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

Dr C Bruce LowConsultant PsychiatristLead Clinician Clinical

Governance

Why ?

• clinical governance• PAF • CSBS • user • carer • clinical effectiveness• communication

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 ?

• Mental Health and Wellbeing Support Group

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

What do information systems need to cover ?• MHWBSG • CSBS • SHAS • MWC • SIGN • HTBS• (NICE)• and now ...QSBHS

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• the motivation• what are they• the infrastructure• the audit• the results• should we give up• the latest

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• 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

• 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• 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

• 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

• completed up to date accurate care cards

• self assessment • end user feedback

The Audit

• two cycles completed• quality gap persists• devil’s advocate position !• guidelines • culture change• support and further audit

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 Progress

• balancing act of simplicity utility and specificity

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

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

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 !