Application of Section 17 Leave on Old Age Psychiatric Ward Audit

Abstract

Aims

Most patients on the old age psychiatry ward have dementia so they would need extra care from the ward team regarding their rights for a better quality of life. Therefore, the purpose is to ensure that inpatients under MHA on the ward are not deprived from their liberty to time off the hospital grounds in accordance with the leave granted by the responsible clinician. Additionally, to ensure that the appropriate steps are followed before the patient leave the ward, to ensure safety for the patient and accompanied staff if escorted.

Methods

1. 1. Data were collected with approval of the ward consultant and the ward manger from RIO records.

2. 2. Data included checking the forms for S17 on RIO, and answering the audit questions after checking the records for each patient.

3. 3. Patients included admissions within the last 6 months on the ward under the MHA weather section 2 or 3 which included 28 patients.

4. 4. Checked data were:

   • • Presence of Section 17 form uploaded to Rio

   • • Documentation of any discussion with the patient or the carer about the leave

   • • Documentations of facilitation of the leave for the patient with accordance to the guaranteed leave by the clinician.

   • • Presence of updated risk assessment before patients go to leave documented on RIO.

Sample

Sample size: 28 patients, (all patients who were admitted on the ward in the period from August 2022 till December 2022 under mental health Act section 2or section 3)

Source: RIO

Results

1. 1. 25% of the sample (7 patients) didn`t have Section 17 leave uploaded to RIO, though it was mentioned in the ward round documentation that arrangements for leave are according to S17.

2. 2. 46.42% of the sample (13 patients), there was no evidence of any discussion with the patient or the care about the section 17 leave on RIO.

3. 3. 3.5% OF THE SAMPLE( 1 patient) , there was no discussion about the S17 leave because of the deteriorated mental state of the patient.

4. 4. 25% of the sample ( 7 patients), there was no evidence on Rio if the leave was facilitated or why it was not. 7.1% (2 patient) refused to leave their bedroom. 39% (11 patients) were ward based and only guaranteed leave off the hospital grounds for medical and physical health appointments.

5. 5. 42% of patients who had been granted leave off the hospital grounds (6 patients), has their leave facilitated.

6. 6. 83% of patients (5 patients) out of 6 patients who had leave facilitated, there was no updated risk assessment on RIO before going to leave.

7. 7. 5 out of the 6 patients who had their leave facilitated were in accordance with the time, and frequency stated by the responsible clinician, and one patient had no specification about the time and frequency he had.

8. 8. 100% of patients who had their leave facilitated has been escorted by staff in accordance with what is specified on their leave form by the responsible clinician.

Conclusion

Senior Psychiatric Patients are physically and mentally exhausted and frail, and it is our duty of care to help them for better recovery. Many of them have no family or friends left, and we are their only chance to get over their time of crisis. Therefore,it requires vigilance and extra care when it comes to keeping good quality of life for patients. The results concluded that patients have not had a chance to have time outside the hospital grounds as granted by the responsible clinician, and when granted there was no updated proper risk assessment before the leave. which could be changed by:

1. 1. Ward doctors should discuss leave form updates with the patient during the ward rounds.

2. 2. Ward staff should use one to one session with patients to bring up the updates in the leave form, and use that as an incentive for the patient to engage with the ward team for better recovery of their mental health.

3. 3. Ward staff should ensure documentation of their risk assessment before the patient leave the ward weather escorted or not on Rio.

4. 4. Ward staff should use the pre leave form available on the ward and upload it on RIO as a reference to their risk assessment and in which state the patient was when leaving the ward.

5. 5. Reaudit after 12 months after changing practices.