The first time a person experiences psychosis can be a challenging, frightening time. The care they receive during this episode can set the stage for all future engagements with the mental health care system. Until recently, however, there was no specific Clinical Order Set (COS) to guide the care of First Episode Psychosis in Victoria. Psychiatrist Dr. Dan Boston drew on support from the Physician Quality Improvement (PQI) initiative and the South Island Medical Staff Association to develop an evidence-based Clinical Order Set and assess its impact on the health status of patients as well as reduce their length of stay in hospital.
Dr. Boston coordinated a series of meetings to develop the COS, drawing on insights and expertise from physicians, managers, nurses, occupational therapists, and administration. They worked to ensure the COS was well-tailored to the clinical realities of these patients; details included specifying which health indicators would be collected at baseline, determining which medications would go on the order set, and how to address the needs of specific patients, such as those diagnosed with schizophrenia or bipolar spectrum disorders, or substance-induced psychosis.
After four different iterations, the final COS has been implemented and is showing positive results. Not only was use of the COS associated with an 11.4% decrease in total polypharmacy use, it was also associated with a 10.8% decrease in the length of stay, from 20.3 days to 18.1 days.
In doing this project, Dr. Boston recognized an essential component of any improvement is engagement: “QI can’t happen without a culture change. This funding allowed us to come together and all own the project so it wasn’t just me imposing things on others”. Next steps include ensuring that the COS is used in 100% of First Episode Psychosis admissions, and getting it uploaded to facilitate Computerized Point of Entry.