Setting

This audit is likely to be most relevant in general adult psychiatry and outpatients. It could also be applied to rehabilitation and forensic units.

Background

The National Institute for Health and Clinical Excellence (NICE) has published an updated clinical guideline for schizophrenia (National Institute for Health and Clinical Excellence, 2009a), with separate audit support tools for pharmacological interventions, organisational criteria and clinical criteria.

Standards

The NICE ‘clinical criteria’ audit support tool has 20 criteria (National Institute for Health and Clinical Excellence, 2009b). Although it would be possible to audit against all 20 criteria, in practice this would be difficult, as some relate to specific phases of illness. When auditing longer-term treatment, the following criteria from the audit support tool can be applied:

ᐅ All patients should receive a comprehensive multidisciplinary assessment, including a psychiatric, psychological and physical health assessment.

ᐅ Advanced statements should be recorded and copies kept in the primary and secondary care plans.

ᐅ Service users who wish second opinion should be supported in obtaining one.

ᐅ Service users should have a crisis plan, with key clinical contacts noted.

ᐅ Service users should have one-to-one cognitive–behavioural therapy (CBT), over at least 16 sessions, following a treatment manual.

ᐅ If the service user lives with, or is otherwise in close contact with, his/her family, they should be offered a family intervention.

ᐅ Counselling or supportive therapy should not be offered unless the individual requests this or CBT is not available locally.

ᐅ Adherence therapy (as a specific intervention) should not be offered.

ᐅ Social skills training (as a specific intervention) should not be offered.

ᐅ The service user should have routine recording of daytime activities in the care plans.

ᐅ Staff should give the service user written information about schizophrenia, its treatment and the service providing treatment and care.

ᐅ If there is a carer, and the service user agrees, he/she should be given written information about schizophrenia, its treatment and the service providing the treatment and care.

In all cases the standard should be 100%.

Method

Data collection

A 12-item data-collection tool (modified from the NICE audit tool) was developed. All service users in a team/service with an ICD–10 diagnosis of schizophrenia or schizoaffective disorder were identified.