Date referral received by EIP service or central triage point in the trust: (See guidance notes) Q7b. Date the patient was assessed by the EIP service: (See guidance notes) Q8a. If first episode of psychosis or suspected psychosis (Q6): (tick all that apply) (See guidance notes) This patient was allocated to an EIP service care coordinator Please specify the date the patient was allocated an EIP service care coordinator: This patient was not allocated to an EIP service care coordinator Copyright HQIP

4 This patient was engaged by an EIP service care coordinator Please specify the date the patient was engaged by the EIP service care coordinator: This patient was not engaged by an EIP service care coordinator Q8b. If ARMS (Q6), please tick all that apply: (See guidance notes) This patient was allocated to an EIP service care coordinator Please specify the date the patient was allocated an EIP service care coordinator: This patient was not allocated to an EIP service care coordinator This patient was engaged by an EIP service care coordinator Please specify the date the patient was engaged by the EIP service care coordinator: This patient was not engaged by an EIP service care coordinator A specialist ARMS assessment commenced for this patient Please specify the date the ARMS assessment commenced: specialist ARMS assessment commenced for this patient Q8c. If other (Q6): (See guidance notes) This patient exits the first episode psychosis referral to treatment pathway and referred to appropriate service or discharged. PLEASE NOTE: If the patient was not allocated to and engaged by a care coordinator the form ends here. Q9. Were any of the following standardised outcome measures used routinely: (tick all that apply) Health of the Nation Outcome Scales for adults (HoNOS) or for children and adolescents (HoNOSCA) DIALOG The Process of Recovery Questionnaire (QPR) Other (please specify): Copyright HQIP

5 ne W. Ga PHYSICAL HEALTH SCREENING AND INTERVENTION The following questions refer to physical health screening and intervention from when the patient was taken on by the EIP service. Physical health screening should have been carried out within 12 weeks from the patient being accepted onto the caseload; the patient should have been referred to / offered the intervention up until the day before the data collection tool was completed. Q10. Tobacco smoking status Current smoker Ex-smoker n-smoker Documented evidence of refusal to provide information on more than one occasion after it was assured that the person had been given the Q11. Drinking alcohol (See guidance notes) Harmful or hazardous use of alcohol 1 Alcohol use that is NOT harmful or hazardous Documented evidence of refusal to provide information on more than one occasion after it was assured that the person had been given the Q12. Substance misuse (See guidance notes) 2 Documented evidence of refusal to provide information on more than one occasion after it was assured 1 Q11 guidance: Identification of harmful or hazardous use of alcohol is described in NICE guideline CG115. It may be assessed using structured measures such as the AUDIT or based on enquiring about quantity, frequency and any health or social consequences of alcohol consumption. Where there is a record of drinking that is neither harmful nor hazardous e.g. rarely drinks / drinks in moderation this should be recorded as Alcohol use that is NOT harmful or hazardous. 2 Q12 guidance: Use of any substance. Resources: NICE guideline CG51, NICE pathways Copyright HQIP

6 that the person had been given the Q13. Weight (please enter at least one value below) Documented evidence of refusal to be weighed/ measured on more than one occasion after it was assured that the person had been given the Patient was pregnant/ gave birth within last 6 weeks (weight not measured) BMI (Body Mass Index) (Kg/m 2 ) and/ or Change in weight over a 3 month period: > 5kg < 5kg increase Q14. Blood pressure (please enter at least one value below) Documented evidence of refusal to take blood pressure on more than one occasion after it was assured that the person had been given the Systolic (mmhg) and/ or Diastolic (mmhg) Q15. Glucose (please ensure you use the correct units) (please enter at least one value below) Documented evidence of refusal of blood test when offered on more than one occasion after it was assured that the person had been given the right information on which to make an informed decision Patient was pregnant/ gave birth within last 6 weeks (glucose screening not carried out) Fasting plasma glucose (mmol/l) and/ or Glycated haemoglobin or HbA1c (mmol/mol) and/ or Random plasma glucose (mmol/l) Q16. Cholesterol (please ensure you use the correct units) (please enter at least one value below) Documented evidence of refusal of blood test when offered on more than one occasion after it Copyright HQIP

7 was assured that the person had been given the right information on which to make an informed decision Total cholesterol (mmol/l) and/ or Non-HDL cholesterol (mmol/l) and/ or QRISK-2 score (%) Q17. Interventions for smoking cessation (please tick all that apply) Brief intervention Referral to smoking cessation service Combined NRT (nicotine replacement therapy) and/ or varenicline Individual/ group behavioural support intervention needed Q18. Interventions for harmful alcohol use (please tick all that apply) Brief intervention and advice Motivational interviewing Referral to psycho-education programme Individual/ group behavioural support Pharmacological intervention for harmful use of alcohol commenced or reviewed (acamprosate, disulfiram or naltrexone) Referral to specialist service intervention needed Q19. Interventions for substance misuse (please tick all that apply) Brief intervention/ advice Referral to detoxification programme Referral to psycho-education programme Motivational interviewing Referral to specialist service Copyright HQIP

8 intervention needed Q20. Interventions for weight gain/ obesity (please tick all that apply) Combined healthy eating and physical activity programme Mental health medication review with respect to weight (e.g. antipsychotic) Advice or referral about diet Advice or referral about exercise Behavioural therapy/ intervention Pharmacological intervention for obesity commenced or reviewed (e.g. orlistat) Referral to primary or secondary care physician intervention needed Q21. Interventions for hypertension (please tick all that apply) Mental health medication review with respect to high blood pressure (e.g. antipsychotic) Advice or referral about diet/ salt intake Advice or referral about exercise Anti-hypertensive drug treatment commenced or reviewed Referral to primary or secondary care physician intervention needed as repeat blood pressure reading normal intervention needed (other) Q22. Interventions for diabetes/ high risk of diabetes (please tick all that apply) Mental health medication review with respect to glucose regulation (e.g. antipsychotic) Advice or referral about diet Advice or referral about exercise Pharmacotherapy for diabetes commenced or reviewed (e.g. metformin, insulin, acarbose or exenatide) Referral to structured lifestyle education programme Referral to primary or secondary care physician Copyright HQIP

9 intervention needed Q23. Interventions for dyslipidemia (please tick all that apply) Mental health medication review to lower blood lipids (e.g. antipsychotic) Advice or referral about diet Advice or referral about exercise Lipid modification medication (e.g. statin) Referral to primary or secondary care physician intervention needed PSYCHOLOGICAL INTERVENTION Q24. Has the patient been offered Cognitive Behavioural Therapy for Psychosis (CBTp) by a suitably qualified therapist? Please note that the therapist must have postgraduate diploma level or equivalent generic CBT training (in the form of a CBT training programme or in the course of training as a clinical psychologist), plus additional specialised CBTp training. (See guidance notes) Q25. If No to Q24, was CBTp by a suitably qualified therapist available? Please note that the therapist must have postgraduate diploma level or equivalent generic CBT training (in the form of a CBT training programme or in the course of training as a clinical psychologist), plus additional specialised CBTp training. (See guidance notes) t known Q26. If CBTp was offered, was this taken up by the patient?, was taken up Copyright HQIP

10 t taken up patient refused t taken up reason recorded t taken up reason not recorded Do not know Q27. Where the patient is in contact with the family, has Family Intervention (FI) by a suitably qualified therapist been offered to members of the patient s family? Please note that practitioners delivering this approach require specific FI training lasting 5 days or more. (See guidance notes), but was available, as FI was not available N/A, patient not in contact with family N/A, patient refused to allow EIP team to contact family N/A, not seen as appropriate for this patient Q28. If FI was offered, was this taken up by the patient s family?, was taken up t taken up - patient refused t taken up reason recorded t take up- reason not recorded Do not know Q29. Has the patient s carer been offered carer-focused education and support programmes? (Patients 18 years old and above only). (See guidance notes) N/A Patient is under 18 years old N/A Patient does not have a carer Copyright HQIP

11 MEDICATION Q30. Is the patient currently being prescribed antipsychotic medication? Q30a. If yes, has the patient made an adequate response to the medication prescribed? (See guidance notes) Q30b. If no, is the patient being prescribed clozapine?, the patient is being prescribed clozapine, not yet had a full trial of two other antipsychotic drugs, clozapine contraindicated for this patient, clozapine tried but patient did not respond, clozapine offered but patient refused, unable to determine whether other antipsychotic doses are adequate ne of the above Thank you for completing the EIP audit data collection form for this patient Copyright HQIP

Early Intervention in Psychosis Network Self-Assessment Tool

Early Intervention in Psychosis Network Self-Assessment Tool Please complete one self-assessment form per Early Intervention in Psychosis team. All data must be collected and submitted by 30 September