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A completed audit cycle and integrated care pathway for the management of depression following brain injury in a rehabilitation setting

Lynne Turner-Stokes

Katherine Pierce

Frances Clegg

Regional Rehabilitation Unit, Northwick Park and St Mark's Hospital Trust, Harrow, Middlesex, UK

Objective: To develop an evidence-based multidisciplinary integrated care pathway (ICP) for the management of depression following brain injury in a rehabilitation setting, and to assess its impact on standards of care and documentation.

Setting: A regional rehabilitation unit providing inpatient rehabilitation for young patients (16–65) with complex disabilities mainly resulting from brain injury.

Methods and design: A completed cycle of audit including:

standards set for documentation, assessment, management and review; L an initial retrospective audit of documented patient management against those standards during a five-year period (26 patient records);

ICP development by a multidisciplinary team of doctors, psychologists and nurses based on clinical opinion and systematic review of the literature;

re-audit from the ICP documentation (48 patient records) over a period of 15 months.

Results: The initial audit demonstrated borderline acceptable documentation of baseline mood state and start of medication (54–61%), but poor documentation of review (29%) and subsequent treatment (27%). Introduction of the ICP improved all standards of documentation to 94–100%, except for assessment using a validated measure (84%) and follow-up assessment (76%).

Conclusions: This ICP raised staff awareness of depression, leading to improved documentation and possibly also standards of care.

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This article has been cited by other articles:

				L Turner-Stokes, M Kalmus, D Hirani, and F Clegg The Depression Intensity Scale Circles (DISCs): a first evaluation of a simple assessment tool for depression in the context of brain injury J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1273 - 1278. [Abstract] [Full Text] [PDF]