Third National Report

Transcription

1 Electroconvulsive Therapy Accreditation Service (ECTAS) Third National Report October October 2009 Editors: Joanne Cresswell & Paul Lelliott

2

3 Background The ECT Accreditation Service (ECTAS) was established in 2003 to promote better standards of practice in ECT services in England, Wales, Northern Ireland and the Republic of Ireland. ECTAS is managed by the Royal College of Psychiatrists Centre for Quality Improvement and works in partnership with the Royal College of Anaesthetists, the Royal College of Nursing and Service Users. The ECTAS standards are based on current best available evidence, are reviewed annually by a multi-disciplinary reference group (see appendix 3) and are published each December. The standards are graded into three types: Type 1 Standards are essential to safety, rights, dignity and the law. Type 2 Standards are those that an accredited clinic would be expected to meet. Type 3 Standards are aspirational and would be met by an excellent clinic. In order to achieve accreditation a clinic must meet all Type 1, the majority of Type 2 and some Type 3 standards. If a clinic does not meet this level it will be deferred for a short period of time in order to make the necessary improvements. The ECTAS model is about more than one-off inspection to assure that minimum standards are met. Its purpose is to encourage clinics to improve continuously and to achieve excellence in ECT practice. Accreditation entails a rigorous process of self- and peer-review against the standards. This involves an audit of health records, policies and procedures, evaluation of the treatment environment and facilities, observation of ECT practice, and structured feedback from clinic staff, referring psychiatrists and patients who have used the service. Each ECTAS cycle takes three years. It begins with a full self- and peer-review, after which a full report is sent to the clinic. At 18 months, there is an interim self-review to ensure the clinic is maintaining standards. Once a clinic has completed the full three-year

4 cycle, the process begins again and the clinic moves to cycle 2 and so on. Further information on the ECTAS standards and process can be found at Update on recommendations made in the second national report The second national report, published in late 2007, made a number of recommendations. Here we report on progress against these. Recommendation 1: ECTAS will work with the National Association of Lead Nurses in ECT to develop and provide generic protocols for clinics to download and modify to suit their own practice. Protocols relating to maintenance ECT, outpatient ECT and discontinuation of ECT are now available on the ECTAS website for clinics to download and amend to suit their own area of practice. Further protocols will be added in the future. Recommendation 2: ECTAS will develop standards relating to the availability of service and travelling distance for patients receiving ECT. These will be included in the 8th edition of the ECTAS standards which will be published in December Recommendation 3: ECTAS will work with other professional bodies to ensure/provide training for all disciplines who work within the ECT service and for referrers to ECT. ECT training for referrers to ECT has now been incorporated into the Royal College of Psychiatrists annual ECT training days. ECT Competency-Based Training for Nurses and Psychiatrists is discussed further on page 7 of this report. Recommendation 4: ECTAS will support research into cognitive impairment and memory testing. ECTAS has part-funded a PhD student to research the effect of ECT on memory and devise or offer advice on a simple tool that clinics can use to measure any memory impairment during the course of ECT. This has recently been completed and submitted and papers relating to the findings will be published in the near future.

5 Overall performance of ECTAS member clinics By October 2009, 104 ECT clinics had participated in ECTAS. Ninetytwo of these were located in England, six in Wales, two in Northern Ireland and four in the Republic of Ireland. Six of these clinics are dormant ; that is they have previously been accredited but are not currently treating patients. There are 138 clinics in England and Wales and we estimate that there are 11 in Northern Ireland and 27 in the Republic of Ireland. This means that about 60% of all eligible clinics participate in ECTAS; the figure for England and Wales is 71%. A full list of ECT clinics, together with their participation and accreditation status can be found at The table below includes only the 98 active participants. Table 1: Status of the 98 active ECTAS clinics (October 2009) Cycle 1 1 Cycle 2 1 Accredited as excellent 7 23 Accredited First time 7 24 Following deferral 11 9 Accreditation deferred 0 2 Not accredited 0 0 In self-/peer-review stage 8 7 Total of the clinics are in their first three-year review cycle and 65 are in their second. Accredited as excellent To achieve the highest category of accreditation a clinic must meet all Type 1, at least 95% of Type 2 and the majority of Type 3 standards, at the point of peer-review. The clinic must also have received positive patient feedback. There are about 200 ECTAS standards and the standards and audit methods are reviewed annually. This has resulted in increasing numbers of standards being rated as Type 1 and Type 2, leading to an

6 incremental raising of the bar in ECT practice. Therefore it is a significant achievement for clinics to achieve this level of accreditation. The 30 excellent clinics are listed in appendix 2. Accredited with Continuing Excellence In 2009 ECTAS introduced a new category to recognise those clinics which have demonstrated excellence over two or more review cycles. This was introduced to reduce the cost and audit burden to such clinics and to encourage other clinics to make the final effort required to achieve this level of sustained high performance. For clinics that meet the criteria and opt to be placed in this category, accreditation is renewed annually subject to their demonstrating that four key indicators of quality remain unchanged. These are: the retention of key staff, maintenance of high quality environment and facilities, complete documentation and client base. If there is any doubt, an experienced ECTAS peer-reviewer will interview the local ECT lead by phone and/or a partial audit might be required. Full details of this process, which takes four to six weeks to complete, can be found at By December 2009, six clinics had completed this process and were awaiting ratification. A further five are eligible to opt for accreditation with continuing excellence in 2010.

7 Improvement in clinics which have undertaken two review cycles By October 2009, 58 ECTAS member clinics had completed their second cycle of self- and peer-review. Fifty-six of these clinics were re-accredited and two are currently deferred; 18 progressed to being accredited as excellent. All clinics performed better in their second review cycle than they had in their first, as indicated by the number of standards met. Overall, the average percentage of standards met rose from 87% to 95%. Six clinics met 100% of standards in their second cycle; a feat that none had achieved in their first. Figure 1 shows the improvement in the percentage of standards met both by type and overall, and figure 2 shows the improvement in standards met in the four key sections of the ECTAS audit. The complete data table for these can be found in appendix 1. Figure 1: Comparison of standards met by type in cycle 1 and cycle % Met Type 1 Type 2 Type 3 Overall Type of Standard Cycle 1 Cycle 2

8 Figure 2: Comparison of standards met by key audit section in cycle 1 and cycle 2 % Met Documentation Observation of ECT Environment & Facilities Staff & Patient Feedback Cycle 1 Cycle 2 Section

9 Developing the skills and competencies of ECT staff Nurses ECTAS has worked with the National Association of Lead Nurses in ECT (NALNECT) to define the competencies required by nurses who work in ECT. These are in line with ECTAS Standards and guidance from the Royal College of Anaesthetists, the Association of Anaesthetists, NICE and the Royal College of Nursing. A three-day course, accredited by the Royal College of Nursing, has been developed to train nurses to meet these competencies. The course is provided in collaboration with the Royal College of Psychiatrists Education and Training Centre. It is free of charge to the lead ECT nurse of clinics which are members of ECTAS. In 2009, 103 nurses attended the three courses which were run. Feedback was positive and a further two courses are planned for January and September Details of these can be found on the ECTAS website: Psychiatrists The College Special Committee on ECT has adapted the nurse competencies to meet the requirements of psychiatrists involved in ECT; including trainees. The College's annual ECT training days now provide competency-based training for both psychiatrists who lead ECT clinics and those who refer patients for ECT. The Special Committee are currently working on a means of assessing the competency of psychiatrists via an online tool.

10 Future developments The Royal College of Psychiatrists Centre for Quality Improvement (CCQI), of which ECTAS is a part, is working to improve its data management system. It is hoped that this will streamline the collection and management of data and make it simpler for ECTAS members. It could also allow member clinics to view their data online and download their own reports. ECTAS is also developing an electronic manual of frequently asked questions from the discussion group, which will be simple to use and accessible from the website. Recommendations ECTAS receives multiple requests for basic data, such as the number of patients receiving ECT and the number of treatments given, from both member clinics and researchers. Therefore ECTAS plans to collect a simple minimum dataset from ECT clinics which will be collated, anonymised and available to enquirers. There are now only 12 Trusts in England and Wales who have no ECTAS member clinics. ECTAS is confident that ECT is practiced safely and to a high quality in accredited clinics but can offer no such assurance to people who use non-accredited clinics. Therefore ECTAS will take proactive action to encourage non-member Trusts to join the service. ECTAS will explore ways to encourage more clinics from Northern Ireland and the Republic of Ireland to join the scheme to enable them to quality assure their own ECT services. The CCQI is planning to agree a memorandum of understanding with the Care Quality Commission in relation to its quality improvement programmes. ECTAS will explore whether the information it holds about the accreditation status of English clinics can be part of this, so that the regulator fully acknowledges the achievement of ECTAS members.

11 Appendix 1 These tables list the 58 clinics which have undertaken the self- and peer- review on two occasions and compare their performance in cycle 1 with that in cycle 2. The first table shows performance in terms of the percentage of standards of each type that were met and the second table in terms of the four key sections of the ECTAS audit. Member services will be able to identify their own clinic from the clinic number in the first column. Clinics are listed in descending order of the overall percentage of standards met; that is the best performing clinics come first. Type 1 Standards Type 2 Standards Type 3 Standards Overall Clinic % Met % Met % Met % Met % Met % Met % Met % Met No. Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle 2 Cycle 1 Cycle

12 Total Clinic No. Standards assessed from documentation Standards assessed through observation of ECT % Met % Met Cycle 1 Cycle 2 Standards relating to environment and facilities Standards assessed from feedback by patients and staff % Met % Met Cycle 1 Cycle 2 % Met Cycle 1 % Met Cycle 2 % Met Cycle 1 % Met Cycle

13 Total

14 Appendix 2 Clinics accredited as excellent as of October 2009, listed in alphabetical order. Ablett ECT Clinic, Denbighshire Arundel ECT Clinic, Middlesborough Bodmin ECT Clinic, Cornwall Broadoak ECT Clinic, Liverpool Bushey Fields ECT Clinic, Dudley Calderdale ECT Clinic, Halifax Chase Farm ECT Clinic, London Cherry Knowle ECT Clinic, Sunderland Dorothy Pattison ECT Clinic, Walsall Elm Mount ECT Clinic, Dublin Fieldhead ECT Clinic, Wakefield Glenbourne ECT Clinic, Plymouth Grafton ECT Clinic, Worcester Green Lane ECT Clinic, Wiltshire Hafan Derwen ECT Clinic, Camarthenshire Huntingdon ECT Clinic, Huntingdon John Conolly ECT Clinic, London Maudsley ECT Clinic, London Morpeth ECT Clinic, Northumberland Newham ECT Clinic, London Park House ECT Clinic, Manchester Parkwood ECT Clinic, Blackpool Princess Grace ECT Clinic, London Princess Marina ECT Clinic, Northampton Prospect Park ECT Clinic, Reading Purbeck ECT Clinic, Poole Sevenacres ECT Clinic, Isle of Wight West Park ECT Clinic, Darlington Whiston ECT Clinic, Prescot Worthing ECT Clinic, Worthing

15 Appendix 3 The ECTAS Central Team (also sit on the AAC and Reference group). Name Ms Joanne Cresswell Ms Emily Doncaster Ms Geraldine Murphy Position Senior Programme Manager/Nurse Advisor Deputy Programme Manager Project Worker ECTAS Accreditation Advisory Committee (as of October 2009). Name Profession Area / Institution Dr Farooq Ahmed Consultant Psychiatrist Reading Dr Elaine Allsop Consultant Anaesthetist Merseyside Dr John Bowley Consultant Anaesthetist Nottingham Mr Anthony Deery Head of Mental Health Operations Care Quality Commission Mr Andrew Easton Consultant Psychiatrist Leeds Dr Jill Emerson Consultant Psychiatrist Wiltshire Dr Chris Freeman (Chair) Consultant Psychiatrist/ ECTAS Chair Edinburgh Mrs Joanna Jackson Lead ECT Nurse Cornwall Professor Paul Lelliott Director, College Centre for Royal College of Quality Improvement Psychiatrists Ms Maureen Longstaff Lead ECT Nurse Middlesbrough Ms Lois Sykes Lead ECT Nurse Yorkshire Dr Simon Walker Consultant Anaesthetist Kent Mr Adrian Worrall Head of College Centre for Royal College of Quality Improvement Psychiatrists Dr Maree Wright Consultant Anaesthetist Devon ECTAS Reference Group (as of October 2009). Name Profession Location Dr Maria Atkins Consultant Psychiatrist Cardiff Mr Peter Bestley Service User Dr John Bowley Consultant Anaesthetist Nottingham Dr Godfrey Bwalya Consultant Anaesthetist Hull Ms Vanessa Cameron Chief Executive Royal College of Psychiatrists Dr Ross Clarke Consultant Anaesthetist Manchester Ms Alison Cobb Senior Policy and Campaigns Officer MIND Ms Janie Cornish ECT Lead Nurse Northampton

16 Mr Derek Cragg Service User Dr Andrew Easton Consultant Psychiatrist Leeds Dr Chris Freeman (Chair) Consultant Psychiatrist/ ECTAS Chair Edinburgh Dr Adoni Gopalaswamy Consultant Psychiatrist York Dr Katherine Hayden Consultant Psychiatrist Stockport Dr Ian Hulatt Mental Health Adviser Royal College of Nursing Dr Usman Khalid Consultant Psychiatrist Walsall Professor Paul Lelliott Director, College Centre for Royal College of Quality Improvement Psychiatrists Professor Declan McLoughlin Consultant Psychiatrist Dublin Dr Rupert McShane Consultant Psychiatrist Oxford Dr Ian Pennell Consultant Psychiatrist Gloucester Dr Roshan Perera Consultant Psychiatrist Leicester Dr Noel Sheppard Consultant Psychiatrist Waterford, Ireland Dr Amanda Spencer Consultant Anaesthetist Leeds Dr Simon Walker Consultant Anaesthetist Kent Mr Adrian Worrall Head of College Centre for Quality Improvement Royal College of Psychiatrists

17

18 Electroconvulsive Therapy Accreditation Service (ECTAS) The Royal College of Psychiatrists Centre for Quality Improvement 4th Floor, Standon House 21 Mansell Street London E1 8AA Tel: /6696 Fax: The Royal College of Psychiatrists For further information contact