High Quality Patient Care and Treatment
In this section:
- Care and Treatment Planning
- Attendance by Clinical Staff at Case Reviews
- Medicines Management
- Psychological Therapies Service (PTS)
- Skye Centre Activities
Providing care to a patient is based on individual needs which is of paramount importance. This determines an appropriate care and treatment plan for each patient as an individual. Progress against treatment plans is monitored continuously and reassessed to ensure patient progress and clinical effectiveness.
Each patient is cared for by a multi-disciplinary clinical team comprising highly skilled professional staff in the fields of psychiatry, nursing, occupational therapy, pharmacy, psychology, activity and recreation, social work and security. The different disciplines bring their clinical expertise, impartiality and objectivity to the functioning of the team.
A significant number of patients have one or more risk factors for cognitive impairment, secondary to longstanding severe schizophrenic illness, substance misuse (including alcohol) and acquired brain injury. Such impairment may impact on a patient’s understanding of, and compliance with, treatment.
Key Performance Indicator (KPI)
Attendance by Clinical Staff at Case Reviews.
The table below provides comparative data on the extent to which professions met their attendance target:
Key Performance Indicator (KPI)
Patients have their care and treatment plans reviewed at six monthly intervals.
This is a Mental Health Act requirement for any patients within high secure settings. This indicator measures the assurance of patients receiving intermediate and annual case reviews. Care and Treatment Plans are reviewed by the multi-disciplinary teams at case reviews and objectives are set for the next six months. Performance increased to 93.8% in 2020/21 compared to 87.9% in 2019/20.
Key Performance Indicator (KPI)
Patients will have their clinical risk assessment reviewed annually.
The indicator links with the Mental Health Care and Treatment Act Scotland, 2003. Examples of clinical risk assessments would be a HCR20 / SARA. At 95.35% performance remained only slightly below the 100% target throughout 2020/21.
Pharmacy supplies are provided to The State Hospital by NHS Lothian which includes medicines supply and a specialist on site Clinical Pharmacy Service.
In line with Healthcare Improvement Scotland guidance for Area Drug and Therapeutics Committees, The State Hospital’s multi-disciplinary Medicines Committee provides professional advice, clinical advice and leadership that supports safe, clinically effective, cost effective and patient centred medicines governance. The Pharmacy Team on site plays a significant role in this delivery.
The Medicines Committee nine month update report covering July 2020 to March 2021 outlines key activities over this period. These include approval of the Safe Use of Medicines Policy and Procedures in March 2021, quality improvement initiatives from a wide range of clinical audit projects, and obtaining supplies of the Covid-19 vaccines for safe administration to staff and patients (which included the development of patient group directions).
EU Exit planning and medicine shortages continued to be a key focus of activity for Pharmacy and the Medicines Committee. Implementation of the EU Falsified Medicines Directive ceased to apply in year following the UK exit from the EU on 1 January 2021. The pharmacy team ensured the core service of medicine supply was maintained throughout the pandemic.
Additionally, over the reporting period:
- The number of patients receiving high dose and multiple antipsychotics were monitored.
- Anti-microbial, controlled drug and non-formulary usage reports were reviewed.
- The monitoring of the physical health of patients being treated with Clozapine improved.
- 17 medication incidents were reported and reviewed, with a process to ensure regular feedback to staff being introduced.
Psychological Therapies Service (PTS)
The State Hospital aims to provide treatment of patients' mental health needs by promoting recovery and reducing their risk of future reoffending. Psychological therapies are a core component of the treatment of patients with severe complex mental disorders and are at significant risk for offending.
During the reporting period of January to December 2020 planned activities were severely impacted by the Covid-19 pandemic. Staff engaged in many alternative activities including escorted walks, supporting ward staff numbers, providing regular input to the Staff Wellbeing zone, launching a Staff Health and Wellbeing survey, and supporting the HR and Wellbeing Group in reducing staff sickness absence across the Hospital.
The table below provides an overview of Annual Activity Levels: Clinical Sessions - Group and Individual Interventions:
Furthermore, a new Violence Risk Assessment and Management Policy was approved, Risk Awareness training was completed, and a new Assessment Checklist was implemented. Areas of work still in progress included the consideration of low intensity training on psychological trauma for nursing staff, the delivery of Healthy Living Group in each hub, improvements to clinical formulations, and the pilot of the new Matrix Consensus Cognitive Test Battery (MCCB).
Key Performance Indicator (KPI)
Patients will be engaged in psychological therapies.
This indictor is a main priority of National Mental Health Indicators. This indicator measures the percentage of patients who are engaged and involved in psychological treatment. The 85% target was met with 86% of patients attending psychological therapies.
Key Performance Indicator (KPI)
Patients will commence psychological therapies <18 weeks from referral date.
In 2020/21 compliance was 97.66% against the target of 100%.
Psychological Therapies (general information) Psychological Therapies Service (February 2021)
The Skye Centre service is defined by four Activity Centres (Patient Learning, Sport & Fitness, Craft & Design, and Gardens & Animal Assisted Therapy) and also includes an Atrium where patients can access the Activity Group Room, Café, Library, Shop and Bank. A variety of groups and services are facilitated in the Skye Centre including the Patient Partnership Group, Christian Fellowship Group, Multi-faith services, Psychological Therapies groups and Allied Health Professions groups. A number of volunteers support activity within the Skye Centre.
Skye Centre Therapies and Activities (general information - Skye Cenre) (February 2021)
Key Performance Indicator (KPI)
Patients will be engaged in off-hub activities.
This is a local priority linking with patient objectives within their care plans and measures the same. The indicator was closed in June 2020 to accommodate engagement in off-hub activity centres during Covid-19.
Key Performance Indicator (KPI)
Patients will be engaged in off-hub activity centres during Covid-19.
This measures the number of patients who are engaging in some form of timetable activity which takes place off their hub. The sessions may not necessarily directly relate to the objectives in their care plan however are recognised as therapeutic activities. In 2020/21 83% of patients were engaged in off-hub activity centres during Covid-19 against a target of 90%. A weekly timetabling group was established to review patient activity on a weekly basis, and to identify gaps and staff deficits that could prevent patients from participating in activity.