Service Improvements in Outpatient ECT in CPFT Introduction

1 Outpatient ECT is where an individual attends for treatment from their home and will be directly discharged back home to the on going care of a responsible adult without the interim involvement of an inpatient ward or day hospital.

Dr B S Mani, Specialty Registrar (6) Liaison Psychiatry, Addenbrookes Hospital

Outpatient ECT can be safely administered with appropriate choice of patients and adequate precautions. There has been an increasing trend towards outpatient ECT since it is cost efficient, safe and offers a chance for patients to stay in their own homes during the treatment episode The ECT Accreditation Service (ECTAS) works with ECT services to assure and improve the quality of the administration of electroconvulsive therapy. Accreditation assures staff, service users and referrers, commissioners and regulators of the quality of the service being provided. ECTAS is an initiative of the College Centre for Quality Improvement. ECTAS has set out standards for all aspects of ECT including Outpatient ECT

Other on-going improvements

We are in the process of unifying the paperwork across Cambridge and Peterborough Looking at a dedicated webpage for ECT At present, paperwork is difficult to access on in the Intra-net because of the way the website is designed we are looking to simplify the process Simplifying the ECT prescription form by use of editable forms using check-boxes and drop-down lists trying to make it more user friendly and less time consuming It is a small effort from our part in making sure less time is spent in paper work and more time with patients Currently in the process of working out a Joint working protocol whereby outpatient ECT can be considered in lot more patients (in whom inpatient ECT was considered purely because of logistics and 24 hour rule of responsible adults

CPFT ECTAS Accreditation

CPFT is a member of ECTAS. The Cambridge ECT suite went through the process of re-accreditation earlier this year. As part of this process, we had to undergo completing staff, referring psychiatrist and patient questionnaires, completing a review of case notes, an organisational checklist and an audit of the environment. These enable the multi-disciplinary team to review the local procedures and practices against the standards and, if necessary, to make the changes required to achieve accreditation 3

Issues Identified in Cambridge ECT suite No separate information for Responsible adults was available The information on driving guidance was not clear The information on PALS was not available Separate ECT treatment card not available The process of obtaining the paperwork for the ECT on local intranet was near to impossible (as identified by the referring teams)

Improvements made

New set of information leaflets designed for outpatient ECT created an outpatient ECT pack including guidance for outpatient ECT, outpatient ECT card and information for carers this pack has been accepted by the ECTAS as evidence of service improvement although it is yet to be ratified by the Trust New patient card has a map of the site of Cambridge ECT suite (we took on board informal patients and carers views that they found in difficult to find the site We have incorporated clear guidance on driving in the new leaflet Information of PALS has been incorporated Cognitive assessments included in nursing assessments