Independent investigation: Edward Shaw, Ladbroke Grove (2006)

It is recommended that the Trust audit the impact of Dual Diagnosis and Personality Disorder Services on the client group held by the CMHTs.

It is recommended that following the development of integrated records, and particularly with the imminent implementation of JADE, that regular audits of care plans, summaries and the rationale for decision taking is made. It is particularly important that the information … Read more It is recommended that following the development of integrated records, and particularly with the imminent implementation of JADE, that regular audits of care plans, summaries and the rationale for decision taking is made. It is particularly important that the information from previous records is not lost when new electronic records are implemented. Show less

In Ms BK’s case there were found to be omissions and misinformation relating to her clinical history. It is recommended that a summary sheet is developed to be sited at the front of patients’ records and updated on a regular … Read more In Ms BK’s case there were found to be omissions and misinformation relating to her clinical history. It is recommended that a summary sheet is developed to be sited at the front of patients’ records and updated on a regular basis. This should include: o Current and Diagnostic History o Risk History o Risk Management Plan o Changing diagnosis if relevant o What medication worked well and problems with medication including allergic reactions o Admission history o Markers for relapse o Signs of relapse o Contingency plans to manage relapse o Current care team and contact details Show less

It is recommended that the Trust follow through their ambition to provide Dual Diagnosis services in-house and training to all staff.