NICE Issue date:

clinical
Short [Year] [XX]
guideline
title of guideline
Audit support

Psychosis and schizophrenia in

children and young people:
Assessment and care planning
in secondary care

Clinical audit tool

Implementing NICE guidance

2013

NICE clinical guideline 155

Clinical audit tool: Psychosis and schizophrenia in children and young people (2013) Page 1 of 12
This clinical audit tool accompanies the clinical guideline: ‘Psychosis and schizophrenia
in children and young people: recognition and management’.

Issue date: 2013

This document is a support tool for clinical audit based on the NICE guidance. It is not
NICE guidance.

Acknowledgements

NICE would like to thank the following person who has contributed to the development
of this clinical audit tool and have agreed to be acknowledged:

Hardeep Uppal, Coventry and Warwickshire Partnership Trust

NICE has adapted the action plan template produced by the Healthcare Quality
Improvement Partnership (HQIP) in their template clinical audit report.

National Institute for Health and Clinical Excellence

Level 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk

© National Institute for Health and Clinical Excellence, 2013. All rights reserved. This material
may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for
commercial organisations, or for commercial purposes, is allowed without the express written
permission of NICE.

Clinical audit tool: Psychosis and schizophrenia in children and young people (2013) Page 2 of 12
Psychosis and schizophrenia in children and young people:
assessment and care planning in secondary care clinical audit tool

This document can be used as a starting point for a local clinical audit project that aims
to improve assessment and care planning in secondary care for children and young
people with psychosis or schizophrenia. It contains:

 clinical audit standards

 a data collection form
 an action plan template.

There is also an electronic audit tool available, which can be used with this document
or on its own to collect and analyse the data.

The audit standards and data collection form can be adapted to focus on a smaller part
of the tool or expanded to include other local priorities.

The audit could be carried out in the following services: mental health services.

The audit should involve clinical and non-clinical stakeholders, which may include the
secondary care multidisciplinary team, service users and carers.

The audit sample should include children and young people with psychosis or
schizophrenia whose condition is being managed in secondary care. Advice on how to
decide on sample size is available on HQIP’s website.

The audit standards are based on the NICE clinical guideline for psychosis and
schizophrenia in children and young people. NICE has also developed audit tools for
psychological interventions and antipsychotic medication for first episode psychosis. In
developing these tools consideration has been given to the clinical issues covered by
the guideline and the potential challenges of data collection. There may be other
recommendations within the guideline suitable for the development of audit standards
or an audit project.

A baseline assessment tool is available. This can help to compare practice with the
guideline’s recommendations and prioritise implementation activity, including clinical
audit.

Clinical audit tool: Psychosis and schizophrenia in children and young people (2013) Page 3 of 12
The audit should be considered with other clinical audits such as:

 National Audit of Schizophrenia

The audit standards in this document include a reference to the guideline

recommendation numbers and exceptions. Exceptions not explicitly referred to in
the guideline can be added locally, for example, service users declining treatment.

NICE recommends compliance of 100%. If this is not achievable an interim local target
could be set, although 100% should remain the ultimate aim.

A data collection form should be completed for each service user. There is a section
for demographic information that can be completed if this information is essential to the
project. Patient identifiable information should never be recorded.

Following the audit the action plan template can be used to develop and implement
an action plan to take forward any recommendations made.

Re-audit is a key part of the clinical audit cycle, required to demonstrate that
improvement has been achieved and sustained. Once a re-audit has been completed,
the shared learning database can be used to share the experience of putting NICE
guidance into practice.

For further information about clinical audit refer to a local clinical audit professional in
your own organisation or the HQIP website.

To ask a question about this clinical audit tool, or to provide feedback to help inform
the development of future tools, please email auditsupport@nice.org.uk

Clinical audit tool: Psychosis and schizophrenia in children and young people (2013) Page 4 of 12
Standards for Psychosis and schizophrenia in children and young people: assessment and care planning
in secondary care

Audit standard Guidance Exceptions Definitions

reference

1. Children and young people receive a comprehensive multidisciplinary 1.3.4 None None
assessment addressing the following:
 mental health problems
 risk of harm to self
 risk of harm to others
 alcohol consumption
 prescribed drug history
 non-prescribed drug history
 medical history
 full physical examination, including
– physical illness
– organic brain disorders
 prescribed drug treatments that may result in psychosis
 psychological and psychosocial issues
 social networks
 relationships
 history of trauma
 social development and skills
 cognitive development and skills
Audit standard Guidance Exceptions Definitions
reference

 motor development and skills

 coexisting neurodevelopmental conditions
 physical health and wellbeing, including:
– weight
– height
– smoking
– diet
– exercise
– sexual health
 accommodation
 culture
 ethnicity
 leisure activities and recreation
 carer responsibilities
 attendance at school or college
 educational attainment
 employment
 functional activity
 family’s economic status.
See data collection form, questions 1 and 2
Audit standard Guidance Exceptions Definitions
reference

2. Children and young people are monitored for other coexisting mental 1.3.5 None None
health problems.
See data collection form, question 3

3. Children and young people are monitored for substance misuse. 1.3.5 None None
See data collection form, question 4

4. A care plan is developed: 1.3.6 None None

 with the parents or carers or jointly with the young person and
their parents or carers and includes:
– activities that promote physical health
– activities that promote social inclusion, including:
o education
o employment
o volunteering
o leisure activities.
See data collection form, question 5

5. An up-to-date copy of the care plan is given to the young person and 1.3.6 A – Young person None
their parents or carers. does not agree to
share the care plan
See data collection form, questions 6 and 7
with their parents or
carers

6. A time to review the care plan is agreed. 1.3.6 None None

See data collection form, question 8
Audit standard Guidance Exceptions Definitions
reference

7. A copy of the care plan is sent to the primary healthcare professional 1.3.6 None None
who made the referral.
See data collection form, question 9

8. If the children or young person is at risk of crisis, a crisis plan is 1.3.8 B – child or young None
developed with the parents or carers or jointly with the young person and person does not
their parents or carers. agree to parental
involvement
See data collection form, questions 10 and 11

9. If the child or young person has a crisis plan, it includes: 1.3.8 None None
 possible early warning signs of a crisis and coping strategies
 support available to help prevent hospitalisation
 where they would like to be admitted in the event of
hospitalisation
 definitions of the role of primary and secondary care
professionals and the degree to which parents or carers are
involved
 information about 24-hour access to services
 the names of key clinical contacts.
See data collection form, question 12

10. If the child or young person and/or their parent or carer is unhappy 1.3.10 None None
about the assessment, diagnosis or care plan, they are given time to
discuss this and offered the opportunity for a second opinion.
See data collection form, question 13
Data collection form for Psychosis and schizophrenia in children and
young people: assessment and care planning in secondary care clinical
audit

Audit ID: Sex: Age:

The audit ID should be an anonymous code. Patient identifiable information should never be recorded.

White Mixed Asian or Asian British Black or black British Other

British White and black Indian Caribbean Chinese
Caribbean
Irish White and black Pakistani African Any other
African ethnic group
Any other white White and Asian Bangladeshi Any other black Not stated
background background
Any other mixed Any other Asian
background background

No Question Yes No Exception*

/NA/Notes

1 Did the child or young person receive a comprehensive

multidisciplinary assessment?
2 If yes, did it include the following?
 mental health problems
 risk of harm to self
 risk of harm to others
 alcohol consumption
 prescribed drug history
 non-prescribed drug history
 medical history
 physical examination
 prescribed drug treatments that may result in psychosis
 psychological and psychosocial issues
 social networks
 relationships
 history of trauma
 social development
 cognitive development
 motor development and skills
 coexisting neurodevelopmental conditions
 physical health and wellbeing, including:
– weight
– height
– smoking
– diet
– exercise
– sexual health
No Question Yes No Exception*
/NA/Notes
 accommodation
 culture
 ethnicity
 leisure activities and recreation
 carer responsibilities
 attendance at school or college
 educational attainment
 employment
 functional activity
 family’s economic status.
3 Was the child or young person monitored for other
coexisting mental health problems?
4 Was the child or young person monitored for substance
misuse?
5 Was a care plan developed:
 with the parents or carers?
 jointly with the young person and their parents or carers
and including:
 activities that promote physical health
 activities that promote social inclusion, including:
– education
– employment
– volunteering
– leisure activities?

6 Was an up-to-date copy of the care plan given to the young

person?
7 Was an up-to-date copy of the care plan given to the A
parents or carers?
8 Was a time agreed to review the care plan?
9 Was a copy of the care plan sent to the primary healthcare
professional who made the referral?
10 If the child or young person was at risk of crisis, was a crisis
plan developed?
11  If yes, was it developed:
– with the parents or carers?
– jointly with the young person and their parents or carers? B
No Question Yes No Exception*
/NA/Notes
12 If the child or young person has a crisis plan, does it include
the following?
 possible early warning signs of a crisis and coping
strategies
 support available to help prevent hospitalisation
 where they would like to be admitted in the event of
hospitalisation
 definitions of the role of primary and secondary care
professionals and the degree to which parents or carers
are involved
 information about 24-hour access to services
 the names of key clinical contacts.
13 If the child or young person and/or their parent or carer is
unhappy about the assessment, diagnosis or care plan
were they:
 given time to discuss this?
 offered the opportunity for a second opinion?
*Circle exception codes as appropriate.

Exception codes

A – Young person does not agree to share the care plan with their parents or carers.
B – Child or young person does not agree to parental involvement.
Action plan for Psychosis and schizophrenia in children and young people clinical audit
KEY (Change status)
1 Recommendation agreed but not yet actioned
2 Action in progress
3 Recommendation fully implemented
4 Recommendation never actioned (please state reasons)
5 Other (please provide supporting information)

Action plan Name: Title: Contact:

lead

The ‘Actions required’ should specifically state what needs to be done to achieve the recommendation. All updates to the action plan should be
included in the ‘Comments’ section.

Recommendation Actions required Action by Person Comments/action status Change

(specify ‘None’, if date responsible (Provide examples of action in progress, stage
none required) changes in practices, problems
encountered in facilitating change, reasons (see Key)
why recommendation has not been
actioned etc)

When making improvements to practice, organisations may like to use the tools developed by NICE to help implement the clinical guideline on
Psychosis and schizophrenia in children and young people.