Taffs Well Medical Centre
Other
Action Taken
The practice has implemented pop-up alerts for patients with mental health history, prioritizes appointments for patients with mental health concerns, and uses the e-consult platform to assess mental health risk. (AI summary)
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Dear Ms Saunders Thank you for your Regulation 28 report following the inquest touching upon the death of Mrs Siwan Smith. We acknowledge the points raised and have reflected on the event. We have implemented the following strategies:
• We appreciate that time is pressured on reception and call handling. In order to quickly alert administrative staff of mental health risk, we have undertaken an exercise whereby all patients on mental health medication and / or a documented history of mental illness have a pop up message stating "High risk mental health". This is displayed as soon as a patient's record is activated, including reception and call handling stages. o Status = Complete
• As noted by in her statement, the call handling and reception staff are not trained in mental health risk assessment. We have therefore implemented a strategy whereby patients contacting the practice with mental health concerns are offered the next available appointment. Where the patient feels that an earlier appointment is required, they will be immediately added to the "on the day triage list" for urgent response by the on-call GP. o Status = Complete
• The e-consult platform provides an excellent risk assessment of depression and provides a PHQ-9 depression score. This provides a convenient and safe method of accessing help from the practice. It enables patients who may struggle to get their concerns across verbally, especially when discussing sensitive points, to articulate these in a structured manner with prompts. We hope that providing this service will help our younger, working age population such as Mrs Smith to alert us of their mental health issues promptly at their convenience. E-consults are continuously monitored throughout the day and those flagged as high risk based on PHQ-9 score (which includes a question on suicidal thoughts) are passed to the on-call
clinician for immediate call-back. The E-consult option is provided for patient convenience, in addition to the existing method of booking via telephone and is not a replacement. o Status = Complete Mrs Smith's death is tragic, and indeed one that has affected us all at the practice. We have undergone a period of reflection and have had frequent discussions surrounding the incident and ways of preventing similar events in the future. As an immediate response we feel that the above strategies, although simple, have improved acute staff awareness of patient's mental health status and improved access. We have many other thoughts to improve general awareness to both staff and the public which we will continue to explore and develop. These are our immediate strategies which have been implemented.
• We appreciate that time is pressured on reception and call handling. In order to quickly alert administrative staff of mental health risk, we have undertaken an exercise whereby all patients on mental health medication and / or a documented history of mental illness have a pop up message stating "High risk mental health". This is displayed as soon as a patient's record is activated, including reception and call handling stages. o Status = Complete
• As noted by in her statement, the call handling and reception staff are not trained in mental health risk assessment. We have therefore implemented a strategy whereby patients contacting the practice with mental health concerns are offered the next available appointment. Where the patient feels that an earlier appointment is required, they will be immediately added to the "on the day triage list" for urgent response by the on-call GP. o Status = Complete
• The e-consult platform provides an excellent risk assessment of depression and provides a PHQ-9 depression score. This provides a convenient and safe method of accessing help from the practice. It enables patients who may struggle to get their concerns across verbally, especially when discussing sensitive points, to articulate these in a structured manner with prompts. We hope that providing this service will help our younger, working age population such as Mrs Smith to alert us of their mental health issues promptly at their convenience. E-consults are continuously monitored throughout the day and those flagged as high risk based on PHQ-9 score (which includes a question on suicidal thoughts) are passed to the on-call
clinician for immediate call-back. The E-consult option is provided for patient convenience, in addition to the existing method of booking via telephone and is not a replacement. o Status = Complete Mrs Smith's death is tragic, and indeed one that has affected us all at the practice. We have undergone a period of reflection and have had frequent discussions surrounding the incident and ways of preventing similar events in the future. As an immediate response we feel that the above strategies, although simple, have improved acute staff awareness of patient's mental health status and improved access. We have many other thoughts to improve general awareness to both staff and the public which we will continue to explore and develop. These are our immediate strategies which have been implemented.