Seclusion Reviews: Audit of Medical Documentation in a Psychiatric Intensive Care Unit

Aims Seclusion is a restrictive intervention used when patient presents with risks that cannot be safely managed in their current environment. The Mental Health Act 1983 Code of Practice (MHA CoP) provides clear recommendations for both frequency and content medical seclusion reviews, compliance previously audited within Cheshire Wirral Partnership NHS Foundation Trust (CWP). Following the initial findings however, change was not implemented. A new audit has therefore been commenced to reassess baseline practice identify areas requiring improvement. Methods MHA CoP tool outlines following timeframes assessment: review 1 hour, 4-hourly reviews until first internal multidisciplinary review, twice daily at least by Responsible Clinician. Documentation should evaluate: physical mental health, medication adverse effects, observation level, prescribed medication, risk others self, need ongoing seclusion. Data were collected retrospectively all episodes occurring CWP Psychiatric Intensive Care Unit during August 2022. Results 5 related 4 patients, ranging from night 15 days duration. Regarding frequency, 20% seen face-to-face hour commencing 75% review. health more consistently commented on than (97% vs 61% respectively), whilst reviewed 69% assessments. Rationale continuing provided 72%, referring 54%. Adverse effects level documented parameters (2%), followed self (7%). Conclusion Assessment time often explicitly stated substituted documentation, meaning may have occurred earlier accounted for. on-call doctor does cover multiple sites overnight, potentially contributing delays attending unforeseen time-sensitive tasks. policy dictates constant visual must maintained throughout this routinely subject or adjustment. Overall interpretation qualitative information fairly subjective low number episodes, however there notable lack recording self. Findings will presented junior induction quick reference sheet designed prior reaudit. CWP's specifies but outline expected documentation. There scope extend local align CoP.