Clinical Psychology Profession Specific Audit of Stroke Care Clinical Casenote Audit Clinical site code. Age (in years).. Patient ID. Date of admission to unit.. Gender.. Inpatient location: Acute Rehabilitation Question Yes No Details N/A Screening 1. Is there evidence of screening (by any member of the MDT) for: (a) Cognitive function? (b) Mood, anxiety or emotional adjustment? (c) Behavioural problems? 2. If problem identified is there evidence of referral to a psychologist? Referral and assessment 3. Is there evidence of involvement of psychology service with either the patient or the family/carer? If no then discontinue If yes then: 4. Is the psychologist part of the specialist MDT? 5. If no is there evidence of psychology input provided by another service? 6. Is there evidence of assessment by the psychologist of: (a) Cognitive function (b) Mood, anxiety or emotional adjustment? (c) Behaviour? 7. Is there evidence that the outcome of the assessment, when undertaken, has been communicated to the patient?
8. Is there evidence that the outcome of the assessment, when undertaken, has been communicated to the family/carer (where consent has been obtained)? 9. Is there evidence of identification of need for assessment of family/carers emotional adjustment? (from any member of the MDT) 10. If yes, is there evidence of assessment by the psychologist of family/carers emotional adjustment? 11. Is there evidence of an assessment made of Mental Capacity? 12. If yes, is there evidence that a psychologist was involved? Therapeutic Intervention & Goal Setting 13. Is there evidence of intervention with the patient for cognitive rehabilitation? 14. Is there evidence of intervention with the patient for mood, anxiety or emotional adjustment? 15. Is there evidence of intervention with the family/carer? 16. Is there evidence of psychology involvement in goal planning/setting? Teamworking 17. Is there evidence of psychology attendance/contribution to MDT meetings, goal planning meetings, etc.? 18. Is there evidence of communication with the team about the outcome of the assessment and intervention? 19. Is there evidence of a psychologist engaging in MDT working? Evaluation/transfer of care/discharge 20. Is there evidence of discharge documentation? 21. If yes, does it include reference to involvement of the psychologist?
Clinical audit Clinical Psychology The clinical audits are profession specific and need to be completed by the relevant discipline. These audits are not designed to cover all aspects of care within professional standards, but are designed to identify key areas of intervention that may evaluate the quality of stroke services. The definition used in this audit for a stroke unit is based on the NSAS (2006): Stroke unit- a multidisciplinary team including specialist nursing staff in a discrete ward designated for stroke patients. This category includes the following: Acute stroke units accept patients acutely but discharge early (usually within 7 days). Rehabilitation stroke units which accept patients after a delay of usually 7 days or more and focus on rehabilitation. Combined stroke units (i.e. no separation between acute and rehab beds) that accept patients acutely but also provide rehab for at least several weeks as necessary. For the process of clinical care audit, you should provide data retrospectively from the records of 20 consecutive patients to your Stroke Unit/team to whom you provided a service from a set date. Your Stroke Unit or Stroke Co-ordinator should be able to provide this information from their admissions data. If a question is considered as being not applicable, this should be recorded and a reason for this decision should be provided. All questions need to be answered. The whole audit should be conducted using either psychology notes or multi-disciplinary notes, according to which are used on your site. If multi-disciplinary notes are used, information can have been recorded by any discipline, i.e. it does not need to have been completed by a psychologist. There are more detailed notes related to the standards and rationale upon which the psychology clinical audit proforma is based in Appendix 1. You should seek advice from your central audit department regarding data collection and data analysis prior to undertaking this audit.
Screening Appendix 1 Clinical Psychology Profession Specific Audit of Stroke Care Help Notes Standard 1. All patients should be routinely screened for problems (this could be carried out by other members of the MDT) (ref. NSF, BPS). To identify cognitive and emotional difficulties at an early stage. Standard 2. If problems are identified then referral should be made to psychology services (ref. RCP, BPS). Referral and Assessment 1. Is there evidence of screening (by any member of the MDT) for cognitive function, mood, anxiety or emotional adjustment, behaviour? 2. If problem identified is there evidence of referral to a psychologist? Standard 3. Psychologists should be members of specialist stroke services (ref. NSF, RCP, BPS). To provide a perspective to treatment and care. 3. Is there evidence of involvement of psychology service with either the patient or the family/carer? 4. Is the psychologist part of the specialist MDT? Standard 4. In depth assessment of cognition and emotional adjustment to be carried out on those patients referred to psychology service (ref. RCP, BPS). To provide detailed information on the cognitive and mood disorders and so tailor rehabilitation to suit the individual. 5. If no is there evidence of psychology input provided by another service? 6. Is there evidence of assessment by the psychologist of cognitive function, mood, anxiety or emotional adjustment, behaviour? 7. Is there evidence of
Standard 5. Outcome and implications of assessment to be fed back to patient and family (ref. BPS). Standard 6. Carers needs regarding adjustment to role changes, identification and treatment of depression and need for education to be monitored and referred to psychology service if appropriate (ref. RCP, BPS). To provide patients and carers with an understanding of the difficulties and ways of coping. To provide carers with emotional support and understanding and also to treat levels of depression and other emotional disorders amongst care givers. an assessment made of Mental Capacity (by any members of the MDT)? 8. If yes is there evidence that a psychologist was involved? 9. Is there evidence that the outcome of the assessment, when undertaken, has been communicated to the patient? 10. Is there evidence that the outcome of the assessment, when undertaken, has been communicated to the family/carer (where consent has been obtained)? 11. Is there evidence of identification of need for assessment of family/carer emotional adjustment? 12. If yes, is there evidence of assessment by the psychologist of family/carers adjustment? Therapeutic Intervention and Goal Planning Standard 7. Psychological formulation and intervention to be carried out on all patients referred to psychology service (ref. BPS). To develop rehabilitation intervention for managing cognitive impairment and working with other team members to implement these interventions. To provide psychotherapy for emotional adjustment and mood disorders 13. Is there evidence of intervention with the patient for cognitive rehabilitation? 14. Is there evidence of intervention with the patients for mood, anxiety or emotional adjustment?
Standard 8. Psychological intervention to be provided for all family/carers referred to psychology service (ref. BPS). Standard 9. Intervention to be goal oriented and progress to be monitored via goal planning meetings/family meetings/case conferences (ref. NSF). Teamworking To provide carers with emotional support and understanding and also to treat levels of depression and other emotional disorders amongst care givers To improve motivation to participate in rehabilitation and to regain some control. Regarded as a behavioural systemic intervention. 15. Is there evidence of intervention with the family/carer? 16. Is there evidence of psychology involvement in goal planning/setting? Standard 10. Convey information about the outcome of assessment and intervention, as appropriate, to team members and putting forward a perspective to team working (ref. BPS). To offer consultation and teaching to team members. Evaluation/transfer of care/discharge Standard 11. A summary of the intervention will be included in the medical notes and any relevant information passed to relatives and carers. Refer to other services as necessary (ref. BPS). 17. Is there evidence of psychology attendance/contribution to MDT meetings, goal planning meetings, etc? 18. Is there evidence of communication with the team about the outcome of the assessment and intervention? 19. Is there evidence of a psychologist engaging in MDT working? 20. Is there evidence of discharge documentation? 21. If yes does it include reference to involvement of the psychologist?
References: Royal College of Physicians National Clinical Guidelines for Stroke 3 rd Edition (2008) The British Psychological Society, Division of Clinical Psychology and Division of Neuropsychology Briefing Paper No.19 Psychological Services for Stroke Survivors and their Families (2002) National Service Framework for Older People in Wales (2006)