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Evidence to Improve Care

Schizophrenia

Care for Adults in Hospitals

Click below to see a list of brief quality statements and scroll down for more information.


Quality standards are sets of concise statements designed to help health care professionals easily and quickly know what care to provide, based on the best evidence.

See below for the quality statements and click for more detail.


Quality Statement 1: Comprehensive Interprofessional Assessment
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia undergo a comprehensive interprofessional assessment that informs their care plan.


Quality Statement 2: Screening for Substance Use
Adults who present to an emergency department or in an inpatient setting with a primary diagnosis of schizophrenia are assessed for substance use and, if appropriate, offered treatment for concurrent disorders.


Quality Statement 3: Physical Health Assessment
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia undergo a physical health assessment focusing on conditions common in people with schizophrenia. This assessment informs their care plan.


Quality Statement 4: Promoting Physical Activity and Healthy Eating
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia are offered interventions that promote both physical activity and healthy eating.


Quality Statement 5: Promoting Smoking Cessation
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia are offered behavioural and pharmacological interventions to alleviate nicotine-withdrawal symptoms and to help them reduce or stop smoking tobacco.


Quality Statement 6: Treatment With Clozapine
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia who have failed to respond to previous adequate trials of treatment with two antipsychotic medications are offered clozapine.


Quality Statement 7: Treatment With Long-Acting Injectable Antipsychotic Medication
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia are offered the option of a long-acting injectable antipsychotic medication.


Quality Statement 8: Cognitive Behavioural Therapy
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia are offered individual cognitive behavioural therapy for psychosis either in the inpatient setting or as part of a post-discharge care plan.


Quality Statement 9: Family Intervention
Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia are offered family intervention.


Quality Statement 10: Follow-Up Appointment After Discharge
Adults with a primary diagnosis of schizophrenia who are discharged from an inpatient setting have a follow-up appointment within 7 days.


Quality Statement 11: Transitions in Care
Adults with a primary diagnosis of schizophrenia who are discharged from an inpatient setting have a team or provider who is accountable for communication and the coordination and delivery of a care plan that is tailored to their needs.

1

Comprehensive Interprofessional Assessment

Adults who are admitted to an inpatient setting with a primary diagnosis of schizophrenia undergo a comprehensive interprofessional assessment that informs their care plan.


An assessment undertaken by an interprofessional health care team—and, ideally, informed by family, caregivers, and/or personal supports—provides an opportunity to thoroughly examine biological, psychological, and social factors that may have contributed to the onset, course, and outcome of the illness. An assessment can establish a diagnosis and determine a baseline level of functioning to track potential changes in the person’s status. It should identify targets for intervention and treatment, as well as the person’s own goals.

For Patients

You should receive a full assessment every time you are admitted to hospital. An assessment means that your care team will want to learn more about you to understand how best to help you. It should include questions about your medical history, what medications you are taking, your social situation, and your goals for recovery.


For Clinicians

For people admitted with a primary diagnosis of schizophrenia, carry out a comprehensive interprofessional assessment, as described in the Definitions section of this statement. The results of these assessments will inform their care plans.


For Health Services

Ensure there are systems, processes, and resources in inpatient settings for teams to carry out comprehensive assessments of people with schizophrenia. This includes access to standardized assessment tools and protocols, and timely access to the relevant sources of information to support comprehensive assessments.

Process Indicator

Percentage of adults admitted to hospital with a primary diagnosis of schizophrenia who receive a comprehensive interprofessional assessment

  • Denominator: total number of adults admitted to an inpatient setting with a primary diagnosis of schizophrenia

  • Numerator: number of people in the denominator who receive a comprehensive interprofessional assessment

  • Data sources: data could be reported through the Ontario Mental Health Reporting System of the Canadian Institute for Health Information. The Ministry of Health and Long-Term Care has mandated mental health reporting using the Resident Assessment Instrument–Mental Health data collection system (RAI-MH, version 2.0) in all hospitals with inpatient beds designated for adults with mental health issues. These facilities are required to collect clinical and administrative data using the RAI-MH, which would be considered a comprehensive assessment


Structural Indicator

Ability to generate Clinical Assessment Protocols from RAI-MH for people with schizophrenia

  • Data source: local data collection

Access to an interprofessional team, within the hospital, for people with schizophrenia

  • Data source: local data collection

Comprehensive interprofessional assessment

This should be undertaken by health care professionals with expertise in the care of people with schizophrenia and ideally be informed by communication with the individual’s primary care and/or community treatment providers. The assessment should address the following domains:

  • Current sources of distress

  • Risk of harm to self or others

  • Family and developmental history (social, cognitive, and motor development and skills, including coexisting neurodevelopmental conditions) including a history of trauma or adversity

  • History of social situation (housing, culture and ethnicity, leisure activities and recreation, and responsibilities for children or as a caregiver), social networks, and intimate relationships

  • Occupational and educational histories (educational attainment, employment, activities of daily living) and financial status

  • Medical history and physical examination to assess medical conditions, nutritional status, and any prescribed drug

  • treatments that may result in psychosis
  • History of substance use

  • Legal history, if any

  • Self-identified goals and aspirations that are aligned with personal recovery

  • Treatment history (including medication duration and dosages) and psychosocial interventions

  • Level of service needs (assessed using a tool or instrument such as the Level of Care Utilization System [LOCUS]) to match resource intensity with care needs

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