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Overdose and Self-Harm CPI
Clinical scenario
Patients who present with SH are at high risk of further self-harm and suicide. The government published guidelines on the management of self-harm in 1984 which recommended that all those seen in the emergency department (ED) following an episode of SH be given a psychosocial assessment prior to discharge by a member of staff trained for the task. The initial assessment of self-harm patients in most hospitals remains the responsibility of medical staff in the ED.
Audit question
Are patients presenting with overdose and/or self-harm managed appropriately according to best practice guidelines?
Method
Retrospective audit
Sample: 30-50 Emergency Department patient records
Criteria
Inclusions: All patients 16 years old and over attending with self-harm (whether physical or pharmacological)
Exclusions: None
Audits
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1st August 2008
Results
| Date | Patients | Measured | Results | Standard | Regional avg. |
|---|---|---|---|---|---|
| 01st August 2008 | Patients attaneding ED following overdose or self-harm episode | Management of patients according to the criteria | If diminished capacity/mental illness established, patient referred for urgent mental health assessment | 100 % | 57 % |
| Appropriate follow-up arranged and documented for patients who leave after triage and prior to assessment, and GP informed | 100 % | - | |||
| Patients offered preliminary psychosocial assessment at triage | 100 % | - | |||
| Psychosocial assessment by ED personnel prior to referral or discharge from the ED | 100 % | 50 % |
Comments
As much of the data is missing due to a lack of appropriate patients/data and small sample size, it is difficult to make comparisons. Of the 2 measures recorded, both have shown a reduction in scores, namely the psychosocial assessment by ED staff, and referral for urgent mental health assessment.
Audit Bottom Line
A small sample and insufficient data makes drawing conclusions difficult, however work needs to be done to improve compliance within the ED both with the preliminary psychosocial assessment, and the subsequent referal to the mental health team.