Sweeney E B, Foley J E, Fitzsimons S, Denihan A
1Department of Psychiatry,Trinity College,Dublin,Ireland.
2Navan Cognitive Clinic, HSE, An Ré Órga, Navan, Co. Meath,Ireland.
Ir J Psychol Med. 2019 Jun;36(2):145-151. doi: 10.1017/ipm.2018.14.
AimTo investigate whether a small regional memory clinic would benefit from engaging with a structured external audit process such as the Royal College of Psychiatrists' Memory Service National Accreditation Program (MSNAP).
The Psychiatry of Old Age service in Navan operates a public cognitive clinic. Despite the publication of the 2014 National Dementia Strategy, there are currently no national standards for memory clinics in Ireland. It may be beneficial to link in with an external quality control system as part of routine clinical governance.
Published data from the MSNAP group was reviewed and a set of audit materials extrapolated to replicate the MSNAP self-review process. The audit cycle involved (1) retrospective case review, (2) institution of a range of interventions and (3) a prospective audit, which included service user feedback.
Overall the results demonstrated a high standard of service, especially in the areas of accessibility, assessment and communication of diagnosis. The clinic performed well against MSNAP key performance indicators. Patient and carer satisfaction with the service was very high. Clinic policies needed further development, particularly in the areas of referral, consent and data protection.
The process was useful, providing clear pointers for action. It highlighted the need to formalise organisational and practice policies, patient support and education, audit and outreach. Although accreditation is a laborious process requiring financial investment, it provides a strong scaffold to maintain and improve standards and is likely to be a valuable learning experience, where national guidelines are lacking.
目的是调查一个小型区域记忆诊所是否能从参与结构化外部审计流程(如皇家精神科医学院记忆服务国家认证计划(MSNAP))中受益。
纳凡的老年精神病服务部门运营着一家公共认知诊所。尽管2014年国家痴呆症战略已发布,但爱尔兰目前尚无记忆诊所的国家标准。作为常规临床治理的一部分,与外部质量控制系统建立联系可能有益。
审查了MSNAP组发布的数据,并推断出一套审计材料以复制MSNAP自我审查流程。审计周期包括(1)回顾性病例审查,(2)一系列干预措施的制定,以及(3)前瞻性审计,其中包括服务使用者的反馈。
总体而言,结果显示服务水平很高,尤其是在可及性、评估和诊断沟通方面。诊所在MSNAP关键绩效指标方面表现良好。患者和护理人员对服务的满意度非常高。诊所政策需要进一步完善,特别是在转诊、同意和数据保护方面。
该流程很有用,为行动提供了明确的指示。它突出了规范组织和实践政策、患者支持与教育、审计和外展工作的必要性。尽管认证是一个需要资金投入的繁琐过程,但它为维持和提高标准提供了有力的框架,并且在缺乏国家指南的情况下可能是一次宝贵的学习经历。