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5.1 To ensure that each service user CPA Community Audit See evidence 5.1 Audit of current CPA has upto date completed CPA administrator January 2013 CPA audits documentation completed on documentation. - community Community Audit ePEX May/June 2013 CPA Community Audit administrator November/December – inpatients 2013 Community Audit In patient audit June 2012 May 2013 July/August 2013 5.2 Provide a framework that Forensic Completed April 2013 See evidence 5.2 Review and implementation of facilitates comprehensive Integrated CPA Guidelines revised service specific CPA assessment and understanding of Resource and revised documentation and guidelines each service user’s risk to self and Team Manager documentation others. Allows recording and Clinical Lead The new MDT Assessment communication of that risk in a Clinical documentation Risk Assessment clear way to all those involved in Psychologist implemented June Care/Risk Management Plan service user’s care and presents 2014. both the MDT’s and service user’s perspectives of risk. Assessment to be used to produce a risk management plan as part of the overall multidisciplinary care plan, incorporating where possible the risk assessment processes and other relevant documents being used in routine multidisciplinary care (eg, risk formulation document used in clinical team meetings, my shared pathway my safety and risks document). A move towards a single care/risk management plan and an outcomes-based approach to planning. 5.3 Following completion of the Forensic Social Workers, See evidence 5.3 Training for Care Co-ordinators training it was expected that staff Integrated Occupational data base would Resource Therapist and band 6 captured the Understand the main elements of Team Manager Nursing staff names and dates Refocusing the CPA (DH 2008) identified (as needed attended training. to complete this Apply the latest CPA guidance to assessment following their practice as a care co- the training. In May Page 12 of 35 ordinator 2010 120 staff across MSU, LSU and FIRT Acknowledge the significance of had been identified values in the CPA for CPA awareness training. Between Work in partnership with others, September 2010 and conduct a comprehensive March 2012 94 of the assessment and construct a care identified staff plan received CPA awareness training. Identify transition points in care and plan to avoid potential gaps No further training has been delivered since 2012 and there management of risk is currently no standard mandatory Incorporate continuous review CPA training available into CPA within the trust. Demonstrate competence as a care co-ordinator 5.4 20 Staff identified from MDT’s Forensic This is an on-going See evidence 5.4 Assess the competency of Care Co- and FIRT, Band 6 and above. Integrated process Care ordinators. Resource Coordination Assurance that staff understood Team Manager 12 of the staff Core Functions CPA and could carry out: identified (OT, SW, and Nursing band 6 and Competencies. Comprehensive needs above) Check list for assessment; assessment of Page 13 of 35 Risk assessment and The process was fast competency for management; tracked and enabled Care Crisis planning and management; the assessment Coordinators Assessing and responding to against descriptors of carers’ needs; the performance Care planning and review; criteria, knowledge Transfer and discharge. and understanding that are required to undertake the role. Due to the robust approach to assessment and communication within MDT’s and the sharing of documentation with outside agencies and provider services. This ensures a more effective approach to assessment and risk management, providing a safer service. Decision making is improved as it is informed by the assessment process. Specialist assessments and the outcomes of interventions are incorporated into the CPA process and documentation. Family history and background is gathered from relatives and the needs of recognised carers are documented within the MDT assessments and victim issue reflected in the MDT and risk assessment documentation. The Care/Risk Plan addresses the management of these. The views are families should be incorporated into the assessment and through the CPA meetings. Improved assessment, understanding and communication of risk should ensure more effective risk management and therefore safer outcome for service users, families and staff. It should also guide decision making and the identification of areas for further assessment and intervention to reduce and manage risk. These documents can be shared with all those involved in the service user’s care if appropriate and should communicate the risks in a clear and comprehensive way. Did it change/improve anything The documentation has been gradually replacing the old CPA documentation since June 2013 and is therefore in the initial stages of use. The impact of the change is difficult to assess at this point. . During CPAs and clinical team meetings more focus has been given to the recording of understanding of risk on the risk formulation guide, which is part of the risk assessment form, and this is used more frequently as a reference when making decisions. Effectiveness of it achieving the aims stated above can be assessed over time. Evidence of the document being used to produce risk management plans can be seen in the CPA care and risk management plans document. Evidence of its use in making clinical and risk management decisions can be seen in CPA meeting minutes and clinical team meeting minutes. Evidence of the various Page 14 of 35 documents being consistent can be seen by examination of the various documents (risk formulation guide, HCR 20, my shared pathway) and evidence of safer outcomes and improved communication with external agencies may be seen as service user’s progress over time and move into the community. CPA documents are located within ePEX patient records and can be audited. The training focused on 9 key areas within CPA 1. Personalisation, Values and the CPA 2. Refocusing CPA – key themes 3. Role, authority and Responsibilities of Care Co-ordinators 4. Transition points in care 5. Comprehensive assessment 6. Managing risk effectively 7. Care planning 8. Whole systems approach 9. Outcomes, evaluation and review of care MDT members with knowledge and understanding of the CPA process improves the functioning and decision making of the team and an improvement in the practitioners ability to contribute to the assessment of needs and the planning, evaluation and review of care and risk management. Key workers and MDT members have a role in engaging with external agencies, families and carers. Assessment of their competency in this area leads to practitioners ensuring families have the opportunity to provide information and engage in the risk assessment process and discharge planning and involvement of external agencies. The combination of the assessment of competency and improved CPA documentation Ensure safer outcomes for patients, families and staff. How the action supports theses outcomes There is a greater understanding of CPA and the importance within the services as previously CPA was seen as an ‘add on’ to specialist assessments and interventions and not the core of information and documentation. Page 15 of 35