Modified Sainsbury tool: an initial risk assessment tool for primary care mental health and learning disability services

Examination of risk assessment tools developed to evaluate risks in mental health areas: A systematic review

The purpose of this research was to identify and examine risk assessment tools evaluating at least two risk dimensions to evaluate the risk assessments of patients in mental health areas in a more comprehensive and standard manner. This systematic review was prepared according to the PRISMA guidelines. The databases to be scanned and the keywords to be entered were identified before scanning the literature. The keywords risk assessment, risk management, mental health, psychiatry, risk assessment scales, and risk assessment tools were scanned. The CINAHL, EMBASE, PsycInfo, Medline, APA PsycNET, Science Direct, Pubmed, ProQuest, and Google Scholar databases were searched. All full-text articles published between December 30th, 1970, and January 1st, 2020, were examined. A total of 7385 papers were investigated using the keywords listed above, and 18 studies meeting the inclusion criteria were identified. The tools involved were SPC, FACE, Clinical Risk Management, Threshold Assessment Grid, Risk Assessment for People with Mental Health Problems, Psychogeriatric and Risk Behavior Assessment Scale, Sainsbury Risk Assessment Tool, Risk Assessment Management and Audit Systems, Generic Integrated Risk Assessment for Forensic Environments, FRAME, Brief Risk Assessment, Clinical Assessment of Risks to Self & Others, RIO, The Risk Assessment and Management, Risk Assessment and Management Self-Efficacy Study, Galatean Risk and Safety Tool, Short-Term Assessment of Risk and Treatability, and Psychiatric Risk Assessment Scale.

Risk assessment of psychiatric in-patients: audit of completion of a risk assessment tool

Aims and Method

Two complete audit cycles were used to assess the completion of a bespoke risk assessment tool and whether an educational intervention, and subsequently the introduction of a standardised admission pack, led to improvements in completion rates.

Results

The total rate of completion of forms improved from 60% to 81% following a brief educational intervention in the form of a lecture and email about the audit. The subsequent introduction of a standardised admission pack containing the tool maintained completion rates.

Clinical Implications

Audit coupled with a simple educational intervention can improve the completion of risk assessment forms by medical and nursing staff.

Confidence in the face of risk: the Risk Assessment and Management Self-Efficacy Study (RAMSES)

Aims and method To evaluate a comprehensive risk management programme. A Risk Assessment and Management Self-Efficacy Scale (RAMSES) was used to evaluate the impact of a clinical guideline and training course. Fifty-three psychological therapists were randomly allocated to training v. waiting list in a controlled, delayed-intervention design. Differences in mean self-efficacy scores between groups were examined using analysis of covariance (ANCOVA).

Results The RAMSES measure had adequate factor structure, internal consistency and construct validity. When adjusting for baseline scores and cluster design, the group exposed to training had a higher mean self-efficacy score than controls. Mean differences between groups were not significant after the control group received training, nor at 6 months’ follow-up.

Clinical implications Exposure to training and clinical guidelines can improve self-efficacy in risk assessment and management. An important advance put forward by this study is the specification of areas of competence in risk assessment and management, which can be measured using a psychometrically sound tool.

Nurses' role in caring for people with a comorbidity of mental illness and intellectual disability: a literature review

This article examines literature on the role of the nurse caring for people with a dual disability (DD) of intellectual disability and mental illness. A search of the literature between 2000 and 2010 resulted in a total of 21 articles that met the inclusion criteria. Seven key categories of the role of the nurse were identified: (i) advocacy/health promotion (including working with family); (ii) assessment/case management; (iii) behavioural interventions; (iv) communication; (v) leadership and the nurse's role within the multidisciplinary team; (vi) functions regarding medication administration; and (vii) safety/risk management. There is a paucity of research about the role of nurses working with people with DD, although a number of opinion-based articles exist. This article identifies a need for the role of the nurse working in DD to be more clearly articulated and for the development of evidence to guide best practice.

The physical health of residents of long-stay wards in Carlow/Kilkenny

OBJECTIVES

This audit is supported by regulations within the Mental Health Act 2001. It is in response to the Mental Health Commission Strategic Priority Number One, Quality Framework, 2002-2008 which aims to promote high standards of physical examination in the care of long-stay residents of psychiatric facilities. It is based on improved awareness of adverse effects of mental illness or its treatment on physical health. This awareness informs better practice.

METHOD

Physical examination proforma and case notes of all long-stay residents in wards in Carlow and Kilkenny were assessed over a six month period to examine the quality of physical examination. Following departmental meetings and literature review, standards of care as recommended by the Royal College of Psychiatrists in Occasional Paper 67 and Irish statutory documents were agreed to be the appropriate benchmark.

RESULTS

Areas of strength were the examination of 'routine' systems (> 92%), ie. cardiovascular, respiratory, alimentary, central nervous, genitourinary and the frequency of clinical review by treating psychiatric team. Areas needing improvement were eye (8%) and ear (3%) examinations, measurements of weight (58%), height (1.6%), body mass index (1.6%), waist circumference (0%), investigating for prostatic specific antigen (50%), discussion of results of physical examination and investigations with the residents (both 0%) and referral to BreastCheck (36%).

CONCLUSION

A new physical examination form has been created for long-stay residents to correct these deficiencies and a new departmental policy document setting out a standard of practice consistent with recommended practice and general statutory requirements has been put into place.