Movement between services.

Do ratings need to be recorded for the end of the community episode, as well as at the beginning of the inpatient episode, when a service user is transferred from community care to inpatient care?

YES. Information provided by the community worker may be utilised to complete the inpatient admission collection (RFC 02).

Collection occasion should be recorded within 24 hours from admission.

Acceptable for one set of data to fill both community discharge and inpatient admission collection occasions.

Where a collection is used twice in this way, each collection must identify the CPN of the clinician who completed the ratings.

Can one set of data fill an inpatient episode end and community episode start?

NO. These two collection occasions are seen as different, and therefore are required to be distinct sets of data.

Do ratings need to be recorded for the end of the community episode, or inpatient episode, when a service user is transferred to NGO services?

YES. If the person is discharged from inpatient or community care and will have no further care in either of those settings, a no further care (RFC07) collection is required.

What happens when care is transferred between teams within the same service setting? Are ratings required?

NO (but useful to do so). Transfer of a service user between teams within the same service setting does not constitute a change in episode, therefore no ratings are required. This transfer can be ‘marked' by completion of a review other (RFC06), as the change of teams can be seen as a clinically significant event.

Multiple team involvement in case management.

Is each team expected to complete separate ratings for the service user?

NO. The service user is regarded as receiving only one episode of care at a time. Decisions about which team (or clinician) is responsible for completing the required ratings need to be made at the local level, however, generally the principle team (or clinician) is responsible for ensuring collection is completed.

Brief episodes of care.

Do brief episodes of care require ratings to be completed?

YES. Admission and discharge collections are required to be completed, however, if discharge occurs less than 14 days in the community, or less than three days in an inpatient setting, HoNOS/ HoNOS65+/ HoNOSCA are not required in the episode end collection.

N.B. If a service user receiving MHS care in a community setting has an admission into an inpatient setting, but does not stay overnight (same day admissions), this should be considered part of the community episode.

Unregistered service users.

When service user is not registered - not admitted to service - should the ratings be completed?

Has an assessment occurred?

• NO. If person received information only or is being triaged for urgency only, no ratings are completed.
• YES. An assessment was completed, with the result determining the person requires no further MHS input. An assessment only (RFC01) collection is required.

Discharge from hospital on indefinite leave.

Does an inpatient episode of mental health end when a service user is placed on extended leave (with the intention that they won't return) but remains, legally, an inpatient - and therefore require discharge ratings?

YES. If it is intended that the person would not return, the current episode ends and a new episode starts. This needs to be treated as any other discharge to the community service setting with a three monthly review when due.

Return to hospital from indefinite leave.

Does a new inpatient episode begin when a service user on leave is admitted to hospital?

YES. This should be treated as a new inpatient episode.

N.B. Local PMS systems may prevent this from occurring.

Rapid readmission to  psychiatric hospital or inpatient unit.

If a service user is discharged from an inpatient unit and is readmitted within a very short period, is this a new inpatient?

YES. It is a new episode - standard information collection requirements apply

A service user is transferred to another ward or unit within the same hospital for medical or surgical care, with a definite expectation that they will return within the following seven days.

Do ratings need to be recorded?

NO. Not if their management continues with the inpatient unit. If the consultation/liaison service is involved then they may complete a review - other (RFC06). Local processes may have an impact on this issue and will need to be addressed accordingly.

Service users in ward for overnight stays on a regular basis.

Service users are admitted to the unit for overnight stays as part of the management plans on a regular basis - does each of these admissions count as a new episode?

These service users are treated as being in the community treatment setting and are reviewed under the community protocol (three monthly reviews).

Service user seen regularly, but at more than three monthly intervals. For example, Clozapine service users, shared care GP service users, shared private psychiatrist service users.

How should the three monthly (91 day) review ‘rule' be applied in these cases? 

These service users will be seen as ‘shared care service users' and ratings are required.

If the service user remains in an open community episode of MHS care, review - other (RFC06) should be completed each time they are seen.

If the service user has a new MHS community episode each time they are seen, assessment only (RFC01) collections should be completed following each contact.

Age protocol.

Does the age group or the type of unit (for example, adult inpatient unit) determine which measures are collected? For example, a 17 year old admitted to adult unit?

Age group determines the measures to be collected. Child and youth measures are collected, but this can be overwritten by clinician as long as the measure is clearly identified.

Lost to care.

If a service user/tangata whaiora is lost to care are the standard measures completed?

Inpatient: If service user has left care against advice or is discharged at own risk the clinical staff member responsible for the discharge should complete the standard measures.

Community: Standard measures should only be completed where valid information is available. If not enough information is available to rate - indicate unable to rate.

It is also important to consider the local protocol which may dictate the no contact/no rating period.

Forensic service user.

How do we treat service users under the Mental Health Act who return for arranged overnight stay in hospital?

These are treated as community episodes.

A service user  is transferred from one DHB mental health service to a mental health service in another DHB.

Is the reason for collection 07 no further care, or 12 discharge other?

RFC12 - discharge other.

RFC07 has implications about the service user's need for further services.

Sub-acute inpatient units.

Is movement between an acute and sub-acute inpatient unit or a step down unit a new episode of care?

NO. Not within the same hospital.

It is recommended that a review is completed.

RFC06 determined by clinical need.

Admission of service user to a regional psychiatric hospital.

Should a new inpatient episode be commenced when a service user is transferred to a regional hospital when this hospital is in the same DHB?

YES. The transfer to a regional psychiatric hospital is seen as transfer is to a different mental health organisational setting.