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1 Physical Assessment and Monitoring Procedure for Mental Health and Learning Disability Services Version 3 March 2018

SH CP 45

Physical Assessment and Monitoring Procedure for Mental Health and Learning

Disability Services (including Older Person’s Mental Health).

Version 3

Summary:

This procedure identifies the minimum standard required of all clinical professionals in providing patient care for Mental Health and Learning Disability Services. This procedure should be read in conjunction with the SHFT Physical Assessment and Monitoring Policy.

Keywords (minimum of 5): (To assist policy search engine)

Mental Health; Learning Disability; Physical assessment; Monitoring; SBAR(d); Track and Trigger, Deteriorating, Deteriorating patient, Deterioration

Target Audience:

All In-patient and Community Mental Health and Learning Disability services staff

Review Date: March 2021

Approved & Ratified by:

Patient Safety Group Date of meeting: 23rd November 2017

Date issued:

March 2018

Author:

Cory DeWet: Consultant Psychiatrist/ Clinical Service Director Kuljit Bhogal: Consultant Psychiatrist John Stagg: Associate Director of Nursing, AHP & Quality (Version 3 update)

Sponsor:

David Kingdon – Clinical Director Adult Mental Health Services


Version Control

Change Record

Date Author Version Page Reason for Change

June 13 1 5 and 9

1.12 / 1,18 / 2.2 / 2.11 clarification observations to be recorded on Physiological observation chart as well as RiO

6 1.21 use term Physiological observation chart instead of detailing all obs required

Appendix 1,2,3 to be transferred from procedure to policy

Nov 2014 2 Annual review

Feb 2017 2.1 Significant revision of all content by Physical Health Group, David Kingdon, Steve Coopey

Nov 2017 2.2 Additional review to compare against the revised SHFT Physical Health Policy

March 2018

3 Agreed at Patient Safety Meeting 23/11/18 with the following additions

To add a GASS for clozapine - already referenced

Section 1.16 SHCP149 needs to be referenced.

OPMH should be referenced - added to title page

Reviewers/contributors

Name Position Version Reviewed & Date

Mayura Deshpande Clinical Service Director v.2 / November 2014

Anne Leitch v.2/ November 2014

Hazel Nicholls Primary Care & italk Clinical Service Director Clinical Director Psychological Therapies Integrated Services Division (MH/LD/Specialised Services)

v.2/November 2014

John Stagg Lead for Quality Improvement (Learning Disabilities) v.2/November 2014

Brian Murtagh Modern Matron v.2 / November 2014

Dr Carol Bailey Deputy Head of Nursing and AHPs (Consultant Nurse) and Clinical Service Director (Hants)

v.2 / November 2014

Eliot Smith Named Professional for Safeguarding v.2 / November 2014

Dr Uresh Ferdinandez Consultant v.2 / November 2014

Tracy Hammond Medical Devices & Clinical Lead v.2 / November 2014

Kelly Merriman Ward Manager v.2 / November 2014

Diane Statham Modern Matron v.2 / November 2014

Sally Forlong Deputy Director of Nursing for MH v.2 / November 2014

Fiona Hartfree Acute Care Pathway Manager v.2 / November 2014

Karen Osola Trust ECT Lead v.2 / November 2014

Stephen Bleakley Acting Chief Pharmacist v.2 / November 2014

Cory DeWet Clinical Services Director (AMH) V2.1 / February 2017

Craig Forbes Consultant psychiatrist (LD) V2.1 / February 2017

David Kingdon Clinical Director (AMH) V2.1 / April 2017

Shelly Mason Matron OPMH V2.2 November 2017

Kuljit Bhogal Consultant Psychiatrist (LD) V2.2 November 2017

John Stagg ADON, AHP & Quality (LD) V2.2 November 2017

Cory DeWet Clinical Services Director (AMH) V2.2 November 2017

SHFT Patient Safety Group V3 23 November 2017

John Stagg ADON, AHP & Quality (LD) V3 March 2018


Contents

Section Title

Page

1. Physical Assessment on an In-Patient Ward

4

2. Physical Assessment and Monitoring in the Community – Mental Health (MH)

7

3. Physical Assessment and Monitoring in Community - Learning Disability (LD)

8

4. Physiological Observation Chart (adult and adolescent track and trigger) (Appendix 1 in Physical Assessment and Monitoring Policy)

9

5. Patient handovers and communication

9

6. Training requirements

9

7. Associated resources

10

Appendices

A1 Summary of Patient Observations

11

A2

Body Map

13

A3 Physical Health Training Pathway for Mental Health and Registered Nurses and Health Care Support Workers

14

A4 Glasgow Antipsychotic Side-effects Scale (GASS)

15

A5 Side Effects Screening – Easy Read 17


Physical Assessment and Monitoring Procedure for Mental Health and Learning Disabilities Only

1 Physical Assessment on an In-Patient Ward 1.1 Initial Assessment: 1.2 All adult and adolescent patients admitted to inpatient wards should have a full physical

examination by a member of medical staff on admission. For patients who are admitted after 4.30pm Monday to Friday and at weekends, physical examination can normally be carried out the following day unless clinical staff who arranged the admission specifically requested earlier physical examination, or clinical staff assessing the patient upon admission feels a more urgent physical examination is required. As a minimum, physical examination should be carried out within 24 hours of admission to an in-patient ward. If this is not achieved this must be documented with the rationale. Within Learning Disability in-patient settings, physical examination is arranged with the attached GP or clinical assistant in all circumstances. On-call admitting psychiatrists will conduct a basic physical assessment and examination of the patient.

1.3 The results of the examination are to be documented in the RiO electronic patient record

system. This should be in the area in Core Assessment described as ‘Physical History and Monitoring’ to ensure that key physical health information is completed in one consistent place and is regularly updated. More detailed physical examination should be undertaken where clinically indicated and the rationale and any resulting treatment recorded on RiO. A member of the medical staff must be informed by the nursing team where there are any concerns. They should discuss appropriate steps to take which will usually involve attending and assessing the patient.

1.4 This process should be done in liaison with the GP in units with a contracted GP service. Documents/reports generated by the GP should be scanned on to RiO and kept in accessible secondary records.

1.5 Issues of sensitivity, gender, ethnicity and preference should be considered and a chaperone

should be used as a matter of course to accompany the doctor carrying out the physical examination.

1.6 If there is evidence of physical injury (bruising, lacerations, pressures sores, fracture, signs of drug abuse etc.), this should be detailed using the body map as shown in Appendix 2. An explanation should be sought, and a referral to Safeguarding should be made if appropriate. The patient should be informed of Safeguarding procedures and their right to live a life free from violence and abuse. Further Guidance is available in the Trust’s Safeguarding Adults Policy and local Multi-Agency Policies and Procedures.

1.7 If the patient’s behaviour is too challenging or they are refusing to consent to a physical examination and/or assessment, the reasons why these assessments have not occurred should be documented on RiO under ‘Physical History and Monitoring’ and in the Progress notes. Even in these circumstances, there should be a record of what can be observed (e.g. evidence of injury, level of consciousness, intoxication with alcohol or drugs, gait). Subsequent attempts should be made on a daily basis for the first week to complete a full physical examination and the outcome of such attempts documented on RiO. If they continue to refuse, there should be further negotiation to seek agreement over the period of admission. A full review needs to specify whose responsibility it is complete this which should then take place weekly and/or as required if an initial physical examination has not been carried out which must be documented.


1.8 In Learning Disability Assessment and Treatment Units where there may be long term refusal of physical examination/investigations a clear assessment of capacity should be documented. Consideration of the immediate need for the examination/ investigation and the level of intervention required to complete the investigations should be documented in the context of best interests and proportionality. These considerations should be put in an individually tailored physical health care plan and revisited according to risk or in the event of a change in presentation.

1.9 If a Mental Health or Learning Disability patient has been transferred from another hospital or service where a physical examination/assessment has already been carried out and is documented in the case notes, transfer note or RiO system, these do not need to be repeated at the time of admission unless:

Repeat examination/assessment is clinically necessary

The previous examination/assessment was more than 3 months ago In all occasions, any significant area not completed in the examination should be obtained and recorded.

1.10 After a period of leave, examinations/ assessments will also be based on clinical need.

Every effort will be made to obtain results of previous relevant investigations from the GP or other services where appropriate using EQUEST, ICE, access to GP records or direct contact with relevant surgery/hospital. Any missing baseline investigations as mentioned in the table for summary of In-Patient requirement should be arranged by the ward doctor under the supervision of the consultant. In units with no ward Dr the Named Nurse should take the lead in this process with support from the Multi-Disciplinary Team (MDT) /Consultant.

1.11 The Mental Capacity Act 2005 provides a statutory framework to empower and protect

people who are not able to make their own decisions. Under the Mental Capacity Act 2005 any person must be assumed to have capacity, unless it is established otherwise (S.1 MCA 2005) and should not be treated as unable to make a decision unless all practicable steps to help the person make a decision have been taken. Any decision made, or act taken, in respect of a person who lacks mental capacity, must be done in the person’s best interests (MCA 2005). The protocols and recording of best interest must be clearly documented within the relevant sections of RiO.

1.12 Where a person refuses to be examined or may lack capacity to consent to physical examination or treatment, an assessment of capacity should be undertaken. Depending on the result of the assessment, any examination or treatment should be provided subject to best interest consideration. A capacity assessment must be documented clearly within the appropriate section on RiO and there should be clear evidence of the best interest decision making process.

1.13 Further guidance is available in the Trust’s Mental Capacity Act 2005 Policy (SH CP 39).

1.14 On-going Monitoring 1.15 Ward staff should actively monitor physical health needs and treatments. These should be

recorded on RiO and documented in the Physical History and Monitoring section. Results should be addressed appropriately and, where indicated, e.g. by completing the Physiological Observation Chart Adult Track and Trigger tool; any concern should be brought to the attention of medical staff for appropriate follow up. In conjunction with the nurse in charge, the frequency of on-going monitoring and observation should be agreed. These should also be included in the physical health and monitoring section of RIO and relevant care plans. It is the responsibility of the ward staff to carry out regular observations using the


Physiological Observation Chart Adult Track and Trigger tool and as requested by medical staff. The minimum frequency of recording should be stated clearly in the patient record

1.16 The clinical pharmacist has responsibility for advising on the appropriate monitoring and, to

ensure the safe and effective use of medicines. Care plans should reflect advice on medication monitoring and the specific policy or guidelines that this relates to. Policy “SH CP 149 Physical health monitoring guideline for medicines commonly prescribed in mental health” should be utilised.

1.17 For longer term in-patients and continuing care patients, a full physical health review should

be done every six months as a minimum and if necessary more frequently. This will include the observations for in-patient requirement as a minimum, plus side effects of medications (use of the Glasgow Side Effects Scale – see appendix 4), appropriate examination and any necessary further investigations. The results should be documented in the physical history and monitoring section of RiO. In Learning Disability services the GASS may be used or another appropriate tool particularly where patients are unable to self-report. For example the Side Effects Scale/ Checklist for Antipsychotic Medication (SESCAM) Adapted from Bennett et al (1994). The easy read “Learning Disability Side Effects Screen” (see appendix 5) may be used with patients who struggle to understand complex terms. It can also be used with their carers or their family.

1.18 A nursing care plan should be written when physical health problems are present and require monitoring, over and above routine checks, and/or intervention. Within Learning Disability Services a Health Action Plan should also be compiled although this will not replace the need for appropriate care plans related to physical health needs.

1.19 Follow Up and Management

1.20 The Ward MDT has overall responsibility for the prompt review of relevant physical

symptoms and test results, treatment initiation and for arranging the follow up. This includes making any necessary onward referrals. Test results, treatment initiated and details of any referrals should be recorded in the RiO electronic patient record.

1.21 In Learning Disability assessment and treatment units, where there is a contracted GP service, the MDT will liaise with the GP in order to ensure appropriate health checks and investigations are carried out and followed up. The MDT will utilise this information and incorporate any physical health needs within usual care planning. Bespoke and individualised care plans will be utilised for all patients which will include physical health monitoring, support and management to maintain health and support health promotion.

1.22 Data Recording 1.23 All observations, investigations and referrals must be fully documented on RiO within the

physical history and monitoring section. Baseline physiological observations should also be recorded on the physiological observation chart. Ongoing observations should be recorded on the physical observation chart as per care plan.

1.24 Communication on Discharge

Significant physical findings, any abnormal results and any other relevant information must be sent to the GP or receiving hospital /team if not discharged back to GP on discharge, in the 24 hour discharge summary. All investigations and results should be included within the discharge summary to the GP

A Summary of patient observations can be found in Appendix 1.

1.25 Smoking:


1.26 Patients who smoke should be offered Nicotine Replacement Therapy (NRT) within 30

minutes of admission, and their smoking status recorded on the appropriate screen. Please refer to SH HR 37 – Smoke-free Trust Policy.

2 Physical Assessment and Monitoring in the Community – Mental Health (MH) 2.1 All patients must have an appropriate assessment (see summary of patient observations

Appendix 1.21) of their physical history and health needs at first contact with a relevant clinician. The care co-ordinator or relevant clinician should ensure appropriate physical observations or investigations are carried out (where appropriate by liaising with the GP or other medical colleagues) and recorded on the RiO physical history and monitoring forms. Where medication is commenced, the completion of the initial health checks is the responsibility of the doctor initiating the prescription.

2.2 In certain circumstances, physical examination may be appropriate. Each area needs to ensure appropriate equipment is available and an area is identified on or off the site to undertake physical examination. Any issues identified, abnormal investigations or where further examination is necessary, should be raised with the general practitioner or psychiatrist and appropriate action taken.

2.3 The following information (which can be obtained from the patient, from a recent admission

within the last 6 months or from the patient’s GP) should be included and documented as a minimum:

Current physical health problems

Past medical history

Current medication and relevant history (both prescribed, bought and herbal medicines)

History of smoking - when started, frequency and quantity, previous attempt to stop, use of Nicotine Replacement Therapy

Alcohol use and history: current intake (units per day/week – use Alcohol Use Disorders Identification Test (AUDIT) if consumption is above recommended levels or any other problem identified, e.g. through use of the Health of the Nation Outcome Scale 3),

Substance misuse (including illicit or prescribed drug abuse –use Drug Use Disorders Identification Test (DUDIT) if currently using any illicit drugs)

For patients on Care Programme Approach, Inpatients or those referred to Early Intervention in Psychosis Service (or where there are physical health problems):

Weight, height, waist circumference and BMI

Nutritional screening

Pulse & BP

Glasgow anti-psychotic side effects scale (where taking antipsychotic medication)

ECG (if indicated due to cardiac problems)

General health problems (especially any underlying physical or psychiatric co-morbidities)

Other relevant lifestyle behaviours e.g. physical activity level, diet, medication adherence in the past

2.4 Additional content and the procedure for this will vary depending on the clinical setting, the

person’s mental or physical illness, medication, age, initial findings and the involvement of primary care.


2.5 To ensure continuity of care, the GP should be kept informed of clinically relevant issues identified by the mental health team; advice sought, where appropriate, and sent details of care provided.

2.6 Issues of sensitivity, gender, ethnicity and preference should also be considered. 3 Physical Assessment and Monitoring in Community - Learning Disability (LD) 3.1 In Learning Disability Community Services, the process and type of referral is varied. In

order to meet the needs of people with learning disabilities in the community, reference should be made to the Table of Summary (Appendix 1) of in-patient and physical health observations should be given full consideration at the point of first contact.

3.2 LD Community patients are referred to a multi-disciplinary team and referrals are received for

a variety of needs. If the initial assessment is undertaken by a nurse or medic, a baseline physical assessment must be undertaken at first contact as per RiO Core Assessment and recorded on physiological observation chart. When the referral is picked up by another professional, liaison is required with the GP to ensure that the person’s physical health is not impacting upon the reason for referral.

3.3 Learning Disability Nurses completing this process should refer to the document “Physical Health Assessment and Monitoring Prompts for Learning Disability Nurses” for guidance on completion.

3.4 The physical health assessment should be made at the point of initial assessment and/or

undertaken as part of an overall assessment e.g. Applied Behavioural Analysis or Assessment of Epilepsy.

3.5 Where the person is unable or unwilling to participate in a physical health assessment, this

matter is deferred and/or liaison with their GP is undertaken to establish factual information about physical health that may impact upon assessment and treatment by the team.

3.6 Where the person is unable or unwilling to participate in a physical health assessment, this

should be clearly recorded within their records. If the person does not have capacity, a capacity assessment must be documented clearly within the appropriate section on RiO and there should be clear evidence of the best interest decision making process. The Best Interest Decision Maker will in most circumstances be the GP or medical staff within acute care etc.

3.7 Where appropriate, a plan to evaluate and monitor a patient’s physical health should be

agreed with the GP/Psychiatrist, particularly where the patient is not consenting and physical health risks are identified or suspected.

3.8 Where applicable every person with a learning disability should be advised and encouraged

to attend their GP for an annual physical health check if this has not been carried out within the last 12 months prior to referral. This recommendation should be made at the initial assessment. A copy of the physical health check should be obtained from the GP practice, generally by FAX rather than through the use of letters.

3.9 At any point a clinician may feel that physical assessment may be indicated when they have

concerns about the person’s life style or physical health symptoms (reported or observed). These should be discussed with the multi-disciplinary team to decide whether additional assessment by the team is warranted or whether the patient is referred back to their GP. In any event, this must be clearly noted within the patient’s risk assessment and risk management plan.


3.10 Where a Mental Health or Learning Disability patient in the community requires an electrocardiogram (ECG), the GP should be contacted to arrange one and the result should be obtained from the GP practice. A FAX or letter containing the results is preferable rather than by word of mouth and the outcome should be entered into RiO while the paper copy should be filed in the secondary notes. ECG’s can also be obtained by other means depending on the clinical setting and if this is required due to medication prescribed by the clinical team (MH or LD).

3.11 Frequency of physiological observations will be determined according to the patient’s

physical condition and documented in the care plan. 4 Physiological Observation Chart – (adult and adolescent track and trigger) (Appendix 1

in Physical Assessment and Monitoring Policy)

4.1 All clinical and social care staff required to undertake physical health assessment and monitoring must be competent in the use of the Physiological Observation Chart.

4.2 The Physiological Observation Chart – will be used to identify and monitor the deteriorating

patient. The staff team including the responsible medical officer must assess each patient individually and make an appropriate clinical decision about the frequency of observations required. This must be documented in the appropriate section on the front page of the chart. Reducing or stopping observations must be done in consultation with the ward doctor under the supervision of the consultant although nursing staff can initiate or increase the frequency of observations if the ward doctor is not available.

4.3 The frequency and type of observations as reflected in the care plan will be documented on

the observation chart and actions escalated in accordance with the physiological observation chart guidance.

4.4 Where more detailed observation is required, for example, neurological observations

additional tools should be used to support the monitoring process. 5 Patient handovers and communication 5.1 Confidence and competence in communication is essential and the Situation Background

Assessment Recommendations Decision (SBARD) tool should be used to ensure effective communication at shift handover and when communicating (both giving and receiving information) with other professionals or at other times. Where alternative means of handover documentation is used, this should follow the principles of SBARD.

5.2 Clinical staff should ensure sufficient time for handover including the giving and receiving of

patient information. 5.3 Communication at weekends and out of hours must maintain the same quality of

communication irrespective of mode of communication and follow the principles of SBARD. 6 Training Requirements: 6.1 All staff completing patient physical health assessments must complete the physical health

pathway (3) to be competent in physical health assessment baseline observations and in the use of physical assessment equipment and assessment tools.

6.2 Staff should also be competent in communicating to other professionals and in the use of

SBARD. Competencies have been developed to support this procedure and a range of


training opportunities are available. It is the duty of all clinical staff and their responsible managers to ensure all staff completing patient physical health assessments attend required training.

6.3 The frequency of e-verification of competency assessment will be 3 yearly unless otherwise

identified at staff appraisal or supervision.

6.4 Reference should be made to the Training Needs Analysis contained within the Physical

Assessment and Monitoring Policy. 7 Associated resources 7.1 SH CP 149 Physical Health Monitoring Guideline for Medicines Commonly Prescribed in

Mental Health


Appendix 1: Summary of Inpatient observations

When? What? Who is responsible?

Within 24 hours of admission

Observations: Comprehensive physical examination. If patient refuses or is too disturbed, this must be fully documented in the patient notes (Core Assessment RiO) and be completed as soon as possible. History: Past medical history, medication history (both prescribed and bought); any medication that is monitored i.e. Clozapine, Levothyroxine, Lithium, Warfarin, Insulin. Investigate side effects, compliance and tolerability. Assessment of dental health (as per physical health monitoring guideline for medicines commonly prescribed in mental health SH CP149 (under review)

Medical staff.

As requested or within 7 days if admission for mental health or learning disability patients.

Full physical health review to include as a minimum: Clinical staff.

Observations:

Physiological Observation Chart.

Weight, height, BMI, exercise, centile charts for adolescents

Urinalysis by dipstick

Nutritional status (MUST tool)

MRSA screening within 48 hours of admission: for OPMH inpatient and for MH and LD inpatients if MRSA risk factors present (see MRSA Policy SH CP20 section 5.2)

MRSA screening for under 18s not required unless in high risk group See MRSA policy)

Use body map for any evidence of scratch, cuts or bruises

VTE risk assessment considered if reduced mobility (VTE Policy SH CP50 Appendix 6 Risk Assessment for

History:

Smoking habit

Alcohol intake

Substance misuse

Diet

Physical activity levels

Family history e.g. Diabetes, IHD

Record of associated interventions (e.g. smoking cessation programme, lifestyle advice, medication review, treatment according to NICE guidelines or onward referral to another clinician for assessment, diagnosis, and treatment).

Note: If diarrhoea present – discuss with relevant clinician to ascertain whether further investigation is necessary.

If indwelling devices present, assess


VTE AMH, OPMH and LD)

Physical examination of patients with known type 1 or 2 diabetes should include a foot examination and documentation of any abrasions, sores or concerns.

need/entry site and discuss with relevant clinician.

Plus investigations/assessments

FBC, LFTs, TFTs, U & E

EEG (if clinically indicated

Blood glucose

Lipids

ECG (if clinically indicated)

CXR (if clinically indicated)

Prolactin (if prescribed an antipsychotic)

U&Es/Cr/ eGFR

Falls assessment

Neurological observations following a slip, trip or fall

LUNSERS or GASS scale (if receiving an antipsychotic)

Epilepsy monitoring

Dietary intake

Temperature

Usual exercise levels

Every month as minimum

Blood pressure, pulse

Weight and BMI (as per physical health monitoring guideline for medicines commonly prescribed in mental health SH CP149 (under review)

Every 6 months (more frequently if necessary)

Full physical health review as above

VTE = venous thromboembolism, FBC= Full Blood Count, TFTs = Thyroid Function Test, ECG = Electrocardiogram, EEG = Electroencephalography, CXR = Chest X-Ray, U&Es = Urine and electolytes,, Cr = Creatine, eGFR = estimated Glomerular Filtration Rate, GASS = Glasgow Antipsychotic Symptom Scale

All information should be entered in the correct RiO field and NOT solely in the progress notes where the information cannot easily be accessed


APPENDIX 2

BODY MAP

Date:

Patient Name:

NHS Number:

To be used if any evidence of injury, scratching, cuts, bruise.

Front Back


Appendix 3

Physical Health Training Pathway for Mental Health and Registered Nurses and

Health Care Support Workers

The education pathway provides staff with signposting to information necessary to support

the development of knowledge and skills in physical health assessment and monitoring

Appendix 4

STEP 1 All staff must be in date with their core statutory and mandatory requirements including Basic Life Support.

STEP 2 All staff must be competent in undertaking physical observations: temperature, pulse, respirations, blood pressure, oxygen saturations and blood glucose monitoring Staff to complete:

a) For initial and update training: Physical observations training (classroom 2.5 hrs) or

learning in practice setting (Practice Educator/trainer led)

b) For refresher training: Physical Health Assessment and Monitoring; Physical

Observations e-videos (Course Code SH-EV1401, and Physical Observation Chart

(Adult Track and Trigger Tool) e-video (Course Code SH-EV1604) can also be used

update training

c) For initial and update Training: Blood Glucose Monitoring training by watching the

Blood Glucose Monitoring Training e-video’s (Course Code SH-EV1511) or attend

Blood Glucose Monitoring face to face training (Course Code SH CT1660)

d) Physical observations workbook (includes the three clinical competency documents for

assessment of clinical competencies in practice)

e) e-verification following successful completion of competencies (3 yearly):

i) Physical Health Assessment and Monitoring: Physical Observations (Course

Code SH-V1610)

ii) Physiological Observation Chart (Adult Track and Trigger Tool) and SBAR(d)

(Course Code SH-V1609)

iii) Blood Glucose Monitoring (Course Code SH-V1611)

f) eLearning - Cardiometabolic (LESTER) Screening and Interventions

Target Audience All Registered Nurses (bands 5 & 6) working in AMH Early

Intervention in Psychosis (EIP), Community Mental Health Teams (CMHTs), Perinatal

and inpatient and rehab units who are required to complete Physical History and

Monitoring Assessments which includes the Cardiometabolic (LESTER)




Appendix 5: Side Effects Screening Easy Read: Am I happy with my medicine?


I take medicine to keep me well. Different medicines are used for different parts of the body.

I will ask you about how you have been feeling. To find out how your medicine is making you feel.


I feel tired all the time.

I feel worried all the time. I find it hard to relax. It is hard for me to see things.


I take more time when I am walking.

My arms or legs are hard to move. My arms and legs shake.

I need to go to the toilet more.


It difficult for me to go to the toilet?

My chest has changed shape or hurts sometimes? My mouth is very dry.

I am eating more food.


I don’t like food anymore. I feel sick every day.

My mouth gets very wet.

My skin is itchy.


Do you have any questions about your medicine? I will think about what you have said.

I will tell you if any of your medicines need to change.

Side Effects Screening Easy Read.pdf