Setting

This audit is relevant to all psychiatric specialties and can be modified where electronic records are not in use.

Background

In August 2008, a new electronic patient record system, PARIS, was introduced to the Tees, Esk and Wear Valleys NHS Foundation Trust. It was intended to replace hard-copy case notes, providing all clinical information in an easily accessible form to clinical teams. Some of this information relates to ‘clinical alerts’, which warn clinicians about significant risks associated with the patient. The decision to add a clinical alert must be based on a specific incident or on expression of a clearly identifiable concern, and the risk needs to be made explicit to other practitioners as soon as they access the record.

As many psychiatric patients have physical comorbidities requiring treatment and others are on high doses of psychotropic medications, a specific ‘significant medication alert’ can be created for a patient where relevant. The audit aimed to ensure that this alert had been applied appropriately according to the trust's electronic records policy.

Standards

According to the trust's policy, a ‘significant medication alert’ is required when a patient is taking one of the following:

ᐅ high dose of antipsychotics

ᐅ high dose of antidepressants

ᐅ lithium

ᐅ warfarin

ᐅ insulin

ᐅ methotrexate.

A high dose of antipsychotic/antidepressant is any dose above the maximum dose stated in either The Maudsley Prescribing Guidelines (Taylor et al, 2007) or the

British National Formulary (Joint Formulary Committee, 2009).

Method

Data collection

All patients within the trust's learning disability department were identified. A random sample of patients was then selected. The patient's current medications were checked by scrutinising out-patient letters and the discharge summary uploaded on the system. The presence or absence of a ‘significant medication alert’ was recorded on a data collection sheet.

Data analysis

Patient records were analysed against the following criteria:

ᐅ adequate documentation of medication

ᐅ the presence or absence of a ‘significant medication alert’

ᐅ if an alert was present, that there was appropriate documentation of the medication

ᐅ where an alert was no longer relevant (e.g. after discontinuation of the medication) that the alert had been deactivated

ᐅ the absence of an alert where there should have been one.