Objectives Adolescence carries the highest rate of childhood morbidity and mortality outside the neonatal period. The HEEADSSS ( Home, Eating behaviours, Education/Employment, Activities, Drugs/alcohol, Sexuality, Suicide/Self harm and Safety) assessment is a widely accepted psychosocial screening tool. The World Health Organisation (WHO) recommends its’ use in all clinical adolescent encounters. Poor compliance with this recommendation results in missed prevention counselling opportunities and risk assessments. To date, there is no Irish data on the use of this screening tool. The aim of this review was to establish the compliance with HEEADSSS in an Irish context and establish the efficacy of a proforma.
Methods This three phase study took place over 8 weeks. Charts of all adolescent medical presentations to the emergency department (ED) over a month were reviewed as part of the initial phase. A standardised data collection form was used to ensure elements pertaining to the use of the HEEADSSS assessment were captured. The data was retrospectively analysed using descriptive statistics. The intervention phase was multi-dimensional. First, a survey was circulated for anonymous completion by the relevant healthcare staff (n=30) enabling precise identification of knowledge deficiencies. Following analysis and local presentation of the results, a comprehensive education session was facilitated. The final arm of the intervention phase involved the inclusion of a blank HEEADSSS proforma in clinical notes of all adolescent patients presenting to the ED, attached at time of nursing triage. One month after the adoption of this quality improvement initiative, a review was conducted on a random chart sample to assess adherence.
Results 103 patient records were reviewed as part of the control phase. Of these, 6.7% (n=7) had a complete HEEADSSS assessment documented, with 57.1%, (n=4) using the recommended format and all with parental accompaniment. An incomplete assessment was documented in 27% (n=28), most commonly addressing home and school life only. Abdominal pain was the most common presenting complaint (n=31), followed by chest pain and palpitations (n=20). Deliberate self-harm represented 14% (n=15) of presentations and only 4 of such cases had either a partial or complete HEEADSSS assessment completed. There were five repeat attendances with chronic non-specific symptoms. There was a 63% ( n=19 ) response rate to the anonymous survey. While most were familiar with HEEADSSS ( n=14 ), 84% (n=16) denied receiving any training on how to use HEEADSSS and cited this as their main obstacle to using it. In the third, post intervention phase 50 charts were reviewed. A proforma was attached to all charts and filled out appropriately in 64% (n=32) of cases; an improvement of 57.3% following provision of a dedicated education and training forum. The assessment was most likely to be completed in the absence of parental accompaniment.
Conclusions The increase in the number of completed HEEADSSS assessments in the intervention phase suggests that the inclusion of a blank proforma in ED clinical notes results in a more comprehensive medical review of adolescent patients. Consequently, there is more opportunity for crucial intervention. Staff education and specific HEEADSSS focused training is beneficial.
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