Assessment of Risk
Every patient has structured clinical assessment of risk (HCR-20; RSVP) as well as situational specific risk management plans. These are reviewed and updated regularly. Lancashire Care NHS Foundation Trust also uses an Electronic Risk Assessment Tool (ERAT) – this is a dynamic tool that forms the basis for individualised Situational Specific Risk Procedures.
Assessment of Cognitive Function
Each ABI ward has an allocated psychologist and associate Practitioner. On admission the psychology team commence formal review and assessment of cognitive functioning. This will often require administration of a full battery of psychometric assessments.
This is a comprehensive assessment and is time intensive. However the results of such assessment enable the care team to determine bespoke treatment and psychological programmes befitting the individual’s cognitive profile.
This battery of assessment and HCR-20 are completed within 12 weeks of admission – however this can vary dependent on severity of cognitive impairment and comorbidity e.g. epilepsy or mental illness that can affect the process.
Our Occupational Therapists and Technical instructors complete functional assessments of independent living skills including social skills, safety assessments, and motor assessments using standardised assessment tools.
Should any communication or swallowing difficulties be identified our Speech and Language Therapist completes a comprehensive assessment.
Mental Health Assessment
There are 2 Responsible Clinicians within the ABI service – one Neuropsychiatrist and one Forensic Psychiatrist with specialism in Neuropsychiatry. Each patient has assessment and regular review of their mental state. The consultants are Responsible Clinician’s as per Mental Health Act and therefore have responsibility to ensure detention in hospital is necessary and proportionate to presenting risk.
Approximately 70% of patients are subject to part iii of MHA (1983) including Hospital Orders as directed by the Court. These can include individuals subject to Ministry of Justice Restrictions and those transferred from the prison estate.
Medication reviews are in collaboration with the Guild Lodge Pharmacy Team who provide invaluable support and contribute to the Care Team Meetings.
Physical Health Assessment
Every patient admitted to the service has a physical health examination, with a minimum yearly update. We encourage our patients to have routine blood screening and an ECG.
Patients with long term medical conditions are referred to the physical health care team within Guild Lodge e.g. COPD, asthma, diabetes. All patients are registered with the visiting GP. A nurse practitioner also holds weekly clinics. Support is given to all patients for smoking cessation and weight management, focussing on adopting a healthy lifestyle through education and health promotion.
All patients with epilepsy have a comprehensive epilepsy care plan. NICE guidelines for epilepsy management are followed.
Further investigations for neurological conditions can be accessed at the local general hospital (Royal Preston Hospital) e.g. EEG, MRI, SPECT.
On completion of the assessment process a formulation4 meeting is held. This aims to identify and establish the following:
Diagnosis – including comorbidities
Neuro-behavioural rehabilitation goals
Cognitive rehabilitation goals
Interventions required – psychological, occupational, nursing
Further assessments needed