3. Using audit support
The audit support document can be used to measure current practice in the treatment
and management of borderline personality disorder against the recommendations in
the NICE guideline. Use it for a local audit project, by either using the whole tool or
cutting and pasting the relevant parts into a local audit template.
Audit criteria and standards are based on the guideline’s key priorities for
implementation. The standards given are typically 100% or 0%. If these are not
achievable in the short term, set a more realistic standard based on discussions with
local clinicians. However, the standards given remain the ultimate objective.
The data collection tool can be used or adapted for the data collection part of the
clinical audit cycle by the trust, service of practice. The tool is based on the key
priorities for implementation relating to clinical activity and on organisational priorities.
Data may be required from a range of sources, including policy documents and
service user records. Suggestions for these are indicated on the tools, although this is
not an exhaustive list and they may differ in your organisation.
The sample for this audit should include adults and young people (under the age of
18) with borderline personality disorder in primary, secondary or tertiary care. Select
an appropriate sample in line with your local clinical audit strategy.
Whether or not the audit results meet the standard, re-auditing is a key part of the
audit cycle. If your first data collection shows room for improvement, re-run it once
changes to the service have had time to make an impact. Continue with this process
until the results of the audit meet the standards.
Audit support: borderline personality disorder (2009) 3 of 15
4. Clinical criteria for ‘Borderline personality disorder’
Criterion 1 Percentage of people with borderline personality disorder who have been
excluded from any health or social care services because of their
diagnosis or if they have self-harmed
Exceptions None
Standard 0%
Definitions None
Criterion 2 Percentage of people with borderline personality disorder with whom the
healthcare professional has worked in partnership to develop their
autonomy and promote choice
Exceptions None
Standard 100%
Definitions This should be done by ensuring that the person with borderline personality
disorder remains actively involved in finding solutions to their problems, even
during crises and/or encouraging them to consider the different treatment
options and life choices available to them.
Criterion 3 Percentage of people with borderline personality disorder who have
explored their treatment options with their healthcare professional and
have had it explained that recovery is possible and attainable
Exceptions None
Standard 100%
Definitions None
Criterion 4a All people with borderline personality disorder who have had the
withdrawal and ending of treatment or services, or the transition from one
service to another should have had these changes discussed carefully
with them beforehand.
Exceptions None
Standard 100%
Definitions Discussion should involve family or carers if appropriate.
Criterion 4b Any ending and withdrawal of treatments or services, or the transition
from one service to another should be undertaken in a structured and
phased way.
Exceptions None
Standard 100%
Definitions Healthcare professionals should anticipate that these changes may evoke strong
emotions and reactions.
Discussion should involve family or carers if appropriate.
Audit support: borderline personality disorder (2009) 4 of 15
5. Clinical criteria for ‘Borderline personality disorder’
Criterion 4c Percentage of service users with a care plans that supports effective
collaboration with other care providers during endings and transitions and
includes the opportunity to access services in times of crisis
Exceptions None
Standard 100%
Definitions None
Criterion 4d If referral for assessment in other services is made, the person should be
supported during the referral period and any arrangements for support are
agreed beforehand with them
Exceptions None
Standard 100%
Definitions Other services include psychological treatment.
Criterion 5a Percentage of service users who have a comprehensive multidisciplinary
care plan developed in collaboration with the service user (and their
family/carers, where agreed with the person)
Exceptions None
Standard 100%
Definitions None
Criterion 5b Percentage of service users who have a care plan, as referred to into
criterion 5a, that:
• identifies roles and responsibilities of all health and social care
professionals involved
• identifies manageable short-term treatment aims and specific steps
that the person and others might take to achieve them
• identifies long-term goals that the person would like to achieve
• sets out a crisis plan, that:
– identifies potential triggers that could lead to crisis
– specifies self-management strategies likely to be effective
– establishes how to access services if self-management strategies
alone are not enough
• is shared with the service user and their GP
Exceptions None
Standard 100%
Definitions Long-term goals should include those relating to employment and occupation.
They should underpin the overall long-term strategy and should be realistic, and
linked to short-term treatment aims.
Audit support: borderline personality disorder (2009) 5 of 15
6. Clinical criteria for ‘Borderline personality disorder’
Criterion 6 Percentage of service users who receive brief psychotherapeutic
interventions (of less than 3 months’ duration) specifically for borderline
personality disorder or for the individual symptoms of the disorder,
outside a service that has the characteristics outlined in criterion 11
Exceptions None
Standard 0%
Definitions The service characteristics that should be in place are:
• an explicit and integrated theoretical approach used by both the
treatment team and the therapist, which is shared with the service user
• structured care in accordance with this NICE guidance
• provision of therapist supervision
Criterion 7 Percentage of people who receive drug treatment specifically for
borderline personality disorder or for the individual symptoms or
behaviour associated with the disorder
Exceptions None
Standard 0%
Definitions Examples of behaviour associated with this disorder include repeated self-harm,
marked emotional instability, risk-taking behaviour, and transient psychotic
symptoms.
Criterion 8 Percentage of service users offered written information about:
• their illness or condition
• the treatment and care they should be offered, including being made
aware of the ‘Understanding NICE guidance’ booklet
(http://guidance.nice.org.uk/CG78)
• the service providing their treatment and care
Exceptions None
Standard 100%
Definitions Service users should be offered written information to help them make informed
decisions about their healthcare. This should cover the condition, treatments and
the health service providing care. Information should be available in formats
appropriate to the individual, taking into account language, age, and physical,
sensory or learning disabilities.
Criterion 9 Percentage of carers offered written information about:
• the service user’s illness or condition
• the treatment and care the service user should be offered, including
being made aware of the ‘Understanding NICE guidance’ booklet
(www.nice.org.uk/CG078)
• the service providing the service user’s treatment and care.
Exceptions A If there is no carer involved
B If sharing information may compromise the service user’s confidentiality or
Audit support: borderline personality disorder (2009) 6 of 15
7. Clinical criteria for ‘Borderline personality disorder’
wishes
Standard 100%
Definitions If the service user agrees, families and carers should have the opportunity to be
involved in decisions about treatment and care.
Number of criterion Local alternatives to above criteria (to be used where other data
replaced: addressing the same issue are more readily available)
Exceptions
Settings
Standard
Definitions
Audit support: borderline personality disorder (2009) 7 of 15
8. Organisational criteria for ‘Borderline personality
disorder’
Assessment
Criterion 10 Community mental health services should be responsible for the routine
assessment, treatment and management of people with borderline
personality disorder
Exceptions None
Standard Met/unmet
Definitions Community health services include community mental health teams, related
community-based services, and tier 2/3 services in child and adolescent mental
health services (CAMHS)
Psychological treatment provision
Criterion 11 When providing psychological treatment the following service
characteristics should be in place:
• an explicit and integrated theoretical approach used by both the
treatment team and the therapist
• structured care in accordance with this NICE guidance
• provision of therapist supervision
Exceptions None
Standard Met/unmet
Definitions None
Multidisciplinary specialist teams
Criterion 12a Mental health trusts should develop multidisciplinary specialist teams and/
or services for people with personality disorders
Exceptions None
Standard Met/unmet
Definitions The specialist teams should have specific expertise in the diagnosis and
management of borderline personality disorder
Criterion 12b The multidisciplinary specialist teams referred to into criterion 12a should:
• provide assessment and treatment services for people who have
complex needs and/or high levels of risk.
• provide consultation and advice to primary and secondary services
• offer general psychiatric services a diagnostic service if they are
unsure about the diagnosis and/or management
• develop systems of communication and protocols for information
sharing among different services and collaborate with all relevant
agencies within the local community
• provide and/or advise on social and psychological interventions,
including access to peer support, and advise on the safe use of drug
treatment in crises and for comorbidities/insomnia
Audit support: borderline personality disorder (2009) 8 of 15
9. Organisational criteria for ‘Borderline personality
disorder’
• work with CAMHS to develop local protocols to govern arrangements
for the transition of young people from CAMHS to adult services
• establish and maintain clear lines of communication between primary
and secondary care
• support, lead and participate in the local and national development of
treatments for people with borderline personality disorder, including
multi-centre research
• develop/provide training programmes that cover diagnosis of
borderline personality disorders and the implementation of this NICE
guideline
• oversee the implementation of this NICE guideline
• monitor the provision of services for minority ethnic groups to ensure
equality of service delivery
Exceptions None
Standard Met/unmet
Definitions None
Number of criterion Local alternatives to above criteria (to be used where other data
replaced: addressing the same issue are more readily available)
Exceptions
Standard
Definitions
Audit support: borderline personality disorder (2009) 9 of 15
10. Service user data collection tool for ‘Borderline
personality disorder’
Complete one form for each service user or episode.
Service user identifier: Sex: Age: Ethnicity:
Data
NA/ NICE
No. item Criteria Yes No
Exceptionsa guideline ref.
no.
Assessment
1 1.1 Has the person been excluded from any health or 1.1.1.1
social care services because of their diagnosis or
because they have self-harmed?
If ‘Yes’:
1.2 From which service were they excluded?
1.3 What reason was given for exclusion?
Autonomy and choice
2 Was a partnership working approach taken to develop 1.1.3.1
autonomy and promote choice by:
2.1 • actively involving the person in finding
solutions to their problems
2.2 • encouraging the person to consider different
treatment options and choices available?
Developing an optimistic and trusting relationship
3 When working with the service user:
3.1 • were the treatment options explored
3.2 • was it explained that recovery is possible and
attainable?
Managing endings and transitions
Audit support: borderline personality disorder (2009) 10 of 15
11. Data
NA/ NICE
No. item Criteria Yes No
Exceptionsa guideline ref.
no.
4 4.1 Was a treatment or service withdrawn or ended, or did 1.1.7.1
the person make a transition from one service to
another? Please state details:
If 4.1 answer was ‘Yes’:
4.2 Were changes discussed beforehand with the
person?
4.3 Were the changes structured and phased?
Did the care plan:
4.3 • document the need for collaboration with
other care providers during endings,
4.4 withdrawals and transitions?
• Include the opportunity to access services in
times of crisis?
4.5 Was the person referred for assessment in other
services? Please state details:
If 4.4 answer was ‘Yes’:
4.6 Was the person supported during the referral period?
4.7 Were arrangements for this support agreed with the
person beforehand?
Care planning
Audit support: borderline personality disorder (2009) 11 of 15
12. Data
NA/ NICE
No. item Criteria Yes No
Exceptionsa guideline ref.
no.
5 5.1 Did the person have a multidisciplinary care plan? 1.3.2.1
If ‘Yes’:
5.2 Was it developed with the service user?
Did the care plan:
5.3 • identify roles and responsibilities of all health
and social care professionals involved
5.4 • identify manageable short-term treatment
aims and specific steps that the person and
others might take to achieve them
5.5 • identify long-term goals that the person would
like to achieve
were these goals:
5.6 – underpinning the overall long-term
strategy
5.7
– realistic
5.8
– linked to short-term treatment aims
• set out a crisis plan, that:
– identifies potential triggers that could lead
to crisis
– specifies self-management strategies
likely to be effective
– establishes how to access services if self-
management strategies alone are not
enough?
5.3 Was the care plan shared with the service user?
5.4 Was the care plan shared with their GP?
Psychological treatment
6 6.1 Was brief psychotherapeutic intervention (of less than 1.3.5.7
3 months’ duration) used specifically for borderline
personality disorder or for the individual symptoms of
the disorder?
Please state details:
6.2 If ‘Yes’, was the intervention carried out in a service
that had the following characteristics:
• an explicit and integrated theoretical approach
used by both the treatment team and the
therapist
• structured care in accordance with this NICE
guidance
• provision of therapist supervision?
Drug treatment
Audit support: borderline personality disorder (2009) 12 of 15
13. Data
NA/ NICE
No. item Criteria Yes No
Exceptionsa guideline ref.
no.
7 7.1 Did person receive drug treatment specifically for 1.3.5.1
borderline personality disorder or for the individual
symptoms or behaviour associated with the disorder?
Please state details:
Person-centred care
8 Was the service user offered evidence-based written Person-centred
information about: care
8.1 • their illness or condition
8.2 • the treatment and care they should be offered
8.3 − including being made aware of the
‘Understanding NICE guidance’ booklet
8.4 • the service providing their treatment and care?
(Data source: service user records)
9 Were carer(s) offered evidence-based written Person-centred
A / B
information about: care
9.1 • the service user’s illness or condition
9.2 • the treatment and care the service user should be
offered
9.3 − including being made aware of the
‘Understanding NICE guidance’ booklet
9.4 • the service providing the service user’s treatment
and care?
(Data source: service user records)
Organisational data collection checklist for
‘Borderline personality disorder’
Organisation/service:
NICE
Data
No Criteria Yes No NA/Comments guideline
item
ref.
Assessment
Systems are in place to ensure that community mental 1.3.1.1
health services are responsible for the routine
10 10.1
assessment, treatment and management of people with
borderline personality disorder.
Psychological treatment provision
Audit support: borderline personality disorder (2009) 13 of 15
14. NICE
Data
No Criteria Yes No NA/Comments guideline
item
ref.
The following service characteristics are in place when 1.3.4.3
providing psychological treatment:
11.1 • an explicit and integrated theoretical approach
used by both the treatment team and the
11 therapist
11.2 • structured care in accordance with this NICE
guidance
11.3 • provision of therapist supervision
Multidisciplinary specialist teams
Multidisciplinary specialist teams and/or services for 1.5.1.1
12.1
people with personality disorders provided.
If these specialist teams are provided do they:
• provide assessment and treatment services for
12.2 those people who have complex needs and/or high
levels of risk
• provide consultation and advice to primary and
12.3
secondary services
• offer general psychiatric services a diagnostic
12.4 service if they are unsure about the diagnosis and/
or management
• develop systems of communication and protocols
for information sharing among different services
12.5
and collaborate with all relevant agencies within the
local community
• provide and/or advise on social and psychological
12 interventions, including access to peer support, and
12.6
advise on the safe use of drug treatment in crises
and for comorbidities/insomnia
• work with CAMHS to develop local protocols to
12.7 govern arrangements for the transition of young
people from CAMHS to adult service
• establish and maintain clear lines of communication
12.8
between primary and secondary care
• support, lead and participate in the local and
12.9 national development of treatments, including multi-
centre research
• develop/provide training programmes that cover
12.10 diagnosis of borderline personality disorders and
the implementation of this NICE guideline
12.11 • oversee the implementation of this NICE guideline
12.12 • monitor the provision of services for minority ethnic
groups to ensure equality of service delivery?
Audit support: borderline personality disorder (2009) 14 of 15
15. Further information
Click here for further information on reporting and monitoring the audit of NICE
guidance in your organisation.
NICE is committed to promoting through its guidance race and disability equality
and equality between men and women, and to eliminating all forms of
discrimination. One of the ways we do this is by trying to involve as wide a range
of people and interest groups as possible in the development of our guidance on
interventional procedures. In particular, we aim to encourage people and
organisations from groups in the population who might not normally comment on
our guidance to do so. We also ask consultees to highlight any ways in which
draft guidance fails to promote equality or tackle discrimination and give
suggestions for how it might be improved.
Supporting implementation
NICE has developed tools to help organisations implement the clinical guideline
on borderline personality disorder (listed below). These are available on our
website (www.nice.org.uk/CG78).
• Costing tools:
− costing report to estimate the national savings and costs associated with
implementation
• Slides highlighting key messages for local discussion.
• Implementation advice on how to put the guidance into practice and national
initiatives that support this locally.
• Audit support for monitoring local practice (this document).
A practical guide to implementation, ‘How to put NICE guidance into practice: a
guide to implementation for organisations’, is also available to download from the
NICE website.
The guidance
You can download the guidance documents from www.nice.org.uk/CG78. For
printed copies of the quick reference guide or ‘Understanding NICE guidance’,
phone NICE publications on 0845 003 7783 or email publications@nice.org.uk
and quote N1765 (quick reference guide) and/or N1766 (‘Understanding NICE
guidance’).
Audit support: borderline personality disorder (2009) 15 of 15
![NICE Issue date: [Year] of guideline
clinical guideline [XX]
Short title
Audit support
Borderline personality disorder
Audit support
Implementing NICE guidance
2009
NICE clinical guideline 78](https://image.slidesharecdn.com/borderlinepersonalitydisorderbpd-auditsupport-110627114222-phpapp01/85/Borderline-personality-disorder-bpd-audit-support-1-320.jpg)
