Annex D - New audit forms, checklists for visits, overall ratings scale.

First Visit Checklist

• The checklist for the first visit is available as a Word document here as Attach:seanvis1.doc Δ

Second Visit Checklist

• The checklist for the second visit is available as a Word document here as Attach:seanvis2.doc Δ

Summary of Ratings

• Rating of Premises
  • 6 = exemplary; RCPsych guidelines, high quality and on-site.
  • 5 = good; RCPsych guidelines, adequate environment and on-site.
  • 4 = adequate; minor shortfalls on-site; theatre suite or distance away.
  • 3 = poor; major deficiency in one main area.
  • 2 = very poor; major deficiency in two main areas.
  • 1 = extremely poor; major deficiency in three main areas.
• Rating of Equipment
  • 6 = exemplary; RCPsych list plus backup anaesthetic equipment.
  • 5 = good; ECT machine + backup, missing a capnograph but otherwise good backup anaesthetic equipment.
  • 4 = adequate; ECT machine + backup, adequate anaesthetic equipment, some backup.
  • 3 = poor; no backup ECT machine (or arrangement) or major anaesthetic equipment missing.
  • 2 = very poor; unsuitable ECT machine, adequate anaesthetic equipment.
  • 1 = extremely poor; unsuitable ECT machine, less than adequate anaesthetic equipment.
• Rating of Induction Training
  • 6 = exemplary; induction day, video, handout, demonstration and exam.
  • 5 = good; induction talk, video, handout, demonstration.
  • 4 = adequate; induction talk, handout or video, demonstration.
  • 3 = poor; induction talk and demonstration.
  • 2 = very poor; induction talk.
  • 1 = extremely poor; induction mention.
• Rating of Ongoing Supervision
  • 6 = exemplary; more than 75% if rota; 50% if block; with backup arranged.
  • 5 = good; more than 50% of sessions if rota < 4.
  • 4 = adequate; more than 25% of sessions if block or rota < 4; more than 50% for rotas > 4.
  • 3 = poor; first two sessions only or once per month.
  • 2 = very poor; once per quarter.
  • 1 = extremely poor; less than once per quarter. (other supervision arrangements to be judged on an individual basis).
• Nursing Standards Checklist
  • 1. There should be a registered first level nurse who has overall responsibility for ECT.
  • 2. There should be a first or second level nurse in charge of each stage of the procedure.
  • 3. There should be one nurse, trained in CPR for every unconscious patient.
  • 4. There should be at least one nurse in charge of recovered patients.
  • 5. Back-up staff should be easily available to deal with restless patients or emergencies.
  • 6. The patient should be accompanied throughout by a nurse known to them, aware of their legal status and what to do if the patient refuses treatment.
• Anaesthetists Rating of Equipment
  • 1. Poor = essential anaesthetic equipment missing or malfunctioning.
  • 2. Adequate = an acceptable range of equipment and drugs for routine and emergency use.
  • 3. Good = satisfactory equipment and drugs with additional back-up.
• Rating of Efficiency of Operation
  • 6 = exemplary; procedures followed accurately, good communication and atmosphere.
  • 5 = good; procedures followed but some difficulty in working relationships.
  • 4 = adequate; treatment according to procedure but prompting maybe required (training excluded).
  • 3 = poor; failure to follow treatment guidelines, some confusion over roles.
  • 2 = very poor; obvious lack of treatment protocols, definite confusion over roles.
  • 1 = extremely poor; no attention to any procedure, major concern for adequacy or safety.