NICE produce audit criteria in their guidelines based on the key priorities for implementation, where these can be easily translated into audit criteria. The audit criteria detailed below related to those key priorities that can be easily audited.
In addition to producing these audit criteria, the NCC-NSC has liaised closely with the audit team at the Royal College of Psychiatrists, which have been devising audit tools and conducting an audit on the short-term management of disturbed/violent behaviour in psychiatric in-patient settings on behalf of the Healthcare Commission. These audit tools cover the main areas discussed in this guideline. These audit tools can be used on at a local level and copies can be freely downloaded from the Royal College of Psychiatrist website at the following URL: http://www.rcpsych.ac.uk/cru/qual.htm
Possible objectives for an audit
People who could be included in an audit and time period for selection
Staff who work or have close associations with the ward/unit being audited.
People who do not have direct links with the ward/unit, for example service user representatives; community health council members in Wales and patient forums in England; staff from other areas involved in the care pathway.
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| Criterion | Exception | Definition of terms |
|---|
1. There is an effective risk assessment and risk management plan to manage risk of disturbed/violent behaviour in the case notes of each service user at high risk.
Refer to key priority 1 (recommendation 1.2.1.1) | Nil | |
2. Services have a policy for training employees and staff-in-training in the short-term management of disturbed/violent behaviour.
Refer to key priorities 2 to 5 (recommendations 1.3.1.1, 1.3.2.2, 1.3.2.4, 1.3.2.5) | Nil | The policy will specify
who will receive what level of training (based on risk assessment) how often they will be trained an outline of the techniques in which they will be trained (for example, training in de-escalation techniques) that staff involved in rapid tranquillisation should receive ongoing competency training to a minimum of immediate life support (ILS) that staff involved in physical intervention or seclusion should be trained to a minimum of basic life support (BLS).
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3. On each admission, it has been recorded that a service user has access to information in a suitable format concerning:
which staff member has been assigned to them and how and when they can be contacted why they have been admitted (and if detained, the reason, the powers used and their extent, and rights of appeal) their rights regarding consent to treatments, complaints procedures and access to independent help and advocacy what may happen to them if they become disturbed/violent.
Refers to key priority 6 (recommendation 1.4.1.2) | Nil | A suitable format includes offering the information to the service user in:
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4. The service user's care plan contains an up-to-date advance directive detailing the service users preferred strategies in the event of a disturbed/violent incident.
Refers to key priority 7 (recommendation 1.4.1.5) |
The service user who is not able to give an advance directive and who does not have an advocate or carer. The service user who has turned down the opportunity to record an advance directive. The service user who is not at any risk of becoming disturbed/violent.
| The term ‘preferred strategies’ refers to the service user's choice of rapid tranquillisation, physical intervention and/or seclusion that may be used without a service user's consent. |
5. The record of an incident involving rapid tranquillisation, seclusion and/or physical intervention adequately justifies the use of these interventions and the procedures taken during these interventions and any adverse outcomes.
Refers to key priorities 8 and 9 recommendations 1.8.1.1, 1.8.2.3) | Nil | |
