Developing an Admission and Discharge ICP in a Mental Health Service for Older People

Abstract

An integrated care pathway (ICP) was developed for patients admitted to wards within the Mental Health Service for Older People, as a means of improving the care they were given at initial assessment and discharge, and their subsequent well-being. The ICP was evidence-based where possible or otherwise relied on perceived good practice. The process of developing the ICP took 3 months, followed by a 3-month pilot; multidisciplinary and multi-agency staff were involved. First, a baseline audit was carried out looking at patients' notes, and a questionnaire was given to patients to discover their views on aspects of the care provided. A questionnaire was also distributed to staff asking how the ICP should be documented. When the pilot was in place link nurses from each ward area were identified to provide a link between the staff on the ward and the ICP lead officer. Staff were kept up to date with ICP development through regular newsletters.

The project failed to obtain meaningful involvement of users and carers, despite efforts made to elicit their views. Mechanisms were put in place to continuously monitor the ICP and gather variance data and feed it back to the staff on the wards. There were some issues regarding completion of documentation throughout the process. However, it was agreed that the ICP would not change for a year, and then the ICP and the accompanying evidence would be thoroughly reviewed. This process is now underway and early evaluation suggests that the objectives and outcomes were achieved in part. While developing the ICP some gaps in the service were identified and addressed, some of which have contributed to improving patient care in their own right.