Authors (including presenting author) :
Chan JWS (1), Lau YS (1)
Affiliation :
(1) Castle Peak Hospital
Introduction :
Special Care System (SCS) aims to provide a framework for managing risk and needs for patients receiving specialist psychiatric service in the Hospital Authority who are at current/potential risk of committing serious violence. The 3 categories under this system are: Intensive Care (IC), Special Care (SC) and Conventional Care (CC).
The SCS guideline specifies different levels of care, defines the upgrading or downgrading criteria, specifies the regularity of review of SCS status, and regulates the tracing mechanisms. All the measures are clearly stated in the Operations Manual on Special Care System for Psychiatric Patients which has been effective since 1st April 2014. Castle Peak Hospital carried out audits on the compliance to SCS in 2015, 2017,2018 and 2020 previously. This is the 5th related audit conducted in the Castle Peak Hospital.
Objectives :
To assess whether the practice of managing patients with violence propensity in the Castle Peak Hospital adheres well to the requirements specified in the Special Care System (SCS) guideline.
Methodology :
Castle Peak Hospital Medical Record Unit retrieved the full list of all in-patient episodes and out-patient attendance with Special Care or Intensive Care status during the audit period. Random sampling was applied afterwards. 120 case notes were selected. Case notes and electronic Clinical Management System (CMS) were cross-checked against the auditable items for both in-patients and out-patients cases according to the latest guideline.
Result & Outcome :
The performance in annual SCS review practice were better compared to audit in 2020. The adherence rate of completing annual review in both PsyCIS and Review Record Form was 89.8% (compared with 66.1% in Audit 2020). 10.2% of the annual SCS review practice did not satisfy the criteria, because the review was not done in due time, or only the PsyCIS was updated but not the paper form. The adherence rate to the level of care required (mandatory Community Psychiatric Service and Medical Social Worker involvement) for Intensive Care case had improved to 100%. 100% of the review form had proper endorsement by seniors (Associate Consultant or above) as compared to 96.3% in 2020. 79.2% had the reason of SCS entered in Psy-CIS as compared to 32.5% in 2020. Individual Care Plan had been documented in 83.3% of the sample (88.3% in 2020). This drop was largely contributed by the low percentage (40%) of individual care plans in outpatient records of SC cases. It was due to the stability of patients and they no longer required CPS round or multidisciplinary meetings for documentation of the care plan.
