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Thursday 20th October 2016

Nurse pioneers new approach for A&E admissions

13th March 2009

A nursing sister at Dorset County Hospital NHS Foundation Trust has created a new procedure for assessing patients with mental health problems when they are admitted to A&E.

Leah Hughes shares her time between the Dorchester hospital’s accident and emergency department and working for the Dorset Primary Care Trust with people with mental illness. As a trained mental health nurse she wanted to improve the understanding and support of people coming into A&E in emotional distress, particularly if they had suffered self-harm.

‘Patients were being admitted to medical wards to wait for assessment, or waiting some time in A&E for a mental health professional. Many patients were in a distressed state, feeling embarrassed and wanting to go home. Some felt they didn’t want to wait for assessment and treatment and were self-discharging without seeing anyone.’

Leah realised it would really help A&E staff if they could make an initial assessment of such patients and proceed to treatment more quickly. So she worked with colleagues in A&E and the psychiatric team to devise an assessment form.

The form she created is the first of its kind and has been attracting interest from across the NHS. It adopts the 2004 NICE guidelines for deliberate self-harm to produce a psychosocial assessment enabling medical staff to make informed choices about appropriate treatment. The form helps them discriminate between patients at higher and lower risk and decide whether to they should be referred to more specialist mental health services.

Since being introduced in 2004 it has reduced the number of patients discharging themselves from 13% to 3%.

‘I’m most proud of the demonstrable improvement in care for patients, but there are also related benefits for staff. Nurses have a better attitude to patients with mental illness and are more confident in assessing and treating them,’ says Leah.

Leah wrote up her project with Nick Kosky, Consultant Psychiatrist and Clinical Director of Dorset Primary Care Trust at Dorset County Hospital, and the article was published by the Psychiatric Bulletin. It drew attention from medical staff in other hospitals and has now been entered for an NHS award.


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