Audit of the NICE Guidelines for Schizophrenia in an NHS forensic psychiatric service

Abstract

The NICE Guidelines for Schizophrenia are designed to give guidance on the best practice in treatment and management of schizophrenia. These guidelines have 13 standards which services can use for the purpose of audit. As schizophrenia is our service's most common diagnosis, an audit against the guidelines was undertaken. The results indicated that we met three of the standards. Recommendations have been implemented to improve practice on standards that were not met, and this has led to some creative practice development. Despite the labour‐intensive nature of the audit, the results gave a clear indication of areas where there was a need for improvement and will act as a good baseline for re‐audit.

A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies

“…The NICE glossary of study designs (National Institute for Health and Clinical Excellence, 2012) was used to classify identified papers into their different methodologies. Twelve were quantitative observational cross-section studies, five national audits (Healthcare Commission, 2007Rethink, 2008; The All Parliamentary Group on Mental Health, 2010; The Schizophrenia Commission, 2012) and seven local service audits (Gough et al, 2007;Haddock et al, 2014;Jolley et al, 2015;Kuipers, 2011;Lewis, , & Evenson, 2012;Macpherson, Hovey, Ranganath, Uppal, & Thompson, 2007;Pawel, Mankiewicz, & Turner, 2012), four were qualitative studies using a mixture of methods (Braehler & Harper, 2008;Fadden & Heelis, 2011;Michie et al, 2007;Williams, 2008), seven were a mixture of qualitative and quantitative cross-section studies (Bailey, Burbach, & Lea, 2003;Jolley et al, 2012;McCann & Bowers, 2005;Onwumere, Chung, Boddington, Little, & Kuipers, 2014;Prytys, Garety, Jolley, Onwumere, & Craig, 2011;Sin, Livingstone, Griffiths, & Gamble, 2014;Sin & Scully, 2008), two were randomized control trials (Ince, Tai, & Haddock, 2015;Michie & Lester, 2005), and one was a non-experimental cases study (Smith & Velleman, 2002).…”

“…Ten articles provided information on the rates of implementation for CBT, estimates ranged from 4% to 100%; eight reported rates for FI, estimates ranged from 0% to 53% (Table 1). These included three national audits and surveys (Healthcare Commission, 2007Rethink, 2008) and seven local audits of services from various settings (Gough et al, 2007;Haddock et al, 2014;Kuipers, 2011;Lewis et al, 2012;Macpherson et al, 2007;Onwumere et al, 2014;Pawel et al, 2012;Prytys et al, 2011). Quality assessment revealed that only one study (Haddock et al, 2014) had a design that minimized the risk of bias to both internal and external validity.…”

“…Quality assessment of the reviewed articles identified other potential explanations for the differing implementation rates. Firstly, there were differences in the way that data were collected, with articles using objective methods (Haddock et al, 2014;Lewis et al, 2012;Pawel et al, 2012) and subjective measures (Gough et al, 2007;Macpherson et al, 2007;Rethink, 2008). Examples of objective methods included electronic file reviews and notes reviews, whereas subjective methods included retrospective questionnaires or audit tools with data gathered in an unstandardized way (Table 1).…”

Family Interventions in Psychosis: A Review of the Evidence and Barriers to Implementation

“…One of the factors that may contribute to the variation in reported estimates is the criteria researchers use to decide whether a service user has been "offered" an intervention or not. Other possible reasons for varied reported implementation rates may include differences in the way data are collected, with some studies using objective measures (Haddock et al, 2014;Lewis, Buffham, & Evenson, 2012;Pawel et al, 2012) and others using subjective measures (Gough et al, 2007;Macpherson, Hovey, Ranganath, Uppal, & Thompson, 2008), studies not providing information regarding the data collection process (H. Commission, 2007;Kuipers, 2011;Prytys, Garety, Jolley, Onwumere, & Craig, 2011), and uncertainty regarding the criteria used to ascertain diagnosis. This highlights a common problem in many of the published papers reporting implementation figures: There is a lack of distinction between reports of services having been "offered," "delivered," or "received."…”