RCEM 2022 National Quality Improvement Programme

Specifications

• Programme: Mental Health (Self-Harm) National Quality Improvement Programme
• Information Pack: 2022 – 2024
• Published: October 2023
• Eligibility: 18 years and older
• Recommended Sample Size: Minimum of 5 eligible cases per week
• Data Entry Portal: Click here to log in
• Data Frequency: Weekly data entry recommended; fortnightly entry as an alternative

Product Usage Instructions

1. Welcome and Introduction
   If your Emergency Department (ED) wishes to participate in the 2022/24 RCEM national quality improvement program (QIP) on Mental Health (Self-Harm), this document provides all the necessary information.

2. Purpose of the QIP
   The QIP aims to continually quality assure and improve services for patients with mental health needs. By participating, your team can record details of QIPs and monitor how each initiative affects key outcome and process measures.

3. Recommended Approach
   For those new to QIPs, it is recommended to follow the Plan Do Study Act (PDSA) methodology. The Institute for Healthcare Improvement (IHI) offers a useful worksheet to guide you through implementing changes.

4. Data Collection
   Ensure you collect data on a minimum of 5 eligible cases per week. Log into the data entry portal at the provided link to enter cases either weekly or fortnightly based on your ED’s capability.

5. Monitoring Performance
   This QIP will track ED performance against clinical standards both within individual departments and nationally in real-time over a 2-year period. Identify areas where standards are not met to drive improvement work.

6. Additional Resources
   For further information on ED quality improvement, visit the RCEM website for valuable resources and guidance.

FAQ

• Q: What is the purpose of the Mental Health (Self-Harm) National Quality Improvement Programme?
  A: The purpose is to continually quality assure and improve services for patients with mental health needs in Emergency Departments

• Q: How often should data be entered into the portal?
  A: It is recommended to enter data weekly, but if this is challenging, data can be entered fortnightly instead.

MENTAL HEALTH
(SELF-HARM)
NATIONAL QUALITY IMPROVEMENT PROGRAMME Information Pack
2022 – 2024
Published: October 2023

Quick guide to running an awesome QIP

• Form your QIP Team
  RCEM recommends a multidisciplinary QI team

• Standards
  Click here to find the standards.

• Questions
  Click here to find the questions.

• Inclusion criteria
  18 years and older are eligible.

• Sample size
  Recommended sample size: Please collect data on a minimum of 5 eligible cases per week.

• Data entry portal
  Log into the data entry site at https://rcem.casecapture.com

• Data frequency
  Recommended: enter cases each week.
  Alternative: If your ED will find weekly data entry difficult enter data fortnightly instead.

• Data Collection Period
  Data should be collected on patients attending

from 4 October 2022 – 3 October 2024
*For the interim reports data collection period, please see the Data collection period section for details.

WELCOME
This document tells you everything you need to know if your Emergency Department (ED) wishes to participate in the 2022/24 RCEM national quality improvement program (QIP) on Mental Health (Self-Harm).

Introduction

Patients presenting to the ED with mental health needs make up around 5% of total attendances. They may have both physical and mental health needs to be met concurrently and some present with high risks of further self-harm and suicide.
In 2018 the Healthcare safety investigation branch (HSIB) published a report on the provision of mental health care to patients presenting at the Emergency Department. A recommendation for RCEM was to improve and standardise the initial assessment of patients. This QIP is part of the ongoing response to this recommendation.
In 2022 RCEM published a revised toolkit for Mental health in Emergency Departments which includes clinical standards for the care of mental health patients in the ED. The standards were developed by consensus and based on guidance published by NICE and the Royal College of Psychiatrists.

• ED Mental Health Triage process
• Observation of patients at risk of further self-harm or absconding
• ED clinician assessment

This QIP will track the current performance in EDs against clinical standards in individual departments and nationally on a real time basis over a 2-year period. The aim is for departments to be able to identify where standards are not being reached so they can do improvement work and monitor real time change.
As well as the three standards above for individual patient care, there are organisational standards for each department to consider and an emphasis on working with mental health professionals to provide joint care and parallel assessment where possible. Departments may also use this 2-year QIP period as an opportunity to consider other ways of improving care of patients with mental health problems. This could be by collecting and responding to patient feedback, initiatives to reduce stigma, improving the ED environment or reviewing the care of patients who are agitated or aggressive.

QUALITY IMPROVEMENT INFORMATION
The purpose of this QIP is to continually quality assure and improve your service whereby the patient benefits as an outcome of the programme. The RCEM system allows your team to record details of QIPs and see on your dashboard how each initiative affects your data on key outcome and process measures.
We encourage you to use this feature in your department. If you are new to QIPs, we recommend you follow the Plan Do Study Act (PDSA) methodology. The Institute for Healthcare Improvement (IHI) provides a useful worksheet which will help you to think about the changes you want to make and how to implement them.
Further information on ED quality improvement can be found on the RCEM website.

The model for improvement (Institute of Healthcare Improvement)

OBJECTIVES FOR ALL RCEM QIPS

To identify current ED performance against clinical standards and previous performance

How RCEM supports you

• Expert teams of clinicians and QIP specialists have reviewed current national standards and evidence to set the top priority standards for this national QIP
• RCEM have built a bespoke platform to collect and analyse performance data against the standards for each ED

Show EDs their performance in comparison with other participating departments both nationally and in their respective country in order to stimulate quality improvement

How RCEM supports you
The QIP will be run over a 2-year period. The longer duration should allow better planning and effective iteration. This should lead to improved patient care. Participating ED’s can see how they perform as compared to National mean. This should enable ED’s revisit changes implemented and plan further PDSA cycles.

To empower and encourage EDs to run quality improvement (QI) initiatives based on the data collected, and track the impact of the QI initiative on their weekly performance data

How RCEM supports you

• The RCEM platform includes a dashboard with graphs showing your ED’s performance as soon as data are entered to benchmark against yourself.
• The dashboard graphs are SPC charts (where applicable) with built in automatic trend recognition, so you are able to easily spot statistically significant patterns in your data.
• The portal has built in tools to support local QI initiatives, such as an online PDSA template.
• Once you have completed a PDSA template with your team, this is overlaid onto your dashboard charts so you can easily see the impact of your PDSA.
• RCEM have also published a QI guide to introducing a range of excellent QI methodologies to enhance QI knowledge and skills.

STANDARDS

Organisational Standards

2. A policy in place for assessing and observing patients should be in place for those considered to be high or medium risk of self-harm, suicide, or leaving before assessment and treatment are complete.| F| [Recommendations | Self- harm:](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners) [assessment, management and](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners) preventing recurrence | Guidance | [NICE](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners)
3. EDs should have a policy which clearly states when patients can or cannot be searched. This should be compliant with relevant legislation. Searches which are for the clinical safety of the patient should be conducted by clinical staff rather than security guards.| D| Mental Health Toolkit – RCEM 2022
4. ED and mental health teams should have joint pathways which promote parallel assessment of patients with both physical and mental health needs. NICE guidance states that psychosocial assessment should not be delayed until after medical treatment is completed.| F| Side by side Consensus statement – 2020

****[Recommendations | Self- harm:](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners) [assessment, management and](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners) preventing recurrence | Guidance | [NICE](https://www.nice.org.uk/guidance/ng225/chapter/Recommendations

assessment-and-care-by-healthcare-professionals-and-social-care-

practitioners)

5. Is there an appropriate area in ED available where patients with mental health problem could be observed? (i.e., A designated quieter/safer area than a regular cubicle)| A| Quality statement 5: Safe physical environments| Quality standards | NICE
6. Departments should follow their trust’s policy for restrictive intervention and should follow guidance for Rapid Tranquilisation (NICE or their own guideline).| F| Restrictive interventions for managing violence and aggression in adults – NICE Pathways
7. EDs should have a policy for patients under the relevant policing and mental health legislation – including section 297 (Scotland), section 130 (Northern Ireland) or section 136 (England and Wales) to

ensure safety, dignity, and timely management.

| F| Mental Health Toolkit – RCEM 2022
---|---|---
8. An appropriate room should be available for the assessment and assistance of people with mental health needs within the ED. These should meet the standards of the Psychiatric Liaison Accreditation

Network (PLAN).

| F| Psychiatric Liaison Accreditation Network (PLAN) Quality Standards for Liaison Psychiatry Services – RCPSYCH 2020
9. An appropriate programme should be in place to train ED nurses, health care assistants, and doctors in mental health and mental capacity issues.| F|

Clinical Standards

Grading explained

• F – Fundamental This is the top priority for your ED to get right. It needs to be met by all those who work and serve in the healthcare system. Behaviour at all levels of service provision need to be in accordance with at least these fundamental standards. No provider should offer a service that does not comply with these fundamental standards, in relation to which there should be zero tolerance of breaches.
• D – Developmental This is the second priority for your ED. It is a requirement over and above the fundamental standard.
• A – Aspirational This is the third priority for your ED and is about setting longer term goals.

EQUALITY STATEMENT
The College is committed to assessing health inequalities relating to patient ethnicity and gender to support departments to provide high quality and equitable care to all.
We will be collecting ethnicity and gender data, monitoring them for systemic inequalities and reporting at the national level.
Our last attempt demonstrated difficulties collecting comprehensive ethnicity data with many reported as ‘not specified’ – We are exploring the cause of this to improve future data sets to increase the accuracy of ongoing analysis of such data

MEASURES

Process Measures|
---|---
Process measures include capturing the times of the key moments in the patient’s journey and overall quality of care delivered in the ED.

**** Mental health triage of patients presenting with self-harm takes time. This will include some time to gain a rapport, asking about risks of further self- harm, or wanting to leave, considering safeguarding and mental capacity issues.

**** See Mental Health (MH) toolkit for examples of MH triage and documentation of observations.

**** From the 2018 QIP feedback, it was apparent that getting this done ≤ 15 minutes was a challenge.

For this reason, a decision was made to record mental health triage done ≤15 minutes and ≤ 30 minutes. Time to mental health triage refers to the start of the mental health triage process.

|

• Time to Mental Health triage (15 mins and 30 mins)
• Evidence of observing patients at high and medium risk of further self-harm or absconding while in ED
• Time to ED Clinician review following mental health triage
• Quality of brief risk assessment by the ED clinician
• Time to review by Adult psychiatric liaison services in the ED following referral
• Where possible ‘parallel assessment’ by both ED clinician and Adult Psychiatric liaison services
• Evidence of compassionate and practical care: e.g. being offered

**** It is difficult to measure the quality of care of patients with a mental health crisis, for example have we taken time to listen to them, ask what might help them right now, explain what will happen etc? One question is included which will ask for a judgement of the reviewer if there is evidence of compassionate and practical care.| food and drink, pain relief, usual medication and explanation of what will happen
---|---

Outcome Measures
Outcome measures are difficult to measure in this cohort. EDs can determine their own outcome measures based on local need for improvement. some examples are: reduction in incidents, reduction in length of stay of non-admitted patients, reduction in patients absconding.

METHODOLOGY

Forming your QIP team
RCEM recommends forming a multidisciplinary QI team; to include consultants, trainees, advanced care practitioners (ACPs), specialty and associate specialist (SAS) doctors, nursing and, patient representatives and others to suit your local set up.

Data entry portal
You can find the link to log into the data entry site at www.rcem.ac.uk/audits (registered users only).

Inclusion criteria
Patients must meet the following criteria for inclusion:

• Patients aged 18 years and older
• Who presented at an ED having intentionally self-harmed (either self-injury or self-poisoning) AND had a referral made by the ED for emergency mental health assessment by your organisation’s specified acute psychiatric service.
• Any patient re-attending due to self-harm within the QIP period can be included irrespective of whether they had been included or not previously

Exclusion criteria
Do not include:

• Any patient under 18 years of age
• Any patient who was unable to undergo a mental health examination or risk assessment in the ED due to their physical condition (e.g. unconscious)
• Patients who left before triage
• Any patient at the time of attending ED was an inpatient in a Mental health unit
• Any patient not requiring ED care and transferred off site for a mental health assessment immediately after triage

Sample size
Please collect a minimum of 5 randomised cases per week that meet the eligibility criteria.

Data entry frequency
Recommended: To maximise the benefit of the run charts and features RCEM recommends entering a minimum of 5 cases each week. This will allow you to see your ED’s performance on key measures changing week by week. PDSA cycles should be regularly conducted to assess the impact of changes on the week-to- week performance.

Alternative: If your ED will find weekly data entry too difficult to manage, you may enter data fortnightly instead. The system will ask you for each patient’s arrival date and automatically split your data into weekly arrivals, so you can get the benefit of seeing weekly variation if you spread the cases across the fortnightly. If you decide to enter data fortnightly, we recommend that you enter at least 10 cases fortnightly (5 cases from week 1 and 5 from week 2). You can then consider fortnightly cycles of PDSA with specific interventions and evaluate their impact by reviewing the trend over that time period.

Data collection period
Data should be collected on patients between 4 Oct 2022 – 3 Oct 2024

Specific QIP Year reporting period:

• Year 1 Interim report period: 04 Oct 2022 – 03 Oct 2023
• Year 2 Final report period: 04 Oct 2023 – 03 Oct 2024

Please note that these dates are different to the usual dates for RCEM QIPs to allow for staff adjustments to new departments during the August changeover period and to relieve pressures on services that have undergo reconfigurations as a result of the Covid-19 pandemic.
The programme length has been increased to allow time to understand your local service offering and establish areas of need. These can then be targeted with PDSA interventions and change monitored over enough time to embedded real change. Nationally we are aiming to improve sharing of best practice to facilitate idea development.

Data submission period
Data can be submitted online between 4 Oct 2022 – 3 Oct 2024.

Data submission period per QIP year:

• Year 1 Interim report period: 04 Oct 2022 – 03 Oct 2023
• Year 2 Final report period: 04 Oct 2023 – 03 Oct 2024

Each year’s patient data must be entered within the same year’s submission period. For example, all patient data collected in year 1’s collection period must be submitted in the Year 1’s submission period to be valid.
Any patient data submitted outside the submission period for it’s collection year will be invalidated and the patient data may not contribute towards reporting.
It is recommended to enter data as close to the date of patient attendance as possible, and to review progress regularly. This will help your QI team spot the impact of intervention more promptly for refinement or disposal depending on the changes observed.

DATA TO BE COLLECTED

Organisational data
(please complete this section three times per ED- at the start of the QIP; One year after the start of the QIP; at the end of the QIP)

Q1| Does the ED have a named mental health lead?|

• Yes
• No

---|---|---
Q2| Is there a policy in place for assessing and observing patients at medium/high risk of self-harm, suicide or leaving before assessment and treatment are|

• Yes
• No

 | complete?|
Q3| Is there a policy in place which clearly states when patients can or cannot be searched?|

• Yes
• No

Q4| Is there an appropriate room available for assessment and assistance of patients with mental health needs?|

• Yes
• No

Q5| Is there an appropriate area in ED available where patients with mental health problem could be observed?|

• Yes
• No

Q6| Does the ED have a policy of parallel assessment of physical and mental health needs where possible?|

• Yes
• No

Q7| Is there a Policy in place for restrictive intervention including rapid tranquilisation?|

• Yes
• No

Q8| Does the ED have a policy for patients under the relevant policing and mental health legislation? Including section 297 (Scotland), section 130|

• Yes
• No

 | (Northern Ireland) or section 136 (England and|
 | Wales) to ensure safety, dignity, and timely management.|
| |
Q9| Is there an appropriate programme in place to train ED nurses, health care assistants, and doctors in mental health and mental capacity issues?|

• Yes
• No

Clinical data – Attendance, Referral and Review

Q1.1| Reference (do not use patient identifiable data e.g.| NHS or hospital number.)
---|---|---
Q1.2| Date and time of arrival|

• ·        dd/mm/yyyy
• ·        HH:MM

Q1.3| Date and time of mental health triage|

• dd/mm/yyyy
• HH:MM
• patient did not undergo mental health triage

Q1.4| Ethnic category| See Appendix 1 for ECDS
 |  | category details
Q1.4.1| Gender| See Appendix 1 for ECDS
 |  | category details
Q1.5| Date and time of ED clinician review:|

• dd/mm/yyyy
• HH:MM
• Not recorded
• Not seen by ED clinician, referral direct to adult psychiatric liaison services

| |
 |  |

• Did not wait (Will lead to Q2.4, Q2.8)

Q1.6| Date and time of first referral to Adult Psychiatric liaison services (or equivalent).|

• dd/mm/yyyy
• HH:MM
• Not recorded

Q1.6.1| Appears if date and time is provided in Q1.6

Who made this referral?

|

• Triage nurse
• ED clinician
• Other clinician
• Not recorded

Q1.7| Date and time of Adult Psychiatric liaison services review of patient in ED:|

• dd/mm/yyyy
• HH:MM
• Not recorded
• Not applicable – Patient admitted before review by

 | Adult Psychiatric Liaison to medical ward or shifted off site for mental health assessment following ED management / acceptable safe discharge plan by ED

• Did not wait/Self- discharged (will lead to Q2.4, Q2.8)

Q1.8| Date and time of leaving ED

(Discharged after ED and Adult Psychiatric liaison team review / admitted to ED SSU or ward / Transferred off site for mental health assessment):

|

• dd/mm/yyyy
• HH:MM
• Unknown (Patient did not wait & time entered not accurate)

---|---|---

Clinical data – Assessment and Observation

Q2.9| Is there evidence of compassionate and practical care within the notes, e.g. Food and drink offered, patient’s own medication given, pain relief offered, information given to the patient, discussions with the patient documented|

• Yes – Good evidence
• Partial evidence
• No/minimal evidence

---|---|---

Reviewing notes is an opportunity to review cases where care was not to accepted standards and escalating these concerns. Reviewers should use their departmental incident process if there are cases where this has happened. Examples of this might be failure to follow up patients who abscond, long wait for assessments, inappropriate restraints, or evidence of stigma from staff.

Parallel assessment by Adult Psychiatric liaison services and ED Team
Timing of mental health assistance should be based on the needs of both the patient and referrers. A patient should be referred to mental health services as soon as they are fit for interview, rather than waiting for medical treatment to be complete. Even prior to interview, liaison psychiatry staff can give advice based on past records, take collateral history from family or carers, support patients, advise clinical teams and plan appropriate timing for psychiatry interview. If a person is agitated, distressed or aggressive then timely assistance from mental health professionals may alleviate distress, prevent escalation, and improve both safety and patient experience [7].

Parallel Assessment

Notes
This section is provided for local use, e.g. to record information that might help during your PDSA cycles. No patient identifiable data should be entered It will not be analysed by RCEM

DATA SOURCES

ED patient records including nursing notes (paper, electronic or both).

Flow of data searches to identify QIP cases
For information about using the Emergency Care Data Set (ECDS) or your ED’s electronic patient record to identify relevant cases, and to extract data from your system, please see Appendix 1.
Using the codes list in Appendix 1, first identify all patients attending your ED between the relevant dates, then by age at time of attendance, then through the other relevant criteria.
If your ED is reliably using the Emergency Care Data Set (ECDS), then your IT department or information team should be able to a) pull off a list of eligible cases for you, and b) extract some or all of the data you need to enter. Please see Appendices 1 and 2 for the list of codes they will need to identify eligible cases or extract the data.

CONTACT US
If you have a clinical or methodology question regarding this QIP, you can email our QIP Clinical Team directly at the below email address. Your question will be sent directly to the relevant team, automatically sharing on your name and contact email for reply.
ad641f8d.rcem.ac.uk@uk.teams.ms

If you would prefer to send your question anonymously, you can send it to our general QIP email address below. Our team will then pass your question onto the relevant team and email you back from our general account.
RCEMqip@rcem.ac.uk.

REFERENCES

1. Overview | Self-harm: assessment, management and preventing recurrence | Guidance |NICE
2. Mental Health Toolkit – RCEM 2022
3. The Patient who absconds – RCEM 2020
4. Side by side Consensus statement – 2020
5. Update information | Self-harm | Quality standards | NICE
6. CQC Guidance: Assessment of mental health services in Acute Trusts (2020)

APPENDIX 1: ECDS CODES TO SUPPORT CASE IDENTIFICATION

The codes below can be used to help initially identify potential cases. This is not an exhaustive list; other search terms can be used but all potential patients should then be reviewed to check they meet the definitions & selection criteria before inclusion in the QIP.
The ECDS codes below relate to CDS V6-2-2 Type 011 – Emergency Care Data Set (ECDS) Enhanced Technical Output Specification v3.0.

QIP question| ECDS data item name| ECDS national code| National code definition
---|---|---|---
Date and time of arrival or triage – whichever is

earlier

| EMERGENCY CARE ARRIVAL DATE

EMERGENCY CARE ARRIVAL TIME

| an10 CCYY-MM-DD an8 HH:MM:SS| Date

Time

Ethnic group| ETHNIC CATEGORY| A| White British
 |  | B| White Irish
 |  | C| Any other White background
 |  | D| White and Black

Caribbean

 |  | E| White and Black African
 |  | F| White and Asian
 |  | G| Any other mixed background
 |  | H| Indian
 |  | J| Pakistani
 |  | K| Bangladeshi
 |  | L| Any other Asian background
 |  | M| Caribbean
 |  | N| African
 |  | P| Any other Black background
 |  | R| Chinese
 |  | S| Any other ethnic group
 |  | Z| Not stated e.g. unwilling to state
 |  | 99| Not known e.g. unconscious
Gender| PERSON STATED GENDER CODE| 1| Male
 |  | 2| Female
 |  | 9| Indeterminate (unable to be classified as either male or female)
 |  | X| Not Known (PERSON STATED GENDER CODE not recorded)

APPENDIX 2: ANALYSIS PLAN (CLINICAL DATA)

This section explains how the RCEM team will analyse and display your data. You may wish to conduct analysis locally. ‘Analysis sample’ shows which records will be included or excluded. ‘Analysis plan (Dashboard Charts)’ defines how the RCEM team will present the data graphically, and which records will meet or fail the standards.

Relevant questions| Analysis plan (conditions for the standard to be met)
---|---
Q1
Time to mental health triage| Analysis Q1.3 – 1.2
Q2 % Of Patients who had a mental health triage| Analysis: numerator: proportion of patients that had mental health triage (date and time entered), where the denominator is all cases submitted.
Q3 Time to ED clinician review after triage| Analysis Q1.5 – 1.3
Q4 Time to Adult Pschiatric Liaison Service patient review in the ED following referral| Analysis Q1.7 – 1.6
Q5 Total time spent in ED before either discharged / admitted / transferred off site for a Mental health assessment| Analysis Q1.8 – 1.2
Q6 Parallel assessment| Analysis Q3.2 (Yes/No)
Q7 Evidence of compassionate and practical care| Analysis Q2.9 (Yes/Partial evidence/No or Minimal evidence)
Q8 Adequate physical health assessment, relevant investigation and treatment been carried out by the ED clinician appropriate to patient presentation| Analysis Q2.3 (Yes/No)
Q9 Safe-guarding concerns addressed| Analysis Q2.5.1 (Yes/No)
Q10 Drug and alcohol concerns addressed| Analysis Q2.6.1 (Yes/No)
Q11 If not seen by Adult Psychiatry liaison and discharged by ED: Was this documented and an acceptable safe discharge plan made| Analysis Q2.7 (Yes/No)
Q12 If patient left prior to ED Clinician review or Adult Psychiatric liaison services review, was this followed up?| Analysis Q2.8 (Yes – appropriate measures taken/No/Not documented)
---|---
Q13 Person carrying out observations for patients at medium or high risk of further self-harm or leaving before assessment or treatment completion| Analysis Q2.1.1.1 (Nurse / HCA / MH Nurse / Doctor /Others (Free text)/not recorded)

Clinical Standards – Analysis plan (Dashboard Charts)

3| Q1.5

Q2.2 (A- D)

| Q1.5 IS NOT

‘Did not wait’ OR

‘Not seen by ED clinician, referral direct to adult psychiatric liaison

services’

| Title: Proportion of patients who had a brief risk assessment of suicide and further self- harm.

Analysis:

• Met Q2.2 (A-D) = Yes to 4 out of 4
• Partially met Q2.2 (A-D) = Yes to 3 out of 4
• Not met Q2.2 (A-D) = Yes to ≤ 2 out of 4

---|---|---|---

RCEM 2022-24 Mental Health (Self-Harm) QIP

References

• Homepage
• RCEM
• rcem.casecapture.com/account/login.aspx
• Self-harm in over 8s: short-term management and prevention of recurrence | Guidance | NICE
• Overview | Self-harm: assessment, management and preventing recurrence | Guidance | NICE
• Recommendations | Self-harm: assessment, management and preventing recurrence | Guidance | NICE
• Quality statement 4: Observation | Self‑harm | Quality standards | NICE
• Quality statement 5: Safe physical environments | Self‑harm | Quality standards | NICE
• Update information | Self‑harm | Quality standards | NICE

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