Borderline personality disorder (bpd) audit support

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Borderline personality disorder (bpd) audit support

  1. 1. NICE Issue date: [Year] of guideline clinical guideline [XX] Short title Audit support Borderline personality disorder Audit support Implementing NICE guidance 2009NICE clinical guideline 78
  2. 2. This audit support accompanies the clinical guideline: Borderline personality disorder: treatment and management (available online at www.nice.org.uk/CG078). Issue date: 2009 This is a support tool for measuring and monitoring local practice against the NICE guidance. It is not NICE guidance.National Institute for Health and Clinical ExcellenceMidCity Place, 71 High Holborn, London WC1V 6NA; www.nice.org.uk© National Institute for Health and Clinical Excellence, 2009. All rights reserved. This materialmay be freely reproduced for educational and not-for-profit purposes. No reproduction by orfor commercial organisations, or for commercial purposes, is allowed without the expresswritten permission of the Institute.Audit support: borderline personality disorder (2009) 2 of 15
  3. 3. Using audit supportThe audit support document can be used to measure current practice in the treatmentand management of borderline personality disorder against the recommendations inthe NICE guideline. Use it for a local audit project, by either using the whole tool orcutting and pasting the relevant parts into a local audit template.Audit criteria and standards are based on the guideline’s key priorities forimplementation. The standards given are typically 100% or 0%. If these are notachievable in the short term, set a more realistic standard based on discussions withlocal clinicians. However, the standards given remain the ultimate objective.The data collection tool can be used or adapted for the data collection part of theclinical audit cycle by the trust, service of practice. The tool is based on the keypriorities for implementation relating to clinical activity and on organisational priorities.Data may be required from a range of sources, including policy documents andservice user records. Suggestions for these are indicated on the tools, although this isnot an exhaustive list and they may differ in your organisation.The sample for this audit should include adults and young people (under the age of18) with borderline personality disorder in primary, secondary or tertiary care. Selectan appropriate sample in line with your local clinical audit strategy.Whether or not the audit results meet the standard, re-auditing is a key part of theaudit cycle. If your first data collection shows room for improvement, re-run it oncechanges to the service have had time to make an impact. Continue with this processuntil the results of the audit meet the standards.Audit support: borderline personality disorder (2009) 3 of 15
  4. 4. Clinical criteria for ‘Borderline personality disorder’Criterion 1 Percentage of people with borderline personality disorder who have been excluded from any health or social care services because of their diagnosis or if they have self-harmedExceptions NoneStandard 0%Definitions NoneCriterion 2 Percentage of people with borderline personality disorder with whom the healthcare professional has worked in partnership to develop their autonomy and promote choiceExceptions NoneStandard 100%Definitions This should be done by ensuring that the person with borderline personality disorder remains actively involved in finding solutions to their problems, even during crises and/or encouraging them to consider the different treatment options and life choices available to them.Criterion 3 Percentage of people with borderline personality disorder who have explored their treatment options with their healthcare professional and have had it explained that recovery is possible and attainableExceptions NoneStandard 100%Definitions NoneCriterion 4a All people with borderline personality disorder who have had the withdrawal and ending of treatment or services, or the transition from one service to another should have had these changes discussed carefully with them beforehand.Exceptions NoneStandard 100%Definitions Discussion should involve family or carers if appropriate.Criterion 4b Any ending and withdrawal of treatments or services, or the transition from one service to another should be undertaken in a structured and phased way.Exceptions NoneStandard 100%Definitions Healthcare professionals should anticipate that these changes may evoke strong emotions and reactions. Discussion should involve family or carers if appropriate. Audit support: borderline personality disorder (2009) 4 of 15
  5. 5. Clinical criteria for ‘Borderline personality disorder’Criterion 4c Percentage of service users with a care plans that supports effective collaboration with other care providers during endings and transitions and includes the opportunity to access services in times of crisisExceptions NoneStandard 100%Definitions NoneCriterion 4d If referral for assessment in other services is made, the person should be supported during the referral period and any arrangements for support are agreed beforehand with themExceptions NoneStandard 100%Definitions Other services include psychological treatment.Criterion 5a Percentage of service users who have a comprehensive multidisciplinary care plan developed in collaboration with the service user (and their family/carers, where agreed with the person)Exceptions NoneStandard 100%Definitions NoneCriterion 5b Percentage of service users who have a care plan, as referred to into criterion 5a, that: • identifies roles and responsibilities of all health and social care professionals involved • identifies manageable short-term treatment aims and specific steps that the person and others might take to achieve them • identifies long-term goals that the person would like to achieve • sets out a crisis plan, that: – identifies potential triggers that could lead to crisis – specifies self-management strategies likely to be effective – establishes how to access services if self-management strategies alone are not enough • is shared with the service user and their GPExceptions NoneStandard 100%Definitions Long-term goals should include those relating to employment and occupation. They should underpin the overall long-term strategy and should be realistic, and linked to short-term treatment aims. Audit support: borderline personality disorder (2009) 5 of 15
  6. 6. Clinical criteria for ‘Borderline personality disorder’Criterion 6 Percentage of service users who receive brief psychotherapeutic interventions (of less than 3 months’ duration) specifically for borderline personality disorder or for the individual symptoms of the disorder, outside a service that has the characteristics outlined in criterion 11Exceptions NoneStandard 0%Definitions The service characteristics that should be in place are: • an explicit and integrated theoretical approach used by both the treatment team and the therapist, which is shared with the service user • structured care in accordance with this NICE guidance • provision of therapist supervisionCriterion 7 Percentage of people who receive drug treatment specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorderExceptions NoneStandard 0%Definitions Examples of behaviour associated with this disorder include repeated self-harm, marked emotional instability, risk-taking behaviour, and transient psychotic symptoms.Criterion 8 Percentage of service users offered written information about: • their illness or condition • the treatment and care they should be offered, including being made aware of the ‘Understanding NICE guidance’ booklet (http://guidance.nice.org.uk/CG78) • the service providing their treatment and careExceptions NoneStandard 100%Definitions Service users should be offered written information to help them make informed decisions about their healthcare. This should cover the condition, treatments and the health service providing care. Information should be available in formats appropriate to the individual, taking into account language, age, and physical, sensory or learning disabilities.Criterion 9 Percentage of carers offered written information about: • the service user’s illness or condition • the treatment and care the service user should be offered, including being made aware of the ‘Understanding NICE guidance’ booklet (www.nice.org.uk/CG078) • the service providing the service user’s treatment and care.Exceptions A If there is no carer involved B If sharing information may compromise the service user’s confidentiality or Audit support: borderline personality disorder (2009) 6 of 15
  7. 7. Clinical criteria for ‘Borderline personality disorder’ wishesStandard 100%Definitions If the service user agrees, families and carers should have the opportunity to be involved in decisions about treatment and care.Number of criterion Local alternatives to above criteria (to be used where other datareplaced: addressing the same issue are more readily available)ExceptionsSettingsStandardDefinitions Audit support: borderline personality disorder (2009) 7 of 15
  8. 8. Organisational criteria for ‘Borderline personality disorder’AssessmentCriterion 10 Community mental health services should be responsible for the routine assessment, treatment and management of people with borderline personality disorderExceptions NoneStandard Met/unmetDefinitions Community health services include community mental health teams, related community-based services, and tier 2/3 services in child and adolescent mental health services (CAMHS)Psychological treatment provisionCriterion 11 When providing psychological treatment the following service characteristics should be in place: • an explicit and integrated theoretical approach used by both the treatment team and the therapist • structured care in accordance with this NICE guidance • provision of therapist supervisionExceptions NoneStandard Met/unmetDefinitions NoneMultidisciplinary specialist teamsCriterion 12a Mental health trusts should develop multidisciplinary specialist teams and/ or services for people with personality disordersExceptions NoneStandard Met/unmetDefinitions The specialist teams should have specific expertise in the diagnosis and management of borderline personality disorderCriterion 12b The multidisciplinary specialist teams referred to into criterion 12a should: • provide assessment and treatment services for people who have complex needs and/or high levels of risk. • provide consultation and advice to primary and secondary services • offer general psychiatric services a diagnostic service if they are unsure about the diagnosis and/or management • develop systems of communication and protocols for information sharing among different services and collaborate with all relevant agencies within the local community • provide and/or advise on social and psychological interventions, including access to peer support, and advise on the safe use of drug treatment in crises and for comorbidities/insomnia Audit support: borderline personality disorder (2009) 8 of 15
  9. 9. Organisational criteria for ‘Borderline personality disorder’ • work with CAMHS to develop local protocols to govern arrangements for the transition of young people from CAMHS to adult services • establish and maintain clear lines of communication between primary and secondary care • support, lead and participate in the local and national development of treatments for people with borderline personality disorder, including multi-centre research • develop/provide training programmes that cover diagnosis of borderline personality disorders and the implementation of this NICE guideline • oversee the implementation of this NICE guideline • monitor the provision of services for minority ethnic groups to ensure equality of service deliveryExceptions NoneStandard Met/unmetDefinitions NoneNumber of criterion Local alternatives to above criteria (to be used where other datareplaced: addressing the same issue are more readily available)ExceptionsStandardDefinitions Audit support: borderline personality disorder (2009) 9 of 15
  10. 10. Service user data collection tool for ‘Borderline personality disorder’ Complete one form for each service user or episode. Service user identifier: Sex: Age: Ethnicity: Data NA/ NICENo. item Criteria Yes No Exceptionsa guideline ref. no.Assessment 1 1.1 Has the person been excluded from any health or 1.1.1.1 social care services because of their diagnosis or because they have self-harmed? If ‘Yes’: 1.2 From which service were they excluded? 1.3 What reason was given for exclusion?Autonomy and choice 2 Was a partnership working approach taken to develop 1.1.3.1 autonomy and promote choice by: 2.1 • actively involving the person in finding solutions to their problems 2.2 • encouraging the person to consider different treatment options and choices available?Developing an optimistic and trusting relationship 3 When working with the service user: 3.1 • were the treatment options explored 3.2 • was it explained that recovery is possible and attainable?Managing endings and transitions Audit support: borderline personality disorder (2009) 10 of 15
  11. 11. Data NA/ NICENo. item Criteria Yes No Exceptionsa guideline ref. no. 4 4.1 Was a treatment or service withdrawn or ended, or did 1.1.7.1 the person make a transition from one service to another? Please state details: If 4.1 answer was ‘Yes’: 4.2 Were changes discussed beforehand with the person? 4.3 Were the changes structured and phased? Did the care plan: 4.3 • document the need for collaboration with other care providers during endings, 4.4 withdrawals and transitions? • Include the opportunity to access services in times of crisis? 4.5 Was the person referred for assessment in other services? Please state details: If 4.4 answer was ‘Yes’: 4.6 Was the person supported during the referral period? 4.7 Were arrangements for this support agreed with the person beforehand?Care planning Audit support: borderline personality disorder (2009) 11 of 15
  12. 12. Data NA/ NICENo. item Criteria Yes No Exceptionsa guideline ref. no. 5 5.1 Did the person have a multidisciplinary care plan? 1.3.2.1 If ‘Yes’: 5.2 Was it developed with the service user? Did the care plan: 5.3 • identify roles and responsibilities of all health and social care professionals involved 5.4 • identify manageable short-term treatment aims and specific steps that the person and others might take to achieve them 5.5 • identify long-term goals that the person would like to achieve were these goals: 5.6 – underpinning the overall long-term strategy 5.7 – realistic 5.8 – linked to short-term treatment aims • set out a crisis plan, that: – identifies potential triggers that could lead to crisis – specifies self-management strategies likely to be effective – establishes how to access services if self- management strategies alone are not enough? 5.3 Was the care plan shared with the service user? 5.4 Was the care plan shared with their GP?Psychological treatment 6 6.1 Was brief psychotherapeutic intervention (of less than 1.3.5.7 3 months’ duration) used specifically for borderline personality disorder or for the individual symptoms of the disorder? Please state details: 6.2 If ‘Yes’, was the intervention carried out in a service that had the following characteristics: • an explicit and integrated theoretical approach used by both the treatment team and the therapist • structured care in accordance with this NICE guidance • provision of therapist supervision?Drug treatment Audit support: borderline personality disorder (2009) 12 of 15
  13. 13. Data NA/ NICENo. item Criteria Yes No Exceptionsa guideline ref. no. 7 7.1 Did person receive drug treatment specifically for 1.3.5.1 borderline personality disorder or for the individual symptoms or behaviour associated with the disorder? Please state details:Person-centred care8 Was the service user offered evidence-based written Person-centred information about: care 8.1 • their illness or condition 8.2 • the treatment and care they should be offered 8.3 − including being made aware of the ‘Understanding NICE guidance’ booklet 8.4 • the service providing their treatment and care? (Data source: service user records)9 Were carer(s) offered evidence-based written Person-centred A / B information about: care 9.1 • the service user’s illness or condition 9.2 • the treatment and care the service user should be offered 9.3 − including being made aware of the ‘Understanding NICE guidance’ booklet 9.4 • the service providing the service user’s treatment and care? (Data source: service user records) Organisational data collection checklist for ‘Borderline personality disorder’ Organisation/service: NICE DataNo Criteria Yes No NA/Comments guideline item ref.Assessment Systems are in place to ensure that community mental 1.3.1.1 health services are responsible for the routine10 10.1 assessment, treatment and management of people with borderline personality disorder.Psychological treatment provision Audit support: borderline personality disorder (2009) 13 of 15
  14. 14. NICE DataNo Criteria Yes No NA/Comments guideline item ref. The following service characteristics are in place when 1.3.4.3 providing psychological treatment: 11.1 • an explicit and integrated theoretical approach used by both the treatment team and the11 therapist 11.2 • structured care in accordance with this NICE guidance 11.3 • provision of therapist supervisionMultidisciplinary specialist teams Multidisciplinary specialist teams and/or services for 1.5.1.1 12.1 people with personality disorders provided. If these specialist teams are provided do they: • provide assessment and treatment services for 12.2 those people who have complex needs and/or high levels of risk • provide consultation and advice to primary and 12.3 secondary services • offer general psychiatric services a diagnostic 12.4 service if they are unsure about the diagnosis and/ or management • develop systems of communication and protocols for information sharing among different services 12.5 and collaborate with all relevant agencies within the local community • provide and/or advise on social and psychological12 interventions, including access to peer support, and 12.6 advise on the safe use of drug treatment in crises and for comorbidities/insomnia • work with CAMHS to develop local protocols to 12.7 govern arrangements for the transition of young people from CAMHS to adult service • establish and maintain clear lines of communication 12.8 between primary and secondary care • support, lead and participate in the local and 12.9 national development of treatments, including multi- centre research • develop/provide training programmes that cover 12.10 diagnosis of borderline personality disorders and the implementation of this NICE guideline 12.11 • oversee the implementation of this NICE guideline 12.12 • monitor the provision of services for minority ethnic groups to ensure equality of service delivery? Audit support: borderline personality disorder (2009) 14 of 15
  15. 15. Further informationClick here for further information on reporting and monitoring the audit of NICEguidance in your organisation.NICE is committed to promoting through its guidance race and disability equalityand equality between men and women, and to eliminating all forms ofdiscrimination. One of the ways we do this is by trying to involve as wide a rangeof people and interest groups as possible in the development of our guidance oninterventional procedures. In particular, we aim to encourage people andorganisations from groups in the population who might not normally comment onour guidance to do so. We also ask consultees to highlight any ways in whichdraft guidance fails to promote equality or tackle discrimination and givesuggestions for how it might be improved.Supporting implementationNICE has developed tools to help organisations implement the clinical guidelineon borderline personality disorder (listed below). These are available on ourwebsite (www.nice.org.uk/CG78).• Costing tools: − costing report to estimate the national savings and costs associated with implementation• Slides highlighting key messages for local discussion.• Implementation advice on how to put the guidance into practice and national initiatives that support this locally.• Audit support for monitoring local practice (this document).A practical guide to implementation, ‘How to put NICE guidance into practice: aguide to implementation for organisations’, is also available to download from theNICE website.The guidanceYou can download the guidance documents from www.nice.org.uk/CG78. Forprinted copies of the quick reference guide or ‘Understanding NICE guidance’,phone NICE publications on 0845 003 7783 or email publications@nice.org.ukand quote N1765 (quick reference guide) and/or N1766 (‘Understanding NICEguidance’).Audit support: borderline personality disorder (2009) 15 of 15

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