/ CHHS17/014

Canberra Hospital and Health Services

OperationalProcedure

MHJHADS- Non-attendance at Appointments (also known as “Did Not Attend” or “DNA”)

Contents

Contents

Purpose

Alerts

Scope

Section 1: Making appointments with people and reminders

Mental Health Services

Alcohol and Drug Services (ADS)

Section 2: For people who do not attend an appointment

Mental Health Services

Alcohol and Drug Services (ADS)

Justice Health Services

Forensic Mental Health Services

Implementation

Related Policies, Procedures, Guidelines and Legislation

Search Terms

Purpose

This procedure provides processesfor responding to situations where a person does not attend their designated appointmentwith a Mental Health, Justice Health and Alcohol and Drug Services (MHJHADS) clinician without notice or previous cancellation. This is to ensure appropriate follow up action is taken as required.

This Standard Operating Procedure (SOP) describes for staff the process to

Scope

Alerts

Staff should always consider whether non-attendance of an appointment may be related to deterioration in a person’s mental state or related to an alcohol or drug issue. An assessment of the risks associated with non-attendance must be made and followed up accordingly, including documentation of the decision-making around any follow up action or inaction.

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Scope

This procedure applies to all MHJHADS staff working in community settings and correctional facilities who are involved in the treatment of people with a physical health issue, mental illness or disorder and/or alcohol or other drug issues. For example, this includes but is not limited to Adult Community Mental Health Services, Alcohol and Drug Services, Child and Adolescent Mental Health Services, Justice Health Services, Mental Health Services for People with Intellectual Disability andOlder Persons Community Mental Health Team.

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Section 1: Making appointments withpeople and reminders

Mental Health Services

  1. The clinician will contact the person and/or their carer or legal guardian or nominated person to arrange a suitable time for an appointment.

Note: any contact with other parties must consider consent, confidentiality and privacy issues as outlined in the relevant legislation and policy (see Related Policies, Procedures, Guidelines and Legislation section below). The person is to be provided with an appointment card or an appointment letter wherever possible.

  1. Clinicians (or administrative staff for Medical Officer appointments) are required to document all appointments in the Electronic Clinical Record (ECR, currently MHAGIC). Where ACTPAS is used in Community Health Centres this information will also be recorded by administration staff.
  2. Clinicianswill remind the person/carer/guardian or nominated person of the scheduled appointment prior to the appointment, particularly where there is an established history of non-attendance.
  3. For Medical Officer appointments, administrative staff are required to contact people one working day prior to their appointment to reduce the likelihood of non-attendance. This is completed by clinicians in Forensic Community Outreach Service (FCOS)
  4. Text messaging reminders, including the use the ACTPAS automated SMS reminder system or ‘Redcoal’ (email system for delivering text messages) should be used wherever possible to remind people of appointments.

Alcohol and Drug Services (ADS)

  1. When making an appointment for a person to see an ADS Medical officer or ADS clinician, the ADS staff member responsible will update all ACTPAS contact details and, where appropriate, provide the person with an appointment card with the appointment details.
  2. Unless the patient has declined, an ACTPAS SMS reminder shall be activated for an automated SMS reminder one to three working day/s prior to the ADS appointment.
  3. People with booked appointments who have not been sent an SMS reminder shall receive a reminder phone call from an ADS administrative officer one working day prior to their booked medical appointment.
  4. If during the course of this phone contact, (for ADS medical appointments) the administrative officer becomes concerned about a person’s wellbeing, at least one of the following staff shall be informed immediately: Opioid Treatment Service (OTS) Clinical Nurse Consultant (CNC), Case manager, Medical Officer.For other ADS clinician appointments, the clinician with whom the person requested an appointment shall be informed immediately.
  5. For clients accessing Police Court Diversion Services appointments, ADS Diversion staff contact the person when referred by phone (if registered on ACTPAS) or by letter to address listed on Police or Court referral. If an assessment is scheduled, a reminder call is offered by the ADS Diversion staff.

Justice Health Services (JHS)

  1. All detainees must submit a Health Request Form to JHS nursing staff in order to request an appointment with Primary Health clinicians. For all non-urgent appointments detainees will be notified on the day of the appointment via Corrections staff who will escort the detainee to the appointment.

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Section 2: For people who do not attend an appointment

Mental Health Services

1.Clinicians will record all non-attendance by the person in the ECR. Where ACTPAS is used in Community Health Centres this information will also be recorded by administration staff.

2.When a person fails to attend an appointment, the relevant Clinician (e.g. Clinical Manager, Duty Officer, Medical Officer) will make phone contact with the person as soon as possible after the missed appointment to ensure the person is safe.

3.If unable to contact the person by phone, an assessment of the risks should be conducted, including consultation with the treating Medical Officer or other available Medical Officer. All planned actions and the rationale should be documented in the ECR.

4.Where a person has missed a Medical Officer appointment and the Medical Officer does not consider the person to be at immediate risk based on their review of the person’s most recent contacts and past history, the Medical Officer will send an ECR message to the relevant team with further instructions around follow-up (e.g. rebook another appointment, phone the next day for welfare check etc).

5.Where a Medical Officer believes that a person is at more immediate risk they will notify the relevant clinician (Clinical Manager/Duty Officer) to provide a more immediate response which may include contacting family/carers, arranging a home visit to the person’s residence etc.

6.When the response cannot be done in a timely manner by the treating team within business hours and there are acute concerns for a person’s welfare then the treating team will contact the Crisis Assessment Treatment Team (CATT) to follow-up afterhours. An ECR message should be sent to CATT and Mental Health Triage noting the concerns.

7.All actions taken and outcomes are to be recorded on the person’s ECR. Where applicable as per the relevant clinical procedure, this will include a completion of a Suicide Vulnerability Assessment Tool.

8.When able to contact the person again, the clinician will reschedule the appointment with them and arrange appropriate follow up and support as required.

9.Clinicians should also attempt to ascertain the reasons why the person was unable to attend the appointment (e.g. transport issues, unsuitable time of appointment etc). This should be done so as to see whether any assistance may be provided which would increase the likelihood of the person attending future scheduled appointments.

10.Where a person does not attend for multiple consecutive appointments without reasonable explanation for same, a decision will be made by the Multidisciplinary Team regarding closure of that episode of care. As noted above, failure to attend appointments may often be associated with deterioration in a person’s mental state or other conditions. Hence, this decision must consider the clinical risks associated with the presentation and must advise the person, carer or other stakeholders (including the General Practitioner) of the closure and the process to re-access services in the future (also see Closure of Episode of Care Procedure).

11.Where a person who does not attend an appointment is also subject to a mental health order (such as a Psychiatric Treatment Order, Forensic Mental Health Order), clinicians must also refer to the relevant procedure on the Policy Register. This includes the following procedures: Care of Persons subject to Psychiatric Treatment Orders (PTOs); Management of People with a Dual Disability who are Subject to Involuntary Psychiatric Treatment Orders (PTO’s); Care of Persons subject to Forensic Mental Health Orders (FMHOs).

Alcohol and Drug Services (ADS)

  1. On completion of each booked medical and clinician sessions, a did not arrive (DNA) letter will be generated from ACTPAS and the administrative officer will ensure these letters are posted to patients in a timely manner.
  2. ADS Medical officers will review all DNA files for their session and document DNA.
  3. ADS Medical Officers may fast-track immediate DNA follow-up by a key worker, co morbidity worker or case manager by documenting this in the clinical records.
  4. On Day Seven following DNA, an ACTPAS-generated report will be emailed to the Opioid Treatment Service(OTS) CNC and Manager of Clinical Services identifying the people who DNA for their medical appointment and who have not rebooked or generated a contact with an ADS worker over the last seven days.
  5. On Day Seven following DNA, ADS administrative officers will also pull all client files for the OTS CNC from the ACTPAS generated DNA Report.
  6. OTS CNC will contact the person by phone, two attempts will be made to contact by phone.
  7. OTS CNC will also make a notation on IDOSE or contact the pharmacy regarding patient’s attendance for dosing and need for appointment.
  8. OTS CNC may delegate follow-up to a co morbidity worker or case manager for clients with an established or co-occurring mental health issue, a recent presentation or exacerbation of an unstable psychiatric condition, or other recent signs of instability. All outcomes will be recorded in ACTPAS and in the person’s clinical record.
  9. For clients accessing Police Court Diversion Services appointments, ADS Diversion staff attempt contact with referred clients by phone/letter 2-3 times during the bail period to establish communication before this information of non attendance is sent back to police/court. If clients fail to attend 3 scheduled appointments, ADS staff to advise police/Court of non attendance.All outcomes shall accurately be recorded in ACTPAS and in the person’s clinical record.

Justice Health Services

  1. When a detainee fails to attend an appointment at Primary Health Hume Medical Centre within the Alexander Maconochie Centre, administrative staff will record this as a Did not Attend(declined to attend) in ACTPAS and make a note of this in the person’s clinical record.
  2. A second appointment will be booked by administrative staff using ACTPAS.
  3. When a detainee fails to attend a second appointment, the administrative staff will record this as a Did not Attend (declined to attend) in ACTPAS and make a note of this in the person’s clinical record.
  4. They will also speak to a relevant clinician (e.g. Medical officer, ADON, CNC, level 2 RN) to obtain instructions regarding follow –up (e.g. rebook another appointment; speak to the client to ascertain reasons why the person declined to attend).
  5. Failure to attend appointments may be related to disadvantageous conditions such as deteriorating mental health, lack of knowledge or increased vulnerability. Hence, the clinician may arrange for a nurse to review the client in their accommodation area to discuss their reasons for not attending and provide encouragement/support to attend future appointments.
  6. The nurse will make a note of contact with the client in the person’s clinical record.

Forensic Mental Health Services

Forensic Mental Health Services follow the same protocol as for other Mental Health Services – See Section 2.

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Implementation

This procedure will be communicated to all staff via a Policy Register update which will also be tabled at MHJHADS Divisional, program and team meetings.

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Related Policies, Procedures, Guidelines and Legislation

Policies

  • Consent and Treatment Policy
  • MHJHADS Procedure: Confidentiality, Privacy and access to MHJHADS Clinical Records
  • Mental Health Officer Procedure
  • MHJHADS Assessment and Intervention for People Vulnerable to Suicide
  • MHJHADS Standard Operating Procedure: Clinical Management in Mental Health Services
  • MHJHADS Standard Operating Procedure: Clinical Management of a Deteriorating Community-Based Mental Health Consumer
  • MHJHADS Procedure: Clinical Case Review
  • MHJHADS Standard Operating Procedure:Management of People with a Dual Disability who are Subject to Involuntary Psychiatric Treatment Orders (PTO’s)
  • MHJHADS Clinical Procedure:Care of Persons subject to Forensic Mental Health Orders (FMHOs)
  • CHHS Clinical Procedure: Care of Persons subject to Psychiatric Treatment Orders (PTOs)
  • ADS Key Worker Guidelines

Legislation

  • Mental Health Act 2015
  • Children and Young People Act 2008
  • Public Advocate Act 2005
  • Human Rights Act 2004
  • Carers Recognition Act 2010
  • Health Records (Privacy & Access) Act 1997

Standards

  • Australian Charter of Healthcare Rights
  • National Standards for Mental Health Services 2010
  • National Safety and Quality Health Service Standards 2012
  • Standards of Practice for ACT Allied Health Professionals 2016

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Search Terms

Did not attend, DNA, Non-attendance, Suicide risk, Deterioration, appointment reminder, SMS reminder

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Disclaimer: This document has been developed by ACT Health, Mental Health Justice Health, Alcohol and Drug Services) specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended / Section Amended / Approved By
25 August 2016 / Section 1 / ED/CHHSPC Chair
Doc Number / Version / Issued / Review Date / Area Responsible / Page
CHHS17/014 / 1 / 14/02/2016 / 01/02/2022 / MHJHADS / 1 of 7
Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register