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.
Are patients presenting with overdose and/or self-harm managed appropriately according to best practice guidelines?
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
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1st April 2009
Date | Patients | Measured | Results | Standard | Regional avg. |
---|---|---|---|---|---|
01st April 2009 | Patients attending the 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 % | 68.323 % |
Appropriate follow-up arranged and documented for patients who leave after triage and prior to assessment, and GP informed | 100 % | 8.333 % | |||
Patients offered preliminary psychosocial assessment at triage | 100 % | 65.81 % | |||
Psychosocial assessment by ED personnel prior to referral or discharge from the ED | 100 % | 78.397 % |
Improvements noted in referral to urgent mental health assessment and psychosocial assessments, however huge decline in follow-up arrangements.
Continued improvement required in all criteria, with particular attention paid to follow-up.