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Care Programme Approach — documentation of past risk-related behaviour

Tayside Primary Care NHS Trust, Carseview Centre, 4 Tom McDonald Avenue, Dundee DD21NH

Tessa Durham, Senior Occupational Therapist

Tayside Primary Care NHS Trust

Mitchell Stewart, Consultant in Liaison Psychiatry

Tayside Primary Care NHS Trust

Scott Kane, Clinical Nurse Specialist in Liaison Psychiatry

Tayside Primary Care NHS Trust

Jim Duffy, Clinical Governance Facilitator

Tayside Primary Care NHS Trust

Declaration of interest and funding

The study was supported by a grant from Dundee Health Care NHS Trust.

AIMS AND METHOD

The aim of the study was to assess the practicality of extracting past risk-related information from case records and to assess how this process might be cost-effectively incorporated in routine practice. Case records of 43 patients referred to the Care Programme Approach in Dundee were examined.

RESULTS

Our study yielded relevant information - 39% of patients had a history of violence, 58% of self-harm or suicide, 58% of severe self-neglect and 72% of non-compliance with medication. However, it took an average of 5 hours to conduct a thorough review of each case because the notes were bulky and poorly organised.

CLINICAL IMPLICATIONS

Retrospective review of conventional case records in routine practice is likely to be incomplete and misleading. Prospective recording should be practicable if used selectively, but requires a standardised approach to clinical recording and case note maintenance. The risk recording system we developed, incorporating a dated index of incidents by risk category, followed by brief summaries of each incident, provides key clinical information not available from a simple check list while not sacrificing brevity.