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G94(P) A quality improvement study of mental health risk assessment in Children and Young People (CYP’s) with Deliberate Self Harm (DSH) on admission to the paediatric ward
  1. C Ratcliffe,
  2. A Owens,
  3. A Tucker,
  4. A Shetty
  1. General Paediatrics, Nevill Hall Hospital, Aneurin Bevan University Health Board, Abergavenny, UK

Abstract

Aim With increasing numbers of children and young people being admitted to paediatric wards with mental health problems, we aimed to ascertain if these CYP’s were being appropriately risk assessed on their admission. After the creation of a dedicated paediatric mental health admission document we re-analysed our compliance with the new proforma and its effectiveness.

Method Initially we conducted a retrospective case note analysis of all patients admitted to the paediatric ward with DSH from January to May 2015, using the quality standards “A better service for people who self harm” by the Royal College of Psychiatrists. Following introduction of the admission document in August 2015, we conducted a retrospective case note analysis of all DSH admissions from August to November 2015.

Results Our initial audit showed an average of 2.8 CYP’s admitted per week with DSH. Overdose was the most common presenting complaint and 84% of patients were female. None had a fully completed suicidal risk assessment or mental state examination. Drug and alcohol use was documented in 15% of patients. After introducing our admission document we had a 53% proforma usage on re-audit. 74% were female and overdose remained the most common presenting complaint. Where the proforma was used, 80% of patients had a fully completed mental state examination and 90% had a complete suicidal risk assessment. 80% were risk assessed and designated to the high or low risk categories; and 80% had documentation of their drug and alcohol usage. Conversely those without proforma uptake showed similar results to our initial findings, with no patient having a fully completed suicidal risk or mental state assessment.

Conclusion We’ve clearly demonstrated that by using a dedicated mental health admission document paediatric patients are much more likely to have appropriate assessments on admission. However, proforma uptake in this sample was suboptimal and we would like to re-audit with a larger sample size after further education of clinical staff on its usage. Paediatric doctors would also benefit from dedicated training from local CAMHS teams to improve skills in mental health risk assessments and further improve the quality and safety of the service.

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