Document name - South West Yorkshire Partnership NHS … · · 2016-02-25problems such as...

Document name: Policy for the Physical Examination of Service Users within Mental Health and Learning Disabilities Services

Document type: Medical Directorate

Staff group to whom it applies:

All mental health and learning disabilities clinical staff within the Trust

Distribution: All mental health and learning disabilities clinical staff within the Trust

How to access: Intranet and ward folders

Issue date: December 2015

Version 5

Next review: April 2017

Approved by: EMT

Developed by: Medical Director - Dr A Berry

Director lead: Medical Director

Contact for advice: Medical Director

Policy for the Physical Examination of Service Users within Mental Health & Learning Disabilities Services Version 5 Approved date: April 2015

2

Contents Section

Page

1

Abbreviations

3

2

Introduction

4

3

Purpose

5

4

Duties

6

5 Capacity and Consent 7 6

Procedure

7

7

Procurement

12

8

Equality Impact Assessment

12

9

Process for Monitoring Compliance of this Policy

12

10

Process for Reviewing and Approving this Policy

13

11

Dissemination, implementation and access to this Policy

13

12

Associated Documentation

13

13 References

14

APPENDICES

Page

Appendix 1

Medical Physical Examination Form

16

Appendix 2

Mandatory Medical Devices/ Equipment for Inpatient and Community Team Clinical Rooms

22

Appendix 3

Equality Impact Assessment

24

Appendix 4

Checklist for the Review and Approval of Procedural Document

26

Appendix 5

Version Control Sheet

28


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1. Abbreviations

AHP Allied Health Professionals AMD Associate Medical Director BDU Business Delivery Unit BMI Body Mass Index CPA Care Programme Approach CT Computerised (Axial) Tomography ECG Electrocardiogram ECT Electroconvulsive Therapy EEG Electroencephalogram EMT Executive Management Team FRAT Falls Risk Assessment Tool GP General Practitioner MCAT Mephedrone/ 4-methylmethcathinone MRI Magnetic resonance imaging NHSLARMS NHS Litigation Authority Risk Management Standards NICE National Institute for Health and Clinical Excellence NSF National Service Framework RCPsych Royal College of Psychiatrists


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2. Introduction

2.1. There is an association between mental illness and poor physical health. Research has consistently confirmed that psychiatric service users have higher rates of physical illness than the normal population. However much of this goes undetected. This calls for better medical screening and prompt treatment of physical illnesses for service users with mental health problems.

2.2. The 2006 Chief Nursing Officer’s review of mental health nursing

– ‘From values to action’ also recommends that a holistic approach should be taken, taking account of physical needs through better assessment and health promotion activities.

2.3. The Disability Rights Commission 2006 investigation into the

inequalities in physical health experienced by people with mental health problems and learning disabilities, found that people with learning disabilities and/or mental health problems are much more likely than to have significant health risks and major physical health problems. For people with learning disabilities these obesity and respiratory disease seem to be of high significance; for people with mental health problems obesity, smoking, heart disease, hypertension, respiratory disease, diabetes and stroke are more common. Both groups are likely to die younger than the average population. Research shows that those suffering from mental health disorders are more likely to have a stroke and/or coronary heart disease before age 55yrs. The mean five year survival rate is also lower for those with co-morbid mental health problems.

2.4. The 2009 Royal College of Psychiatrists occasional paper

‘Physical Health in Mental Health’ states that the “General health morbidity among people with mental health problems is high” and looks to explore a range of issues concerning the general health of people with mental health problems. The RCPsych Occasional paper (March 2013) “Whole-person care: from rhetoric to reality” also emphasizes upon achieving parity between mental and physical health.

2.5. The 2011 cross-government mental health outcomes strategy ‘No

Health without Mental Health’ states: “Having a mental health problem increases the risk of physical ill health. Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults. People with mental health problems such as schizophrenia or bipolar disorder die on average 16–25 years sooner than the general population. They have higher rates of respiratory, cardiovascular and infectious disease and of obesity, abnormal lipid levels and diabetes.”


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2.6. In England, section 1 of the Health and Social Care Act 2012 states that, “ The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement – in the physical and mental health of the people of England, and in the prevention, diagnosis and treatment of physical and mental illness”.

2.7. This policy has been developed to support research, NICE, Royal

College, Government, Health and Social Care Act 2012 etc. (see section 12 for list of references) with a view that people with severe mental health problems should have their physical needs regularly assessed. This policy should be read in conjunction with the Trust’s “Guidelines for obtaining consent to examination and treatment or clinical intervention” reviewed November 2013.

2.8. The policy was developed by the Medical Director in consultation with: Trust’s Medical Consultants Trust’s Heads of Nursing and Allied Health Professional

Leads Representation from the Physical Health Care Work Stream Representation form the NICE Obesity Work Stream Drug and Therapeutic Sub Committee Previous policy reviews have included consultation with: Representation from the Practice Effectiveness Trust Action

Group Community Team Leaders Head of Dietetics / AHP Professional Lead Care Programme Approach Manager Current policy review process in consultation with: Representatives from trust-wide psychiatric medical body

including Consultant, SAS and trainee representatives Trust-wide Assistant Directors of Nursing Trust-wide Community Service Managers Mental Health Act Office

3. Purpose

3.1. All people with mental health problems or a learning disability are

entitled to receive an equal quality of health and social care as those without. The Trust is committed to optimizing the physical wellbeing of all its service users and this document provides the trust-wide procedure to be followed for the assessment of physical health needs in a mental health and learning disabilities inpatient and community settings.


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4. Duties 4.1. The lead Director (currently the Medical Director) is responsible

for ensuring the policy is reviewed, approved and monitored by the appropriate Trust groups.

4.2. The appropriate Trust groups, currently the Executive

Management Team will provide policy approval and ratification. 4.3. Medical Clinical Leads, General Managers & Practice

Governance Coaches are responsible for ensuring the policy is disseminated and implemented in their own service line.

4.4. Medical Clinical Leads, General Managers & Practice

Governance Coaches will ensure the dissemination and implementation of the policy within their area of responsibility.

4.5. Medical Clinical Leads, General Managers & Practice

Governance Coaches to identify training needs on appropriate medical devices as stated in Medical Devices Management Policy.

4.6. General Managers to coordinate the procurement of required

equipment where appropriate.

4.7. General Managers to ensure appraisals of appropriate non-medical staff within their areas consider whether the skills and competencies required for undertaking physical assessments and examinations are up-to-date.

4.8. Medical Director to ensure appraisals of medical staff consider

whether the skills and competencies required for undertaking physical assessments and examinations are up-to-date.

4.9. For the in-service user services, the admitting doctor to complete

the assessment or arrange for it to be undertaken by a colleague at an appropriate time.

4.10. AMD for Medical Education and all appropriate managers to

ensure this policy is covered in the workplace induction.

4.11. All doctors, care coordinators and lead clinicians to work in accordance with the policy.

4.12. The policy’s lead Director will ensure annual monitoring of the

policy in consultation with representatives from the trust-wide medical body, nursing and AHPs. Monitoring evidence will be considered and actions requested as appropriate.


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5. Capacity and Consent 5.1. Healthcare professionals must proceed in accordance with the

Mental Capacity Act 2005 (DCA 2005) before proceeding with a physical examination. Reference to be made to the Trust’s “Guidelines for obtaining consent to examination and treatment or clinical intervention” policy.

6. Procedure

6.1. Inpatient services

Service users can be admitted to the Trust’s mental health / learning disability units directly from their homes via the crisis and home treatment services, Accident & Emergency Departments, 136 Suites, police stations, prisons or transferred from other acute units, rehabilitation units, specialists units or other psychiatric hospitals etc. Regardless of the point or method of admission every service user will receive a similar standard of physical examination on their admission to the Trust.

Whether admitted during working hours or out of hours the physical examination will be carried out as part of the general clerking procedure as early as possible. If this could not be completed at the time of clerking-in of the service user, the inpatient team should endeavour to complete a comprehensive physical examination within a week of their admission. Where this is not possible there should be clear documentation of the reasons and an attempt to liaise with the service user’s GP to get a recent picture of their general physical health condition. The aim of taking a physical health history and undertaking an examination is to obtain as much information as possible about our service user’s physical problems. This will form part of their assessment and treatment plan, enabling the team to make the appropriate referrals.

The following steps will be followed for every service user who is admitted to any of the Trust’s mental health / learning disability units.

6.1.1. Every admission or readmission (irrespective of the date of the last examination or from where they have been transferred from) will be physically examined by the admitting doctor and the result recorded (including time and date) on the Trust’s physical assessment form (Appendix 1) and filed with the service user’s notes and entered on RiO as appropriate. The staffs are involved should be aware of the Trust’s “Guidelines for obtaining consent to examination and treatment or clinical intervention” - Reviewed November 2012. The admitting doctor should endeavour to complete a thorough physical examination for all service users if


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unable to do so this should be reattempted as soon as the mental state of the service user allows it. This reflects the minimum standard for physical examination. In case of any concerns or specific indications a more detailed examination will be carried out or requested for given condition e.g. neurological examination, frontal lobe examination, DVT examination etc. The results will form a baseline assessment for any future requirement to utilise the National Early Warning Score which supports recognition of service users who are at risk of physical deterioration.

6.1.2. In addition to the physical examination, nursing and medical

clinicians should undertake a Falls Risk Assessment using the Falls Risk Assessment Tool (FRAT) and a cardiopulmonary risk assessment and document it under the appropriate sections on RiO.

6.1.3. In order to allow nursing and medical clinicians to carry out the

physical examination the clinical examination rooms will be equipped with the equipment as listed under Appendix 2.

6.1.4. The nursing or medical clinicians will seek the service user’s prior

consent in keeping with the Trust’s “Guidelines for obtaining consent to examination and treatment or clinical intervention” - Reviewed November 2012. If the admitting doctor is unable to undertake the physical examination, either because the service user is too disturbed, asleep, not to be disturbed, late at night or refuses the physical examination, then the admitting doctor must document their observations e.g. respiratory rate, level of alertness, movements observed etc. and give reasons for why a more thorough physical examination could not be carried out. This should be clearly documented on RiO including the date and time the service user was approached, the admitting doctor should also leave a message for the service user to be examined as soon as possible by the ward doctor or next doctor on-call and document this information on RiO. The medical clinicians will continue to review the service user at regular intervals to assess their suitability for physical examination and document all discussions and responses at all stages. All obvious physical conditions will also be noted.

6.1.5. The physical examination will be undertaken in an appropriate

environment ensuring the service user’s privacy, dignity and comfort during the examination.

6.1.6. Medical clinicians are advised to have a chaperone (i.e. a

healthcare professional) to accompany them at all times whilst conducting a physical examination. This protects the service and staff member from inappropriate actions or allegations of inappropriate actions. (See GMC Supplementary Guidance: Maintaining Boundaries. November 2006))


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6.1.7. Consideration must be given regarding gender, religious and

cultural sensitivities regarding physical assessments at all times. The Trust’s cultural awareness training will provide knowledge around these issues.

6.1.8. Medical clinicians should pay special attention to any physical

injuries e.g. lacerations, contusions, abrasions, rashes etc. A description of these lesions should be noted and location marked on the body map within the physical examination form both in the case notes and on RiO.

6.1.9. The medical clinicians should liaise with the General Practitioner

as soon as possible to gather additional information about a service user’s physical health problems.

6.1.10. It is the responsibility of the medical team to ensure that the

physical examination is carried out on admission and the result of the examination is recorded in the service user’s notes and on RiO as appropriate and any necessary actions/referrals to internal/external teams undertaken by the multi-disciplinary team. Any subsequent physical examinations or specialists examinations after the initial examination will also need to be entered on RiO but the paper form in case notes need not be updated.

6.1.11. Where physical symptoms are identified and further specialist

medical input is felt necessary, referral to the appropriate specialist will be made in consultation with the supervising consultant and documented in the service user’s notes / on RiO as appropriate. Good channels of communication with for example the acute hospitals will be encouraged to seek expert advice from specialist services to enable joint work on more advanced / complicated physical health problems. The medical team will also document findings of any physical examinations conducted by specialist services outside the hospital who do not have access to RiO e.g. when a referral is made to a specialist service within a General Hospital with whom the Trust does not share RiO with.

6.1.12. The medical team will ensure that all necessary investigations are

arranged, results recorded of RiO and appropriate action/follow-up arranged as indicated by the results.

6.1.13. The admitting nurse will perform a weight and nutrition screen,

using the Nutrition Risk Screening Tool (available on RiO by clicking on the hyperlink ‘Nutrition Risk Screening Tool’), as early as possible after admission in keeping with the Trust’s “Guidelines for obtaining consent to examination and treatment or clinical intervention” , reviewed November 2012. This identifies service


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users with high BMIs (BMI>30 kg/m2) or low BMIs (BMI <18.5 kg/m2). A suitable nutrition care plan will be developed as part of the nursing care plan if a nutrition risk is detected. This may include a referral to the Dietetic Service if indicated by the Nutrition Risk Screening Tool. The nursing team will also ensure that a cardio-metabolic assessment has been completed on RiO in collaboration with the medical team. Assessment and management of high and low BMIs will form part of the on-going physical health monitoring and care planning. This is in addition to other physical health monitoring required with the prescription of psychotropic medication (see shared care guidelines for atypical antipsychotics and guidelines for the management of weight gain induced by atypical antipsychotics).

6.1.14. Junior doctors undertaking physical examinations and

investigations are advised to discuss the results with a senior colleague and ensure the supervising Consultant is made aware of this information as clinically indicated.

6.1.15. The supervising Consultant should include the results of physical

health examinations and investigations as part of their routine reviews e.g. Ward Round, Multidisciplinary team reviews etc.

6.1.16. All medical clinicians undertaking physical examinations are

expected to maintain their general medical skills in identifying and treating common physical health problems. Individual training needs will be identified through the appraisal process.

6.1.17. Physical examinations must not be limited to the time of

admission and reviews of physical health will be undertaken on a regular basis. This should be at least but not limited to once every six months for long-term admissions or as indicated by the service user’s physical health needs. It is recommended that those service users on extended admission will have further comprehensive physical examinations on at least an annual basis.

6.1.18. In addition to physical examinations any subsequent physical

health monitoring for service users being treated with psychotropic medication should be in accordance with the Trust’s “Reference document for monitoring the physical health of service users taking psychotropic medication” Version 3.

6.2. Community

6.2.1. The care coordinator / lead clinician will encourage the service

user to attend their GP practice or a well-being clinic for regular physical health assessment/monitoring and also signpost/refer to smoking cessation, weight management clinics, provide health promotion literature etc., as appropriate and as recognised good


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practice. It is recommended that significant findings from the primary care investigations should be updated on the care plan.

6.2.2. In treatment and management of psychosis and schizophrenia in

adults, NICE guidelines CG 178 recommends that the secondary care team should maintain responsibility for monitoring service users' physical health and the effects of antipsychotic medication for at least the first 12 months or until the person's condition has stabilised, whichever is longer. Thereafter, the responsibility for this monitoring may be transferred to primary care under shared care arrangements.

6.2.3. The care coordinator should liaise with the GP annually to confirm

that an annual physical health screen has been undertaken. If this is not possible, alternative arrangements should be found for service users to have an annual physical health screen. Refer to the Trust’s “Reference document for monitoring the physical health of service users taking psychotropic medication” or up to date national guidelines for further details.

6.2.4. Community service users should have access to appropriate

community groups that support and encourage good physical health, e.g. walking groups, weight management and healthy living groups.

6.2.5. The Trust has Shared Care Guidelines formally agreed through

the Area Prescribing Committee that clearly identifies the responsibility for physical health monitoring of service users receiving psychotropic medication.

6.2.6. If physical health issues are suspected at any time, these will be

discussed with the service user and they will be encouraged to see their GP or other appropriate physical care specialist. In consultation with the service user the care coordinator / lead clinician will also communicate their concerns directly to the service user’s GP.

6.2.7. Any identified physical health issues are to be alerted through

Primary Care and clearly documented on RiO. 6.2.8. During the CPA reviews, physical wellbeing will be discussed and

any necessary actions undertaken / identified. 6.2.9. All community team staff should record all physical health related

information/updates on the service user’s notes / RiO as appropriate.


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6.3. Electroconvulsive Therapy (ECT)

6.3.1. All service users for whom ECT is planned, a physical examination will be undertaken prior to the ECT. This would include a DVT assessment. The physical examination should take place as close to the commencement of ECT treatment as possible and certainly within the preceding 2 weeks. The physical examination should be performed in line with the Trust’s Electroconvulsive Therapy Policy.

6.4 Physical health monitoring of service users taking medication

6.4.1 All nursing and medical clinicians she follow the Trust’s

prescribing guidelines and “Reference document for monitoring the physical health of service users taking psychotropic medication” Version 3 with regards to the physical health monitoring requirements for specific medication e.g. lithium, clozapine, etc.

7 Procurement

7.1 All purchasing of new / replacement equipment required to

complete the physical health examination, for example ECG machine, will be undertaken in line with the Trust’s Medical Devices Management Policy.

8. Equality Impact Assessment

8.1. The organisation aims to design and implement services, policies

and measures that meet the diverse needs of the service, population and workforce, ensuring that none are placed at a disadvantage over others. The Equality Impact Assessment tool has been utilised to ensure equality has been assessed within this policy. See Appendix 3.

9. Process for Monitoring Compliance of this Policy

9.1. Each BDU will ensure that a regular audit of the inpatient and

community services compliance with the policy is undertaken as part of the Trust’s annual audit plan. As a minimum this should cover ensuring staff are carrying out their relevant duties, ensuring physical assessments of service users are carried out on admission, that physical symptoms are followed up and that on-going review takes place as described in the policy. The audit should also cover the competency of staff involved in the physical assessment of service users. The results of the audit will be reviewed at the appropriate BDU meeting and actions agreed and implemented.


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10. Process for Reviewing and Approving this Policy

10.1. This document will be reviewed biennially or whenever national policy or guideline changes occur (whichever occurs first), primarily by the lead Director in consultation with appropriate Trust groups. Following which it will be subject to approval by the appropriate Trust groups, currently the EMT.

11. Dissemination, implementation and access to this Policy

11.1. This policy will be implemented and disseminated throughout the

organisation immediately following approval and will be published on the Trust’s intranet website, including the medics intranet pages. It will also be included in the induction process for all new staff. All staff will be alerted to changes to the policy through the Trust’s management briefing process.

12. Associated Documentation

12.1. The policy should be read in conjunction with the appropriate

Trust procedural documents. Key documents include:

Cardiopulmonary Resuscitation Policy Rapid Tranquillisation Protocol Physical health monitoring: Reference document for monitoring

the physical health of service users taking psychotropic medication The management of weight gain induced by atypical

antipsychotics Shared care guidelines for atypical antipsychotics Care Plan Approach and Care Coordination policy and

procedures First Aid Policy Relevant Infection Control Policies Health and Safety Policy Moving and Handling Policy Food and Nutrition Policies and Procedures Medical Devices Management Policy Guidelines for obtaining consent to examination, treatment or

clinical intervention (does not apply to treatment prescribed under the Mental Health Act) Mental Capacity Act Framework for the prevention and management of pressure

ulcers Induction Policy Electroconvulsive Therapy Policy Equality and Diversity Strategy


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13. References

In additional to Trust policies and procedures there are a range of other documents relevant to this policy, including:

1. Philips, R.J., Physical disorder in 164 consecutive admissions to a

mental hospital: the incident and significance. British Medical Journal (BMJ) 1984; 2:363-6

2. Koran, L.M. Sox, H.C., Marton, K.I., Moltsen, S., Kraemar,. H.C. et al.

Medical evaluation of psychiatric service users. Results in a state mental health system. Arch Gen. Psychiatry 1989; 46: 733-40

3. National Service Framework for Mental Health, Department of Health

1999

4. McCreadie RG. Diet, smoking and cardiovascular risk in people with schizophrenia. Descriptive study. Br J Psychiatry 2003; 183: 534-9

5. Smoking and service users with mental health problems. Health

Development Agency 2004

6. Choosing Health: Supporting the physical health needs of people with severe mental illness, Department of Health 2006

7. From value to action: The Chief Nursing Officer’s review of mental

health nursing. Department of Health 2006

6. Equal Treatment: Closing the Gap - One Year On. Report of the Reconvened Formal Inquiry Panel of the DRC’s Formal Investigation into the inequalities in physical health experienced by people with mental health problems and learning disabilities (September 2007)

7. South West Yorkshire Partnership NHS Foundation Trust Nursing

strategic Plan 2006 – 2010/11

8. Supplementary Guidance: Maintaining Boundaries, General Medical Council November 2006

9. Schizophrenia: Core interventions in the treatment and management

of schizophrenia in adults in primary and secondary care. NICE Clinical Guidance 82 (2009)

10. Psychosis and Schizophrenia in Adults: Treatment and Management

Clinical Guidance 178(2014)

11. The Management of bipolar disorder in adults, children and adolescents in primary and secondary care. NICE Clinical Guidance 38 (2009)


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12. Bipolar Disorder, the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care: NICE guidelines [CG185] Published date: September 2014

13. Physical Health in Mental Health: Final report of a scoping group,

Royal College of Psychiatrists January 2009, OP67.

14. New Horizons: Towards a Shared Vision for Mental Health. Department of Health 2009

15. New Ways of Working for Psychiatrists. Department of Health 2009

16. Venous Thromboembolism – reducing the risk. NICE Clinical

Guidance 92 (2010)

17. No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages. Department of Health 2011

18. Thornicroft G. Physical health disparities and mental illness: the

scandal of premature mortality. Br J Psychiatry 2011; 199:441-2

19. Royal College of Psychiatrists, Whole-person care: from rhetoric to reality, Achieving parity between mental and physical health, Summary, OP88, March 2013

20. South West Yorkshire Partnership NHS Foundation Trust, Guidelines for obtaining consent to examination and treatment or clinical intervention, Reviewed November 2012

21. South West Yorkshire Partnership NHS Foundation Trust, Reference document for monitoring the physical health of service users taking psychotropic medication” Version 3, Reviewed March 2012

22. Recommended medical equipment for psychiatric wards ( Garden,

2005)


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MEDICAL PHYSICAL EXAMINATION Assessment type: Initial/Six Monthly/Annual Review Unable to undertake Consultant’s name: Service user’s name: Address: Date of birth:

NHS number:

General Practitioner:

RiO number:

COMPLETE IF UNABLE TO UNDERTAKE PHYSICAL EXAMINATION:

Details of why unable to undertake: Action required:

MANDATORY INFORMATION

Date & time of examination ………………………………………………………………………….. Capacity to consent? Yes No Consent given? Yes No If no, to either please state reason: Chaperone present? Yes No Name ……………………….…………………

Medical History and Treatment (ask for any current medication side effects)

Appendix 1


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Allergies? Yes No If YES give details:

Smoker? No Yes - Discuss smoking cessation and refer if interested

General physical examination

Oxygen saturation

Pulse Respiratory

Rate Blood

Pressure Temperature

See Nutrition Risk Screening Tool on RiO for details of height, weight & body mass index (BMI)

General appearance: (e.g. pallor, icterus, cyanosis, oedema, clubbing, lymphadenopathy)

Mouth and throat examination: (Dentures if any)

Eyes and vision: (e.g. glasses, contact lenses, pupils)


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Ears and hearing: (Hearing aid if any)

Thyroid examination: (if relevant from history)

Joints & bony abnormalities: (if relevant from history)

Ulcers, rashes, pressure areas: (if relevant from history)

Signs of Physical Injury: (e.g. cuts, bruises, scars, signs of IV drug use)

Signs of Physical Injury:

Describe and draw to identify location


19

Cardiovascular system: (e.g. JVP, heart sounds, murmurs, peripheral pulse)


20

Respiratory system: (e.g. shape & expansion of chest, percussion, breath sounds)

Abdomen: (Pain, masses, bowel sounds, hernias, organomegaly, include any peripheral stigmata of alcohol misuse)

Pregnancy status and breast feeding: (if applicable)

Neurological examination: (e.g. gait, posture, motor power, sensations, tone, reflexes)

Involuntary movements: (e.g. tremors, Parkinsonism, extra pyramidal side-effects, akathasia, tardive dyskinesia)


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Any other comments: (including any relevant investigations and blood tests done/needed):

Summary of physical examination:

Doctor’s Name ……………………………………………………………………… Anticipated review date …………………………………………………………… (In accordance with the Physical Examination of Service Users Policy, reviews should be undertaken on six monthly basis or sooner if required by the service user’s physical needs. It is recommended that those service users on extended admission have full examinations on at least an annual basis)


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Appendix 2 MANDATORY MEDICAL DEVICES/ EQUIPMENT FOR INPATIENT AND CLINICAL ROOMS Examination couch

Ophthalmoscope + Otoscope

Stethoscope

Sphygmomanometer – Manual/electric (with variable sized cuffs)

Different size BP Cuffs

Pulse Oximeter

ECG Machine + paper & appropriate tabs

Tympanic Thermometer

Tendon hammer

Snellen chart

Tuning fork (256Hz)

Height measure

Weighing scales

Disposable non latex gloves

Urinalysis sticks

Blood sugar monitoring device

Peak flow meter with disposable mouthpiece

Access to Urine Drug screening

Syringes with retractable needles

Dressings

Suction machine and equipment

Emergency Bag

Clinical observation charts

Sharps boxes

Pathology bottles/vacutainers/ retractable butterflies

Alcometer/Breathalyser with disposable mouthpieces

Oxygen Cylinder

Measuring tape

Examination light/torch

Disposable Tongue depressor


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Tourniquet

DESIRABLE EQUIPMENT FOR INPATIENT SPECIALIST SETTINGS

Urinary catheters

CO2 monitors

COMMUNITY TEAMS

Stethoscope

Sphygmomanometer Manual/electric ( with variable sized cuffs)

Thermometer

Urinalysis sticks

Syringes with retractable needles

Dressings

Sharps boxes

Disposable gloves

Blood sugar monitoring device

Ophthalmoscope + Otoscope

Height measure

Weighing scales

Pathology bottles/vacutainers/ retractable butterflies

Equipment for community teams that perform vaccinations:

Pulse Oximeter

Emergency bag/, suction equipment and Oxygen


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Appendix 3 Equality Impact Assessment Tool Equality Impact

Assessment Questions:

Evidence based Answers & Actions:

1

Name of the policy that you are Equality Impact Assessing

Policy for the Physical Examination of Service Users within Mental Health and Learning Disabilities Services

2

Describe the overall aim of your policy and context? Who will benefit from this policy?

The overall aim of the policy is to describe the Trust’s approach to the physical examination of service users within the mental health and learning disabilities service Those staff and service users covered by the policy

3 4

Who is the overall lead for this assessment? Who else was involved in conducting this assessment?

Medical Director Business Manager, Medical Directorate

5

Have you involved and consulted service users, carers, and staff in developing this policy? What did you find out and how have you used this information?

See section 2.8 for those that have been consulted Feedback received has been incorporated in the policy e.g. further investigations for illicit drug screening, frequency of physical examinations for in-service users

6 7

What equality data have you used to inform this equality impact assessment? What does this data say?

N/A N/A

8

Have you considered the potential for unlawful direct or indirect discrimination in relation to this policy?

It is not felt the Policy promotes unlawful direct or indirect discrimination. It allows for a Trust-wide process to be communicated which will ensure a common process to be followed.

9

Taking into account the information gathered.

The policy provides for a standard physical examination process for all service users with the


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Does this policy affect one group less or more favourably than another on the basis of:

mental health and learning disabilities services, irrespective of the equality group.

YES NO

Race N

Disability N

Gender N

Age N

Sexual Orientation N

Religion or Belief N

Transgender N

10

What measures are you implementing or already have in place to ensure that this policy:

promotes equality of opportunity,

promotes good relations between different equality groups,

eliminates harassment and discrimination

Regardless of gender, race, disability, age etc, this policy provides for a standard physical examination process across the mental health and learning disabilities services for all those service users that are admitted to the Trust and a consistent approach to those service users in the community.

11

Have you developed an Action Plan arising from this assessment? If yes, then please attach any plans at the back of this template

N/A

12

Who will approve this assessment and when will you publish this assessment.

Executive Management Team


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Appendix 4 Checklist for the Review and Approval of Procedural Document .

Title of document being reviewed: Yes/No/ Unsure

Comments

1. Title

Is the title clear and unambiguous? Yes

Is it clear whether the document is a guideline, policy, protocol or standard?

Yes

2. Rationale

Are reasons for development of the document stated?

Yes

3. Development Process

Is the method described in brief? Yes

Are people involved in the development identified?

Yes

Do you feel a reasonable attempt has been made to ensure relevant expertise has been used?

Yes

Is there evidence of consultation with stakeholders and users?

No

4. Content

Is the objective of the document clear? Yes

Is the target population clear and unambiguous?

Yes

Are the intended outcomes described? Yes

Are the statements clear and unambiguous? Yes

5. Evidence Base

Is the type of evidence to support the document identified explicitly?

Yes

Are key references cited? Yes

Are the references cited in full? Yes

Are supporting documents referenced? Yes

6. Approval

Does the document identify which committee/group will approve it?

Yes

If appropriate have the joint Human Resources/staff side committee (or equivalent) approved the document?

N/A


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Title of document being reviewed: Yes/No/ Unsure

Comments

7. Dissemination and Implementation

Is there an outline/plan to identify how this will be done?

Yes

Does the plan include the necessary training/support to ensure compliance?

Yes

8. Document Control

Does the document identify where it will be held?

Yes

Have archiving arrangements for superseded documents been addressed?

Yes

9. Process to Monitor Compliance and Effectiveness

Are there measurable standards or KPIs to support the monitoring of compliance with and effectiveness of the document?

No

Is there a plan to review or audit compliance with the document?

Yes

10. Review Date

Is the review date identified? Yes

Is the frequency of review identified? If so is it acceptable?

Yes

11. Overall Responsibility for the Document

Is it clear who will be responsible for implementation and review of the document?

Yes


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Appendix 5 Version Control Sheet

Version Date Author Status Comment / changes

Version 1 Dr N H Booya

Replaced

Version 2 Nov 08

Dr N H Booya

Replaced Amended to reflect requirements in relation to development and approval of policy documents. Inclusion of community procedure. Revised physical examination form.

Version 2.2

Aug 09

Dr N H Booya

Replaced Amended for inclusion of missing BMI chart (Appendix 2), inclusion of pregnancy status in Appendix 1, inclusion of 5.2.2. Also version control sheet inclusion and updated Trust branding.

Version 3 Nov 10

Dr N H Booya

Replaced Revised medical physical examination form. Inclusion of separate medical investigation form. Inclusion of reference to ECT & medication. Updated for requirement for service users in the community. Updated for clinical leadership structure

Version 3.1

May 11

Dr N H Booya

Replaced Simplification of medical physical examination form

Version 4 Oct 12

Dr N H Booya

Replaced Review to harmonise with Barnsley procedures

Version 5 April 15

Dr A Berry

Current Medical Investigation form removed, List for Mandatory Medical Devices/ Equipment for Inpatient and Community Team Clinical Rooms added, recommendations from The RCPsych Occasional paper (March 2013) “Whole-person care: from rhetoric to reality” also emphasizes upon achieving parity between mental and physical health incorporated into the policy, Mental Capacity and Consent guidance incorporated into the policy. Medical Physical Examination form amended.

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